Journal of Education and Health Promotion

Abstract BACKGROUND: Gestational diabetes is the most common medical complication and a common
metabolic disorder during pregnancy. Increasing people’s self‑efficacy is one of the best ways to
control this disease. As there is a lag of intervention in this regard, the purpose of this study was to
determine the effect of couple supportive counseling on self‑efficacy in women with insulin‑treated
gestational diabetes.
MATERIALS AND METHODS: In this randomized clinical trial, 64 women with gestational diabetes
who referred to diabetes clinic of Mashhad Ommolbanin Hospital were divided into intervention and
control groups through block randomization during 2019. Their gestational age was in 26–30 weeks.
For the couples in the intervention group, three couple supportive counseling session was held. Each
session lasted 1 h and was held one time per week. The instruments were diabetes self‑efficacy
questionnaire, fasting and 2‑h postprandial checklist and Cassidy social support, which were assessed
before and 4 weeks after intervention in both groups. Data was analyzed by SPSS software version 25
through Mann–Whitney and Wilcoxon test. P values of < 0.05 were reported to be significant.
RESULTS: In the preintervention, the diabetes self‑efficacy score had no significant difference
in the intervention (30/6 ± 38/50) and control groups (09/8 ± 56/51) (P = 515/0). However, in
the postintervention, the diabetes self‑efficacy score was significantly higher in the intervention
group (58/6 ± 41/71) compared to the control group (15/7 ± 31/51) (P < 001/0). Also, before the
intervention, there was no significant difference between the intervention (30/2 ± 72/10) and control
group (87/1 ± 63/11) (P = 137/0) regarding social support. However, after the intervention, there was
a significant difference between the intervention and control groups (879/0 ± 53/13, 03/2 ± 41/11,
P < 0/001 respectively). Also, data analysis showed a significant correlation between self‑efficacy
and social support (r = 0.451, P < 0.001), self‑efficacy and fasting blood sugar (P < 0.001, r = ‑0.577),
and 2 h post prandial (r = ‑0.778, P < 0.001).
CONCLUSION: Couple supportive counseling leads to increased self‑efficacy and social support
in pregnant women with gestational diabetes. Therefore, it is recommended to use this counseling
as an effective method in the management of diabetic pregnant women during their prenatal care
to have a healthier pregnancy.

Abstract BACKGROUND: Couples’ attitudes toward infertility are related to different dimensions of infertility.
Counseling can change attitudes toward infertility in infertile couples. Therefore, this study was
conducted to determine and compare the effect of face‑to‑face counseling and telephone counseling
on infertility attitudes in infertile couples.
MATERIALS AND METHODS: This two‑group intervention study was performed on 34 infertile
couples who were randomly assigned to face‑to‑face and telephone counseling groups. The couple
attended counseling sessions as scheduled by the researcher. An Infertility Attitude Questionnaire
was completed by all participants at the beginning and end of the study. Data were analyzed using
SPSS software version 16.
RESULTS: The results of independent t test showed that after the intervention, the mean score
of attitude toward infertility in the face‑to‑face counseling group was significantly higher than
the telephone counseling group. Based on paired t test, the mean score of infertility attitude in
the face‑to‑face counseling group was significantly increased two weeks after the intervention
compared to before. The mean score of infertility attitude in the telephone counseling group was
significantly increased two weeks after the intervention compared to before. According to the results
of independent t test, the attitude score toward infertility was not statistically significant between
the two groups.
CONCLUSION: The results of the present study showed that with counseling, the mean score of
infertility attitude in infertile couples in both groups had increased. In other words, counseling can
change attitudes toward infertility in infertile people.

