Journal of Education and Health Promotion

Abstract BACKGROUND: Prevention of smoking is very important at a young age and during the student
period. Because of the lack of a questionnaire based on the prevention of smoking behavior,
this study was conducted to design and standardize a tool according to the protection motivation
theory (PMT).
MATERIALS AND METHODS: This was an analytical cross‑sectional study where information
and opinions of experts and then designing tools and assessing the face validity in the first phase
and content validity, construct validity, test–retest reliability, and internal consistency of questions
in the second phase were examined. The initial themes and structures were determined based on
the literature Review and the opinion of experts. Three hundred students of Yazd Universities were
selected by cluster sampling and included in the study. All analyses were performed in SPSS and
AMOS software version 24 with a significance level of less than 5%.
RESULTS: The final version of the scale had 39 questions in eight dimensions. The overall Cronbach’s
alpha value was 0.89, and for each dimension, it was more than 0.7. The content validity ratio and
content validity index for the whole tool were 0.87 and 0.94, respectively. The results of confirmatory
factor analysis showed that the latent construct model had good fit (X2/df = 4.31; RMSEA = 0.07;
CFI = 0.94; NFI = 0.92; TLI = 0.91, P < 0.001).
CONCLUSION: In this study, a valid and reliable tool based on PMT to predict smoking behavior
in students was introduced. This tool can be used in interventional and etiological studies. It also
has questions related to the coronavirus disease 2019 (Covid 19) virus and can be used in the
coronavirus pandemic.

Abstract BACKGROUND: Impulsiveness is a multidimensional and multifaceted construct that plays an 
important role in understanding various psychopathology and problematic behavior. It is necessary 
to study the psychometric properties of instruments in the new culture before its scientific 
application, and it also contributes to external validity. The current study was conducted to 
determine the psychometric properties of the Persian version of Short Form of the Impulsiveness 
Questionnaire UPPS‑P (SUPPS‑P) in a sample of male soldiers serving in the military service.
MATERIALS AND METHODS: The present research design is cross‑sectional in 2019–2020. The Iranian 
version of the SUPPS‑P was prepared across forwarding translation, reconciliation, and back‑translation. 
The research sample included 254 soldiers who were selected via convenience sampling method and 
completed a set of scales, including the SUPPS‑P scales, short‑form self‑compassion scale, McLean 
Screening Instrument for Borderline Personality Disorder(MSI‑BPD), Cognitive Flexibility Inventory (CFI), 
Perth Alexithymia Questionnaire (PAQ), and the Deliberate Self‑harm Inventory (DSHI). The construct 
validity of SUPPS‑P scale was measured using confirmatory factor analysis and convergent and 
divergent validity. For reliability, Cronbach’s alpha and test–retest reliability (with 2 weeks interval) were 
used. Data were analyzed using LISREL software (version 8.8) and SPSS version 22.
RESULTS: The results showed that the SUPPS‑P scale is a reliable and valid scale with acceptable 
internal consistency and acceptable test–retest reliability among soldiers. In terms of convergent 
validity, SUPPS‑P showed a significant positive correlation with measures of MSI‑BPD, PERS, 
and DSHI. SUPPS‑P showed a negative correlation with self‑compassion and cognitive flexibility, 
thus demonstrated a good divergent validity. The results of this study also provide support for the 
five‑factor model of the SUPPS‑P scale.
CONCLUSION: The SUPPS‑P instrument showed acceptable validity and reliability and could be 
useful in assessing impulsivity in Iranian society. The SUPPS‑P scale shows notable promise as a 
measure for use in impulsivity research and clinical settings.

