Journal of Education and Health Promotion

Abstract BACKGROUND/AIM: The COVID‑19 pandemic has created a long period of stress for people
worldwide and has significantly affected sleep duration. The pandemic revealed new stress factors
that are likely to affect sleep. Uncertainty is a factor that leads to anxiety and depression, which
affects sleep. It should also be noted that reductions in sleep quality rather than sleep duration are
associated with negative consequences on mental health. This study aims to investigate online that
how this situation affected university students.
MATERIALS AND METHODS: This research, with a descriptive study design, was conducted in
Turkey between June 01, 2021 and July 30, 2021. The sample included 604 people who accepted
voluntary participation, chosen by the random selection method. In the study, sociodemographic
information form, Pittsburgh sleep quality index (PSQI), morningness–eveningness questionnaire
scale (MEQ Scale), Beck depression inventory (BDI), and Beck anxiety inventory (BAI) were used as
data collection tools. Pearson correlation analysis was utilized to examine the relationship between
the scales. Multiple regression analysis was performed to investigate the role of morningness–
eveningness, anxiety, depression, and insomnia severity on sleep quality.
RESULTS: Sleep quality was negatively correlated with morningness–eveningness scores (r = –0.32,
P < 0.01), and positively and significantly related with anxiety (r = 0.43, P < 0.01), depression (r = 0.40,
P < 0.01) and insomnia severity (r = 0.55, P < 0.01). According to regression coefficients, while
anxiety (ꞵ = 0.041, P < 0.001) and insomnia severity scores (ꞵ = 0.226, P < 0.001) positively predicted
sleep quality, depression did not predict it significantly (ꞵ = 0.009, P > 0.05). A significant difference was
found in sleep quality according to morning, evening, and intermediate types (F = 27.401, P < 0.001).
CONCLUSION: Events related to the COVID‑19 pandemic are associated with reduced sleep quality
in connection with increasing negative moods. Considering the importance of sleep for a healthy
life, efforts should be made to raise awareness about this issue and to provide psychological help
to affected individuals.

Abstract BACKGROUND: Menopause is one of the developmental stages of women. One of the most common
problems during this period is sleep disorders. Sleep disorders can affect the quality of life of these
people. To improve sleep disorders, auriculotherapy has received less attention due to its low cost
and effectiveness, and side effects. Therefore, the aim of this study was to determine the effect of
auriculotherapy on improving sleep quality in postmenopausal women aged 45–60 years.
MATERIALS AND METHODS: The present study is a clinical trial study that was performed on
82 postmenopausal women aged 45–60 years under the auspices of health centers in Mahshahr
city, Iran from 2021–2022. Women with inclusion criteria were randomly divided into two groups
(intervention and control). The intervention group underwent auriculotherapy for 4 weeks. The St.
Petersburg Sleep Quality Questionnaire was completed by both groups at the beginning and 4 weeks
after the start of the intervention. Finally, the data were analyzed by SPSS software version 22 and
independent t‑test, paired t‑test and Chi‑square test.
RESULTS: At the beginning of the study, both groups were homogeneous in terms of demographic
variables. The results of data analysis using independent t‑test showed that before the intervention,
mental quality (P = 0.513), length of incubation period (P = 0.285), sleep duration (P = 0.121), sleep
efficiency (P=0.513), sleep disorders (P=0.685), use of sleeping pills (P=0.530), daily functioning(P=0.60),
and overall sleep quality score (P = 0.30) in the control and intervention groups were not statistically
significant.However, comparing the mean scores afterthe interventionin the control and interventiongroups
showed that mental quality (P < 0.001), incubation period (P < 0.001), sleep duration (P < 0.001), sleep
efficiency (P < 0.001), sleep disorders (P < 0.001), use of hypnotics (P=0.002), daily functioning (P=0.001),
overall sleep quality score (P < 0.001), sleep duration (P = 0.822), sleep efficiency (P = 0.889), sleep
disorders (P = 0.889), use of sleeping pills (P = 1.00), daily performance (P = 0.767), overall sleep quality
score (P = 0.69) were statistically significant between the two groups. In‑group comparison using paired
t‑test in the control group showed that mental quality (P = 0128), length of the incubation period (P = 1.00),
and before and afterthe intervention did not differ significantly in the mean scores. However, a within‑group
comparison in the intervention group showed that mental quality (P < 0.001), incubation period (P < 0.001),
sleep duration (P < 0.001), sleep efficiency  (P < 0.001), sleep disorders (P = 0.003), use of sleeping
pills (P = 0.007), daily functioning (P < 0.001), and overall sleep quality score (P < 0.001) before and after
the intervention had a significant difference in the mean scores.
CONCLUSION: The results showed that auriculotherapy has significant effectiveness in improving the
quality of sleep, and its dimensions and can be used as an effective method in this area that can be
implemented at a low cost and easily. According to reports from participants and previous studies in this
field, auriculotherapy did not have any side effects and can be used as a safe way to improve sleep quality.