Abstract BACKGROUND: In the COVID‑19 outbreak, women with a history of miscarriage need more mental
health. Anxiety and meta‑worry as consequences of miscarriage, besides concerns due to pregnancy
during coronavirus, show the necessity of appropriate online and face‑to‑face educational counseling.
This study aimed to evaluate the effectiveness of online metacognitive educational counseling versus
face‑to‑face method on anxiety and meta‑worry in these women.
MATERIALS AND METHODS: In this randomized clinical trial, 80 women with a history of
miscarriage, anxiety, and meta‑worry referred to Imam Jafar Sadegh hospital (labor, women ward
and women clinic), Meybod, Iran, were selected conveniently and randomly assigned into two
groups (n = 20/each). The participants received 8‑session metacognitive educational counseling
package online or face‑to‑face. Data were collected by Beck Anxiety Inventory, Wellz meta‑worry
questionnaire at baseline, week eight, and follow up as primary outcomes and analyzed via SPSS
software (Anova and Repeated measure statistic tests).
RESULTS: Anxiety in the 12th week (online group 13.75 ± 3.59 vs. face to face 18.25 ± 5.91,
P = 0.04) was statistical significantly less than baseline (respectively 22.15 ± 5.67 vs. 22.35 ± 4.93,
P =  0.56); with fewer anxiety scores in the online group. Meta‑worry in the 12th week (online
group 11.90 ± 2.59 vs. face to face 15.70 ± 4.06, P = 0.03) was statistically significant compared to
baseline (respectively 17.15 ± 2.70 vs. 18.50 ± 3.47, P = 0.36); with fewer meta‑worry scores in the
online group. Belief about worry in 12th week (online group 66.50 ± 14.60 vs. face to face 78.45 ± 9.27,
P = 0.01) was statistical significantly less than baseline (respectively 85.50 ± 8.87 vs. 86.05 ± 8.85,
P = 0.96); with less score of belief about worry in the online group.
CONCLUSION: Online and face‑to‑face metacognitive educational counseling methods decreased
anxiety, meta‑worry, and belief about worry in women with miscarriage. But online educational
counseling was more effective. Distance online counseling in COVID‑19 can help the mental health
of women with miscarriage.

Abstract BACKGROUND: The loss of a pregnancy can result in grief, guilt, self‑doubt, anxiety, and
post‑traumatic stress disorder (PTSD). Considering the side effects mentioned for mental health
and the fact that the symptoms will linger if left untreated and even adversely affect the subsequent
pregnancies. The current study was designed to assess the impact of individual counseling on stress,
anxiety, and depression in mothers with pregnancy loss.
MATERIALS AND METHODS: The study commenced 100 women who experienced pregnancy loss
(in Urmia/2018-2019); they were enrolled using convenience sampling and block randomization. The
intervention group received four individual counseling sessions (weekly sessions with a duration of
1 h) based on Warden’s principles. The control group received routine care. The Depression Anxiety
Stress Scale (DASS‑42) was filled out at baseline, the pre‑ and post‑intervention. Analyses were
performed using the Chi‑square, paired, or individual t‑tests, when necessary. P value < 0.05 was
considered significant.
RESULTS: There were no significant differences regarding socio‑demographic characteristics and
clinical features between groups at baseline. Intra‑group analysis showed that all outcome measures
in the intervention group were significantly improved. According to inter‑groups analysis, a significant
association was found between pre‑test and post‑test in the intervention group (P < 0.05).
CONCLUSION: Results of this study can clarify the psychological effects of pregnancy loss in these
mothers and help the officials and responsible parties to plan the treatment and rehabilitation of these
women and include them in the healthcare system.