Abstract BACKGROUND: In the coronavirus disease 2019 pandemic era, clinical programs and mandatory 
hands‑on activities have been supplanted by remote teaching to maintain the fundamental capabilities 
of medical training and to furnish medical students with quality education. Nonetheless, the satisfaction 
of faculty members with this training method in the current pandemic has yet to be assessed. The 
aim of this study was to design a Persian questionnaire with appropriate validity and reliability on 
cardiology professors’ satisfaction level with virtual education.
MATERIALS AND METHODS: In this cross‑sectional study, a questionnaire was devised drawing 
upon scientific sources and Iranian medical educators’ expertise. Seventeen faculty members 
in various specialties evaluated the questionnaire concerning face and content validity. Content 
validity was assessed through the calculation of the content validity ratio (CVR) (values >0.62 
were considered acceptable) and the content validity index (CVI) (values >0.79 were considered 
acceptable), construct validity was evaluated through principal component factor analysis by the 
Kaiser–Meyer–Olkin (KMO) statistic and Bartlett’s sphericity test, internal reliability was measured 
through the calculation of Cronbach’s alpha coefficient, and consistency was appraised through the 
use of test‑retest reliability at two different time points.
RESULTS: The questionnaire had a reliability rate of 95%, indicating high internal validity. Concerning 
test‑retest reliability, the intraclass correlation coefficient was 0.96 (P < 0.001), demonstrating relatively 
good stability. The CVI was 0.81, and the CVR was 0.85. The KMO measure of sampling adequacy 
was 0.954, indicating the acceptability of the degree of common variance among the all items.
CONCLUSIONS: This Persian questionnaire on virtual education aimed at cardiology faculty members 
in the current pandemic with its low question count and appropriate domains had high reliability 
and validity. By knowing the level of professors’ satisfaction with the new method of education, it 
is possible to take steps to better provide specialized medical education to cardiology residents.

Abstract BACKGROUND: Dental education is considered a challenging and taxing program as on successful
completion one is required to attain unique and diverse competencies. There is an established
perception that students do not enjoy their experiences in the dental institution and they always
demand for certain amendments. Therefore, a dental education perceptions and metacognition
assessment tool (DEPMAT) was developed for Indian undergraduate and postgraduate dental
students for assessing their learning in Deemed University versus Maharashtra University of Health
Sciences in Pune, Maharashtra.
MATERIALS AND METHODS: This cross‑sectional study was conducted among students of four
dental colleges of two types of universities in Pune, India, using a 31‑item DEPMAT based on
Dundee Ready Education Environment Measure and metacognition awareness inventory using five
subscales. Psychometric properties were also tested for this new tool. Data were analyzed using
the SPSS software.
RESULTS: Of 512 participants, 498 (96.88%) students had duly returned the questionnaire.
Cronbach’s alpha coefficient value for reliability was found to be 0.87 which indicated good internal
consistency and test‑retest reliability was found to be kw = 0.76, which indicated substantial agreement.
Significant difference was found among undergraduates in domains regarding their perception toward
academics, infrastructure and learning environment, and health and stress.
CONCLUSION: This study suggested that the general perception toward learning among final year
postgraduate students was positive in both the universities. However, the perception of final year
undergraduates toward learning was negative and students have suggested certain amendments in
both the universities. This study also suggested the new tool was effective in assessing the attitude
of practice of both undergraduate and postgraduate students.

Abstract BACKGROUND: Evidence‑based performance competence has a significant impact on the
performance of care measures. The higher the qualifications of nurses, the more effective and
desirable their performance. Evidence‑based practice demonstrates the competencies and abilities
of nurses. There is a need for valid and reliable tools for evaluating and promoting evidence‑based
competence in nursing students, and there are few tools in reviewing studies, but they have not
considered the cultural dimension. The purpose of this study is to validate cultural competence in
evidence‑based practice for nursing students.
MATERIALS AND METHODS: A methodological and validation study was conducted in the School
of Nursing and Midwifery of Kermanshah and Ilam University of Medical Sciences in 2018. The
Evidence‑Based Performance Competency Questionnaire (  EBP‑COQ) is one of the most valid tools
used in various studies by Ruzafa‑Martinez et al. Initially, the original version of the competence in
evidence‑based practice questionnaire was translated into Persian after securing a permission from
the designer of the tool. Totally 300 nursing students were selected through simple sampling method
and entered into the study. The validity of the tool was evaluated using face validity and performing
factor analysis. The reliability of the questionnaire was evaluated using Cronbach’s alpha and internal
consistency. Statistical works were carried out in SPSS and AMOS.
RESULTS: To determine the content validity of the tool, comparative fit index of the statements
was obtained equal to 0.88. Factor analysis of the items yielded acceptable and statistically
significant results (P < 0.001). The reliability of the tool was determined using internal consistency
method (Cronbach’s alpha) for the whole tool, which was equal to 0.7. The reliability of the
questionnaire was investigated at two stages, and pretest/posttest correlation coefficients were
obtained (P < 0.05).
CONCLUSION: The questionnaire had an acceptable validity and reliability. It can be used to
evaluate evidence‑based practice. Among advantages of the tool is that it is easy to administer in
health‑care fields.