Abstract BACKGROUND: Fear of childbirth is a common problem during pregnancy, which can give rise to
sleep disorders and diminish sleep quality. This study aimed to determine the effect of cognitive–
behavioral training on fear of childbirth and sleep quality of pregnant adolescent slum dwellers who
visited the slum health centers of Zahedan city, Iran, in 2020.
MATERIALS AND METHODS: This quasi‑experimental study was conducted in 2020 on 100 pregnant
adolescent slum dwellers between 11 and 19 years old at 24–28 weeks pregnant. Multi‑stage sampling
was used and the participants were randomly divided into an intervention and a control group. The
intervention group received four sessions of cognitive–behavioral training at weekly intervals. The
control group only received routine care. The Wijma Delivery Expectancy/Experience Questionnaire
and the Pittsburgh Sleep Quality Index were filled before and 4 weeks after the training course.
The data were analyzed in SPSS 21 using independent t‑test, paired t‑test, Fisher’s exact test, and
Chi‑squared test. and covariance. A P value of < 0.05 was considered significant.
RESULTS: After the intervention, the fear of childbirth significantly decreased (P = 0.004), and sleep
quality significantly improved (P = 0.001) in the intervention group compared with the control group.
The results of analysis of covariance to control the significant effect of pre‑test scores showed that
the mean score of fear of childbirth (P = 0.03) and mean score of sleep quality (P = 0.001) in the
two groups after the intervention was statistically significant.
CONCLUSION: The results showed that in addition to reducing fear of childbirth, cognitive–behavioral
training improved the sleep quality of women in the intervention group. Therefore, this training could
be used as an easy and accessible method without complications to improve women’s health.

Abstract BACKGROUND: Internet addiction (IA) is a severe problem, especially in academic communities.
The association between IA and unfavorable emotional conditions (e.g., anxiety, stress, and
depression) can harm students’ relationships and academic and career performance. The present
study evaluated (a) the prevalence of IA in a sample of medical sciences university students; (b) the
association between IA and depression, anxiety, stress, and sleep disorders; and (c) the association
between demographic characteristics and IA, depression, anxiety, and stress.
MATERIALS AND METHODS: In this descriptive cross‑sectional study, 268 students from Abadan
University of Medical Sciences were selected using Morgan Table. The participants responded to
the Young Internet Addiction Test, the Depression Anxiety Stress Scales‑42, and the Pittsburgh
Sleep Quality Index. Data were analyzed using descriptive statistics, Pearson correlation coefficient,
independent sample t‑test, one‑way ANOVA, and least significant difference.
RESULTS: The mean score of IA was 45.65 ± 35.40. IA was found to be significantly related to
depression, anxiety, stress, and sleep disorders (except for sleep disturbance) (P < 0.001). Males
were found to be more likely than females to suffer from IA, depression, anxiety, stress, and sleep
disorders. Furthermore, age was inversely related to IA, depression, and stress. Finally, medical
sciences students suffered from depression, anxiety, and stress more than students majoring in
other fields.
CONCLUSIONS: The simultaneous occurrence of IA and depression, anxiety, stress, and sleep
disorders in students indicates that IA is associated with other psychological problems. Therefore,
researchers and policymakers need to identify preventive measures to help internet‑addicted students.