Abstract BACKGROUND: Adolescence is a stressful time period. Adolescents experience new changes 
physically, mentally, emotionally, and socially. The purpose of this study was to determine the effects 
of acceptance and commitment therapy (ACT) on anxiety (primary outcome), depression, and quality 
of life (secondary outcomes) of adolescents.
MATERIALS AND METHOD: This was a quasi‑experimental study with pre and postintervention 
design. One hundred female students aged 16–18 years with mild to moderate anxiety selected 
through multistage cluster sampling from five educational districts of Tabriz. During six group 
counseling sessions, students were consulted with the acceptance and commitment approach 
according to the protocol. Beck Anxiety and Depression Inventory and the World Health Organization 
brief Quality of Life Questionnaire consultation were completed before, immediately after, and 8 weeks 
after the consultation. Data were analyzed using repeated measure ANCOVA.
RESULTS: The mean anxiety score decreased significantly immediately after the intervention (mean 
difference [MD]: −4.0, 95% confidence interval [CI]: −5.9 to − 2.0; P < 0.001) and 8 weeks later (MD: 
−3.9, 95% CI: −5.8 to − 1.9; P < 0.001). The mean depression score immediately (P < 0.001) and 
8 weeks after intervention (MD; −4.2, CI: −1.6 to − 6.8), P < 0.001) declined significantly. The mean 
overall quality of life score increased significantly after the intervention (P < 0.001) and 8 weeks 
later (MD: 4.7, 95% CI: 7.1–2.3, P < 0.001) compared to baseline.
CONCLUSIONS: Based on the effectiveness of counseling based on ACT on anxiety, depression, 
and quality of life in the female students with the mild and moderate anxiety over time, it can be used 
as a helpful method in high schools.

Abstract BACKGROUND: The beginning of a marital relationship is very important as a part of a family
relationship, and it satisfies many mental and physical necessities in a safe environment and has
a great impact on people’s health. The aims of this study were to investigate the effectiveness of
sexual health counseling based on cognitive behavioral approach on satisfaction and excitability of
newly married women.
MATERIALS AND METHODS: A randomized clinical trial study was conducted in 50 newly married
women who referred to the health center of Jiroft City. They randomly divided into the intervention
and the control groups. All of the participants completed Linda Berg’s Sexual Satisfaction Scale
before intervention, 8 weeks after intervention and 4 weeks later (follow‑up). The interventional
group participated in CBT (8 sessions, 90 min), but the control group received routine counseling.
In all tests, a significance level of 0.05 was considered. Data were analyzed by SPSS version 20.
Descriptive test, t‑test, and repeated measure test used to analyze data.
RESULTS: In intervention group, sexual satisfaction was obtained 51.88 ± 12.27, 57.2 ± 12.88
and 62.76 ± 11.35 (P < 0.05) and in the control group was gotten 47.12 ± 9.6, 45.8 ± 8.07 and
43.48 ± 7.39 (P > 0.05) before intervention, 8 weeks after intervention and 4 weeks later (follow‑up),
respectively. In intervention group, sexual excitability was obtained 82.80 ± 17.24, 91.72 ± 13.07,
and 99.28 ± 11.2 (P < 0.05) and in the control group was gotten 87.04 ± 12.99, 87.48 ± 11.64, and
81.96 ± 12.83 (P > 0.05).
CONCLUSION: It can be concluded that cognitive‑behavioral counseling can help to improve the
sexual satisfaction and excitability of the newly married and can be used to improve and promote
women’s sexual health.

Abstract BACKGROUND: Quality of relationship marital status affects all aspects of family functioning,
including sustainability of cohabit living, supporting children, and happiness of couples. This study
was conducted to examine the effect of group cognitive‑behavioral counseling on optimism and
self‑esteem of women during the 1st month of marriage that referring to marriage counseling center.
MATERIALS AND METHODS: A semi‑experimental study was designed by a test, posttest, and
follow‑up. Participants consisted of 30 women admitted to premarriage counseling center of Farsan
city in 2018 with using purposive sampling by random numbers’ table into experimental and control
groups. The experimental group participated in eight consecutive 2‑h group counseling sessions.
Data collection tools were demographic questionnaire, Rosenberg’s Self‑Esteem Scale, and optimism
designed by Mir Ahmadi (reliability and validity are calculated and was 0.96) and completed in three
rounds. Women’s self‑esteem retested was done after 1 month. Data were analyzed with independent
t‑test and repeated measures ANOVA (significance level <0.005). Quantitative variables were
analyzed using the Kolmogorov–Smirnov test.
RESULTS: There were no significant differences between optimism scores in the
experimental (M = 150.47, standard deviation [SD] = 22.07) and control groups (M = 149.2,
SD = 21.54) prior to intervention (P = 0.875). The mean optimism score was significantly different in
intervention (M = 169.33, SD = 17.01) and control (M = 147.2, SD = 22.22) groups immediately after
counseling (P = 0.005) and 1 month after counseling (P = 0.002, M = 171.08, SD = 17.98). The mean
self‑esteem scores were statistically significant in both groups immediately after counseling (P = 0.023,
I: M = 37.06, SD = 8.69, C: M = 31.4, SD = 4.83) and 1 month after counseling (P = 0.028, I: M =
34.73, SD = 4.93, C: M = 30.06, SD = 4.8).
CONCLUSION: Cognitive‑behavioral counseling enhances women’s optimism by emphasizing
the training of communication and conflict resolution skills, which leads to positive attitude and life
satisfaction. Therefore, using cognitive‑behavioral counseling in marriage counseling sessions can
improve couples’ relationships.