Abstract BACKGROUND: Faculty development programs as useful approaches for organizational development
improved competencies in faculty members which assist them to cope with workload and environment
changes. Evaluating organizational development for faculty development programs provides insight
into the impact of these programs on system development. The aim of present study was conducted
to study the organizational development for faculty development programs at Kerman University of
Medical Sciences.
MATERIALS AND METHODS: This analytical and cross‑sectional study was conducted between
October and December 2020. The organizational development for faculty development questionnaire
was sent to a simple random sampling of 100 faculty members who had been participated in the
“Medical Education Fellowship” program. The data were analyzed using descriptive statistics including
independent sample t‑test, one‑way ANOVA, and post hoc, using version 24.0 of SPSS.
RESULTS: The response rate was 82%. Most of the faculty highly agreed that the “Medical Education
Fellowship” program had produced organizational development. The score of the “Development and
sustaining faculty development programs” domain (mean = 3.35, standard deviation [SD] =0.96) was
higher than “Development and innovation in teaching and learning process” (mean = 3.31, SD = 0.74).
CONCLUSIONS: Specific characteristics of the organizational development process for faculty
development programs in health profession education were recognized. The findings emphasized on
the importance of these interventions on creating developments in the broader community system.

Abstract BACKGROUND: The coronavirus disease 2019 (COVID‑19) pandemic has prompted the further
virtualization of medical education. The satisfaction level of specific users such as cardiology residents
with virtual education can augment its quality; hence, the significance of a valid and reliable questionnaire
to obtain feedback is needed. This study aimed to design and measure validity and reliability of a
satisfaction questionnaire for virtual education of cardiology residents during COVID‑19 pandemic.
MATERIALS AND METHODS: In this cross‑sectional study, a self‑administered questionnaire
was developed by the faculty members of Rajaie Cardiovascular Medical and Research Center.
Reliability was tested utilizing Cronbach’s alpha  and intercorrelation which was tested using Pearson’s
correlation coefficient test (ICC). Factor analysis was done by the Kaiser–Meyer–Olkin measure of
sampling adequacy and Bartlett’s sphericity test. The statistical analyses were performed with the
SPSS software version 22.
RESULTS: The face validity index was determined via an assessment of the relevance, clarity, and
simplicity of each item, and values >0.79 were accepted. The total Cronbach’s alpha coefficient was
calculated 0.93. Concerning test–retest reliability, the correlation between two rounds of evaluation
was >80 (P > 0.001) and ICC was 0.99 (P = 0.001). The content validity evaluation yielded an index of
0.95 and a ratio of 0.91. The principal component factor analysis, conducted to investigate construct
validity, generated four domains.
CONCLUSIONS: The study results confirmed the validity and reliability of the designed questionnaire
to evaluate the level of satisfaction of cardiology residents with virtual learning in COVID‑19 pandemic.