Abstract BACKGROUND: Nurses in their workplace, for a variety of reasons, always face moral distress that
is an underlying issue in the nursing profession, which can lead to problems such as reduced quality
and quantity of care and sleep disorder. Besides, given the increased privatization of hospitals, this
study aimed to explore the association between nurses’ moral distress and sleep quality and its
comparison among nurses in private and public hospitals.
MATERIALS AND METHODS: This was a descriptive‑analytical study involving 150 nurses working
in Ilam Province hospitals. Sampling conducted using a multistage random sampling method. Data
were collected through the questionnaire of sociodemographic characteristics, the Corley’s Moral
Distress Scale, and the Pittsburgh Sleep Quality Index. Data were analyzed using SPSS software
version 22. Descriptive statistics such as frequency, mean, ANOVA, independent t‑test, multiple linear
regression, and Pearson correlation coefficient at the significant level of P < 0.05 were calculated.
RESULTS: The analysis revealed that moral distress was positively associated with sleep quality.
Furthermore, the scores of nurses’ moral distress and sleep quality were different in private and
public hospitals, so that the level of moral distress in the public hospital and sleep quality in the
private hospital was higher and lower, respectively, but the difference was not statistically significant.
Moreover, sleep quality, and the type of employment was the most important predicting variables of
moral stress (B = 1.86) and sleep quality (B = 2.39), respectively.
CONCLUSION: According to the study results, a positive and significant association was found
between moral distress and nurses’ sleep quality. It is recommended that appropriate strategies
and training program be formulated by the health‑care system to increase nurses’ ability to combat
moral distress adverse effects.

Abstract INTRODUCTION: Low quality of sleep is a common problem among hemodialysis patients. This
study was conducted to evaluate the effect of a cold dialysis solution on the quality of sleep in patients
undergoing hemodialysis.
METHODOLOGY: This double‑blind clinical trial was performed on 26 hemodialysis patients with
chronic renal failure and sleep disorders in the dialysis center of Sabzevar, Iran, in 2016–2017. Of the
26 patients, 13 each were allocated to the intervention and control groups. The patients in both groups
received 4 weeks of hemodialysis (3 sessions per week) using a standard solution with a temperature
of 37°C. In the next stage, the control group continued to receive the standard‑temperature dialysis,
while the intervention group received dialysis using a solution with a temperature of 35.5°C for
4 weeks (3 sessions per week). The Pittsburgh Sleep Quality Index was used to assess and compare
the quality of sleep before and after the intervention in the two groups. Data were analyzed using R
1.2.3 software, at 95% confidence level.
RESULTS: Although the mean scores of sleep quality were not significantly different between the
intervention (9.53 ± 3.12) and control (11.23 ± 3.37) groups at baseline, postintervention, significant
differences were observed (intervention group: 4.7 ± 4.55; control group: 10.61 ± 2.69; P < 0.001).
CONCLUSION: This study showed that dialysis with cold solution is a simple, cost‑effective, and
nonpharmacological method that can be used to improve sleep quality in patients undergoing
hemodialysis.

Abstract INTRODUCTION: The postpartum period is a transition to a critical stage. Moreover, the rapid
changes experienced after delivery, expose the mother to unpleasant experiences such as changes
in sleep patterns. Trying to an appropriate training method is necessary. This study aims to conduct
a comparative study between the impact of face‑to‑face training and e‑training on maternal sleep
during the postpartum period.
MATERIALS AND METHODS: The present study was empirically conducted on 110 postpartum
mothers who visited the selected healthcare centers of Isfahan in 2015. Mothers randomly divided into
three groups (face to face, electronic and control). Data collection tools included demographic and
fertility questionnaire and Pittsburgh Sleep Quality Index. Intervention groups were received training
such as mothers with necessary instructions regarding the health approaches, relaxation techniques,
sleeping place, and energy‑saving techniques. Mothers’ quality of sleep was measured and compared
before training (until the 10th day after childbirth) then in the second and third cares (from the 10th to
30th day after childbirth) in all three groups. Data were analyzed using descriptive statistics and ANOVA
and analyze variance with repeated measures in SPSS (SPSS Inc., Chicago, IL, USA,) version 17.
RESULTS: The results showed there was a significant difference among the sleep quality scores in
the three times in the e‑training (P < 0.001) and face‑to‑face groups (P < 0.001) and in the control
group (P = 0.01), but the improvement in the sleep quality score has been higher in the two groups;
e‑training and face‑to‑face, than in the control group. In addition, the mothers’ mean sleep quality
score was different between the control group and face‑to‑face group as well as between the control
group and e‑training group. While, no statistically significant difference was found between the
e‑training group and face‑to‑face group.
CONCLUSION: Training through both methods; face‑to‑face and electronic, had the same impact
on maternal sleep quality during the postpartum period. Therefore, despite the belief that in‑person
trainings are more effective, the findings of this research showed the effectiveness of electronic methods
too, and determined that this method, has the same effectiveness as the face‑to‑face method has.