Abstract BACKGROUND: Fertility is always one of the most important functions of the family. Having a
child equals growing up and entering the adult world. Adoption is one of the methods that can be
considered to treat infertility. One of the duties of health professionals, especially midwives, is to
advise and educate infertile people, which helps them in a way beyond medical treatment. Therefore,
this study was conducted to determine the effect of face‑to‑face and telephone counseling on the
desire for adoption in infertile couples.
MATERIALS AND METHODS: The present study was a two‑group counseling intervention study that was
performed on 34 infertile couples referred to Mashhad Infertility Center. Infertile couples were randomly
assigned to face‑to‑face and telephone counseling groups. All participants completed the Adoption
Adoption Questionnaire at the beginning and end of the study. Data were analyzed by spss16 software.
RESULTS: The mean score of propensity to adopt in the face‑to‑face counseling group 2 weeks after
the intervention was significantly higher than before the intervention. Furthermore, the mean score
of desire for adoption in the telephone counseling group increased significantly 2 weeks after the
intervention compared to before (P < 0.001). Adoption scores varied in the face‑to‑face counseling group
at 3.15 and in the telephone counseling group at 3.23. There was no statistically significant difference
between the two groups (P < 0.885). The most common reason for not wanting to adopt was hope
for self‑treatment and having children (70.6% women and 67.6% men). The most common reason for
accepting an adopted child was the strong need to have a child (23.5% in women and 23.5% in men).
CONCLUSION: According to the results of this study, counseling can increase people’s awareness
of the conditions of adoption and thus increase the desire of people to accept the adopted child. For
this reason, considering adoption counseling sessions for infertile couples who have been receiving
infertility treatment for a long time but have not become pregnant can help the couple decide.

Abstract BACKGROUND: Reproductive motivation is a complex issue that has cultural, behavioral, and
ideological roots and changes in the context of population transfer and economic and social
development. Reproductive motivations include positive and negative motivations that can be
influenced by education. Training can be done in different ways. It seems that face‑to‑face training
increases learning. On the other hand, face‑to‑face training increases participants’ cooperation and
desire for educational topics. Therefore, the aim of this study was to compare and determine the
effect of two counseling methods on the fertility motivation of infertile couples.
MATERIALS AND METHODS : This intervention study was performed on 68 men and women
with infertility referring to Milad Infertility Center in Mashhad in 2016–2017. Subjects were randomly
assigned to two methods of counseling. Participants completed written consent to participate in
the study. Infertile couples were included in the study if they met the inclusion criteria. The fertility
motivation questionnaire was completed by the participants at the beginning of the study before
the consultation and 2 weeks after the consultation. The collected data were analyzed by SPSS
Software Version 16.
RESULTS: According to the independent t‑test, there was no statistically significant difference
between the mean scores of positive fertility motivation in the two groups of face‑to‑face and telephone
counseling before the intervention. Independent t‑test showed that 2 weeks after the intervention,
there was no significant difference between the two groups in terms of this variable (P = 0.283). There
was no statistically significant difference between the mean scores of positive fertility motivation in the
face‑to‑face counseling group before and after the intervention. Further, in the telephone counseling
group, there was no significant difference between the mean scores of positive fertility motivation
in the two stages before and after the intervention. According to the independent t‑test, there was a
statistically significant difference between the mean scores of negative fertility motivation in the two
groups of face‑to‑face and telephone counseling before the intervention (P = 0.025). However, this
test showed that there was no significant difference between the two groups in terms of this variable
2 weeks after the intervention.
CONCLUSION: The results of this study showed that face‑to‑face and telephone counseling did not
have a significant effect on fertility motivations of infertile couples. In other words, the mean scores
of positive and negative fertility motivations before and after counseling remained unchanged in both
groups and the two groups did not differ in this regard. In other words, the issue of fertility motivation
in infertile women can be affected by different characteristics such as social, family, cultural, and
economic conditions of individuals. If infertile people do not make having a child a necessity in their
lives and cope with it more easily, no counseling can change their motivation. On the other hand,
if infertile women consider having a child as an essential part of their married life and the health of
their married life, counseling can have the greatest effect on them.