Abstract INTRODUCTION: The pandemic caused by novel coronavirus (severe acute respiratory syndrome
coronavirus 2) in Wuhan, China, in December 2019 is a highly contagious disease. The World Health
Organization has declared the outbreak of coronavirus diseases (COVID‑19) as a global public health
emergency. Currently, the research on novel coronavirus is still in the primary stage. The aim of this
study is to assess the knowledge and awareness on COVID‑19 disease and related infection control
measures among the dental fraternity in Visakhapatnam – the smart city.
METHODS: A total of 808 dentists from the Visakhapatnam region completed a questionnaire‑based
survey on the knowledge, awareness, and infection control measures related to COVID‑19 infection.
The questionnaire was tailored from the guidance and information for health‑care workers issued
by the US Centers for Disease Control and Prevention. Suitable sampling method was used for the
collection of data and the distribution of responses was presented as percentages. Explanatory
statistics were performed for all groups and subgroups based on the percentage of correct responses.
Individual pair‑wise comparisons were done using the Chi‑square test for the percentage of correct
responses.
RESULTS: A total of 825 participated in the survey, of which 808 dentists completely answered the
survey, and the response rate was 98%. Among the respondents, males and females are 46.8%
and 53.2%, respectively. There was a statistically significant difference for all the questions solicited,
among age groups (P = 0.001, 0.001) and occupation (P = 0.001, 0.001, 0.004). Private practitioners
seem to more awareness compared to teaching faculty, undergraduates, and postgraduates, as they
have answered correctly (>70%) for almost all the questions.
CONCLUSION: The inputs from the survey help us throw some light and fill up lacunae where required.
There is a strong need to implement periodic educational interventions and training programs on
infection control practices for COVID‑19 among dentists in particular. The information from this survey
helps us to make necessary changes in implementing periodic educational webinars and stress on
areas where necessary, which is important for the dental fraternity for protecting themselves and
shielding our society from COVID‑19.

Abstract BACKGROUND: Organizational capacity development is an important outcome of faculty
development programs, but there is a lack of an appropriate instrument for its evaluation.
AIMS AND OBJECTIVES: The aim of this study was to develop a questionnaire to evaluate the
organizational capacity development for faculty development programs and to test its psychometrics.
MATERIALS AND METHODS: The initial capacity development for faculty development
questionnaire (CDQ‑FD) of 26 items was developed based on a literature review and opinion
of experts. Content validity ratio (CVR), content validity index (CVI), content validity index for
items (I‑CVI), and the content validity index for scales (S‑CVI) were computed for content validity.
Confirmatory factor analysis (CFA) and exploratory factor analysis (EFA) were performed for construct
validation.
RESULTS: The score for CVR, CVI, I‑CVI, and S‑CVI was 0.71, 0.83, 0.87, and 0.90, respectively.
EFA resulted in a three‑factor model with total variance extraction of 64%. Cronbach’s alpha and
Spearman Brown coefficient were investigated for reliability assessment. The Cronbach’s alpha of
overall scale was 0.8 and the test‑retest reliability of the overall scale was 0.78. The final CDQ‑FD
contained 21 items and three categories.
CONCLUSIONS: The CDQ‑FD questionnaire appears to be a valid and reliable instrument for the
evaluation of organizational capacity development for faculty development in the medical education.

Abstract BACKGROUND AND AIM: Considering the important role of universities in advancing educational,
social, cultural, economic, and political affairs and given the significant and effective role of social
determinants of health (SDH) in personal and social life, this study aimed to design a preliminary
questionnaire to assess the awareness and attitude of students and professors of relevant medical
sciences departments toward the SDH.
METHODS: This is a descriptive survey study of the instrumentation type and is done on the
students and professors of Isfahan and Kashan medical sciences universities in 2019. The
content and face validity of the questionnaire were assessed. Cronbach’s alpha coefficient and
the correlation coefficient for each question as well as the total score of the questionnaire were
reported for this attitude measurement questionnaire. The difficulty coefficient, optimum difficulty
level, discrimination coefficient, and the relevant variance were calculated for every question in the
awareness measurement questionnaire.
RESULTS: The internal consistency of the questionnaire for the awareness toward the SDH for 15
questions was 0.742. This consistency was acceptable for 18 questions in the attitude measurement
questionnaire after omitting two questions with not appropriate distinguishing ability. The difficulty
level of the questions was relatively high.
CONCLUSION: Given that no tool was observed in the search strategy to measure the SDH,
therefore, the design and psychometrics of such a tool can be used to measure the awareness and
attitude of the target audiences; since this tool had an acceptable validity and reliability at its initial
stages, researchers are suggested to apply it for standardization in different academic societies.