Abstract BACKGROUND: Elderly people often suffer from sleep disorders. Chamomile due to the many health
benefits such as sedation may be effective in improving sleep quality in elderly people. This study
aimed to determine the effect of Matricaria chamomilla extract on sleep quality in elderly people
admitted to nursing homes of Isfahan in 2014.
MATERIALS AND METHODS: The present study is a quasi‑experimental clinical trial. The study
population was 77 cases of elderly hospitalized in nursing homes. Participants were selected through
random continuous sampling and divided into intervention and control groups. The intervention group
received 400 mg oral capsules of chamomile twice daily, after lunch and after dinner for 4 weeks. The
control group did not receive the intervention. Sleep quality in older adults before and after intervention
were compared using the Pittsburgh Sleep Quality Index questionnaire. Data were analyzed using
descriptive statistics and paired t‑ and independent t‑tests, one‑way analysis of variance and liner
regression analysis, using SPSS software version 17.
RESULTS: Before intervention, the mean score of sleep quality both experimental and control groups
showed no significant difference (P > 0.05). After intervention, the mean score of sleep quality was
a significant difference between experimental and control groups (P < 0.001).
CONCLUSIONS: Oral administration of chamomile extract has sedative properties in sleep quality of
hospitalized elderly patients in nursing homes. Therefore, it can be used in similar cases and nursing care.

Abstract Background and Aim: The postpartum period is a critical then effects on the structure of the
family. Most women in the postpartum period may place at risk of undesirable experiences such
as changes in sleep patterns. Therefore, this study aimed to identify the efficacy of the relaxation
program on sleep quality of mothers with premature infants. Materials and Methods: This
study is a clinical trial that 60 mothers with premature infants. The mothers in the intervention
group were trained for muscle progressive relaxation by Jacobson method within 24–72 h
after delivery. Research tool was the Pittsburgh Sleep Quality Index, which was completed by
the mother at the beginning of the study, end of the first and the second 4‑week. Data were
analyzed using parametric statistics tests by SPSS software version 16. Results: No significant
difference was observed between two groups in terms of underlying characteristics (P < 0.05).
The independent t‑test at the beginning of the study showed that the comparison of the mean
scores of mothers’ sleep quality has no significant difference between two groups (P = 0.43).
But, 1‑month after the intervention (P = 0.024) and 2 months after the intervention (P > 0.001),
mean sleep quality score in the intervention group was significantly less than the control group.
Conclusion: Relaxation training can improve mothers’ sleep quality at postpartum period.

Abstract Psychological problems as state anxiety (SA) in the work environment has negative effect on
the employees life especially shift work nurses, i.e. negative effect on mental and physical
health (sleep quality, eye fatigue and comfort thermal).The purpose of this study was
determination of effects of state anxiety and thermal comfort on sleep quality and eye fatigue
in shift work nurses. Methods: This cross-sectional research conducted on 82 shift-work
personnel of 18 nursing workstations of Isfahan hospitals in 2012. To measure the SA, sleep
quality, visual fatigue and thermal comfort, Spielberger state-trait anxiety inventory, Pittsburg
sleep quality index, eye fatigue questionnaire and thermal comfort questionnaire were used
respectively. The data were analyzed with descriptive statistics, student test and correlation
analysis. Results: Correlation between SA and sleep quality was −0.664(P < 0001), Pearson
correlation between SA and thermal comfort was −0.276(P = 0.016) and between SA and eye
fatigue was 0.57 (P < 0001). Conclusion: Based on these results, it can be concluded that
improvement of thermal conditions and reduce state anxiety level can be reduce eye fatigue
and increase the sleep quality in shift work nurses.