Abstract BACKGROUND AND AIM: Some people exposed to disasters will suffer from acute stress
disorder (ASD) due to the negative consequences of these disasters. Evaluating this disorder at a
large scale requires a credible and standardized tool. Therefore, the current study aims to investigate
the psychometric properties of the ASD questionnaire for people exposed to Kerman earthquake.
METHODS: This is a descriptive‑tooling study, conducted on 435 men and women older than 18 years
living in earthquake‑affected areas of Kerman Province (Kouh‑e‑Banan). The study was carried out
using the Persian translating of the English version of the Diagnostic and Statistical Manual of Mental
Disorders, Fifth Edition ASD questionnaire on accessible individuals living in temporary residence
tents in two initial and final stages and different stages of validity and reliability evaluation was carried
out. The findings were analyzed using descriptive statistics and Pearson’s correlation coefficient.
RESULTS: During the evaluation of content validity, no questions were eliminated. To carry out
factor analysis, sampling competence, and suitability of sample size were confirmed through
Kaiser–Meyer–Olkin and Bartlett’s tests. In the factor analysis stage, 14 items in three factors were
defined. The factors were included reexperiencing and analysis, arousal (continuous irritability), and
avoidance factors which together explained 59.43% of percentage distribution. In the next stage
of evaluating divergent validity, the results indicated a significant and inverse correlation between
ASD score and quality of life score (r = −0.43, P = 0.002) of the participants, while there was also
a positive and significant correlation between ASD score and general health disorder score of
the participants (r = 0.47, P < 0.0001). The reliability of the questionnaire was investigated using
Cronbach’s alpha, and inner class correlation coefficient was calculated to be 0.9.
CONCLUSIONS: The tool investigated in this study has suitable validity and reliability and is effective
for use by psychologists and relief workers for necessary interventions and prevention of ASD in
disasters.

Abstract BACKGROUND: Structural empowerment (SE) is an effective method of advancing work
environments and has previously been widely discussed in Western countries. Due to the lack of
culturally and academically accepted scales in Iran for measuring SE, localization of a foreign scale
in this field is necessary.
OBJECTIVES: This study aimed at investigating the validity and reliability of the Persian Version of
the Conditions of Work Effectiveness Questionnaire‑II (CWEQ‑II‑PV) among Iranian nurses.
METHODS: The present cross‑sectional methodological research was conducted during 2017–2018.
Participants were 230 nurses working in four teaching hospitals affiliated to Kashan University of
Medical Sciences in Kashan, Iran, who were selected using quota sampling. A standard forward–
backward translation procedure according to Wild et al. (2005) was used to translate the English
Version of the CWEQ‑II to Persian. The psychometric evaluation processes were achieved by face,
content, and construct validity (confirmatory factor analysis [CFA]). Reliability was examined using
test–retest and Cronbach’s alpha for internal consistency reliability.
RESULTS: The CWEQ‑II‑PV showed good content validity (the mean content validity scores for
relevancy, clarity, and simplicity were 94%, 96%, and 94%, respectively). In the CFA, the original
six‑factor version with 19 items was confirmed. The original model was presented and incorporated in
the CFA, indicating an acceptable fit for the model (root mean square error of approximation = 0.06,
comparative fit index = 0.92, goodness of fit index (GFI) = 0.94, and adjusted GFI = 0.91). Cronbach’s
alpha coefficient for the total scale was 0.84 and for each component ranged from 0.71 to 0.87,
indicating good internal consistency, and the test–retest Spearman and intraclass correlation
coefficients were 0.93 and 0.87, respectively, showing good test–retest reliability.
CONCLUSIONS: Evidence was found to support the reliability and validity of the CWEQ‑II‑PV scale
that measures the quality of the work environment for nurses from a SE perspective.

Abstract AIM: To translate OHIP‑14 into Hindi and test its psychometric properties among school teacher
community.
METHODS: The OHIP‑14 was translated to OHIP‑14‑H using WHO recommended translation
protocol. During pre‑testing, an expert panel assessed content validity of the questionnaire. Face
validity was assessed on a sample of 10 individuals. The OHIP‑14‑H was administered on a random
sample of 170 primary school teachers. Internal consistency and test‑retest reliability were assessed
using Cronbach’s alpha and Intra‑class correlation coefficient (ICC) respectively, with 2 weeks
interval. Predictive validity was tested by comparing OHIP‑14‑H scores with clinical parameters.
The concurrent validity was assessed using self‑reported oral health and discriminant validity was
ascertained through negative association with sociodemographic variables.
RESULTS: The mean OHIP‑14‑H score was 9.57 (S.D = 4.58). ICC and Cronbach’s alpha
for OHIP‑14‑H was 0.96 and 0.92 respectively. Concurrent validity using binomial regression
model indicated that good (OR = 0.56, 95% CI = 0.55 – 4.47) and moderate (OR = 0.25, 95%
CI = 0.17 – 1.87) OHIP‑14‑H scores were negative but significant risk indicators of poor self reported
oral health (P < 0.009). Significant predictive validity was observed between OHIP‑14‑H scores and
clinical parameters (P < 0.000).
CONCLUSION: Translated and culturally adapted OHIP‑14‑H indicates good reliability and validity
among primary school teachers.

Abstract CONTEXT: Fresh Bachelor of Medicine and Bachelor of Surgery graduates (FMGs) are responsible
for the majority of prescription errors and irrational use of medicines. Little research has explored
their knowledge on rational prescribing practices.
AIMS: The present study aimed to evaluate the awareness of rational use of medicines (RUMs)
among the FMGs.
SETTINGS AND DESIGN: A multicentric, cross‑sectional, and questionnaire‑based study was
conducted among 308 FMGs during the internship orientation program.
SUBJECTS AND METHODS: The structured and prevalidated questionnaire consisted of
35 statements on important aspects of RUM.
STATISTICAL ANALYSIS USED: Data were analyzed using SPSS version 24.0 at 95% level of
significance with Fisher’s exact test.
RESULTS: Nearly 31% of FMGs did not know that the generic drugs are equally efficacious as branded
drugs whereas 53% were in support of pregnant female should not consume any drug. Nearly 58% of
FMGs were confused about deciding the dose in children and 18% were in favor of using antibiotics
in common cold. Almost 55% of FMGs were disagree for adjusting the dose of antidiabetic drugs by
patient depending on the meal taken whereas 12% were not aware of the importance of compliance
of antihypertensive drugs and 40% were supporting the safety of fruits in chronic renal disease. The
FMG from government colleges answered more correctly than that of the private colleges.
CONCLUSIONS: The awareness of RUM among FMG is not satisfactory, and also there is a gap in
its implementation. Thus, they should be supervised during the initial phase of their medical practice.

Abstract Introduction: Measurement tools designed to ensure the achievements of studies’ objectives
must be evaluated. Based on the health promotion model (HPM), the present study was
conducted to assess the validity and reliability of the designed questionnaire of hypertensive
patients’ nutritional perceptions. Methodology: In a cross‑sectional study, the mentioned
questionnaire was assessed based on opinions of 11 experienced faculty members and
671 hypertensive patients in rural areas in the year 2013. To evaluate the reliability, internal
consistency (Cronbach’s alpha) was calculated. Concerning the validity of the questionnaire,
its content and construct validity were examined. Data analysis was performed using
Statistical Package for the Social Sciences version 18 (SPSS Inc., Chicago, IL, USA).
Results: Spearman‑Brown and Cronbach’s alpha coefficients results were acceptable in all
constructs indicating a satisfactory reliability of the questionnaire. Questionnaire’s questions
were highly correlated with the total score signifying the internal consistency of the questions;
therefore, all questions had a similar effect on the total score and the removal of each did no
increase the alpha significantly (all questions had acceptable reliability). Factor analyses showed
that all questions had acceptable factor loading and suitable validity. Moreover, the entire
constructs of the questionnaire were approved by experts with high validity coefficient of 0.9.
Conclusion: The designed questionnaire for assessment of the HPM constructs regarding
hypertensive patients’ nutritional issues had appropriate psychometric characteristics. Reliability
and validity of the questionnaire were also satisfactory and its overall structure was approved.