Abstract BACKGROUND: Pregnant women are classified as one of the vulnerable groups. Physiological and
psychological changes during pregnancy predispose them to serious psychiatric disorders; if not
identified and treated in time, it can have a negative and long‑term impact on mental health. The aim
of this study was to determine the effect of cognitive–behavioral counseling of pregnant women with
the presence of a spouse on the level of stress, anxiety, and postpartum depression.
MATERIALS AND METHODS: The present study is a clinical trial that was performed on 40 pregnant
women with a gestational age of 32–28 weeks (20 in the intervention group, 20 in the control group)
who were randomly assigned to the intervention group and the control group according to the inclusion
criteria. Cognitive–behavioral group counseling in the presence of spouses was performed by the
midwife and under the supervision of a psychologist, in eight sessions, each session lasting 90 min,
once a week for the intervention group. The control group received routine care and a counseling
session. Data collection tools were demographic information questionnaire and Depression–Anxiety–
Stress Scale 21, which were completed before the intervention, immediately after the intervention,
and on the 14th day after delivery in both groups. Data analysis was performed using statistical tests,
independent t‑test, repeated measures test, Bonferroni post hoc test, and Kolmogorov–Smirnov test.
RESULTS: The results of this study showed that the mean scores of stress, anxiety, and depression
in the two groups in the preintervention stage were not significantly different (P < 0.05), but in the
postintervention stage and follow‑up, the mean scores of stress (P < 0.001), depression (P = 0.010),
and anxiety (P = 0.029) in the intervention group were significantly reduced compared to the control
group.
CONCLUSION: According to the research findings, cognitive–behavioral group counseling can be
effective as an approach in improving the symptoms of stress, anxiety, and depression in pregnant
women. Therefore, it is necessary to plan properly to use this counseling approach to manage stress,
anxiety, and depression in women during pregnancy.

Abstract INTRODUCTION: Many infertile people have heard about adoption, but little is known about the true
meaning of adoption and how it is accepted. Giving the right information about adoption is effective
in making the right decision for couples. As a result, there is a need to intervene and provide training
to improve community attitudes and increase adoption among infertile people. Therefore, the present
study aimed to determine the effect of two counseling methods (face‑to‑face and telephone) on
awareness and attitude toward adoption in infertile couples.
MATERIALS AND METHODS: The present study is a randomized quasi‑experimental study of two
groups in the Milad Infertility Center of Mashhad on 34 (each group of 17 couples) infertile couples
with the criteria to enter the study. Couples were randomly assigned to two telephone and face‑to‑face
counseling groups, and each individual’s awareness and attitudes toward adoption were completed
separately before and after counseling. The average number of face‑to‑face sessions for face‑to‑face
counseling was three 60‑min sessions and six 30‑min sessions for telephone counseling.
RESULTS: Based on the results of t‑test, there was a statistically significant difference between
the average score of awareness of adoption before and after the intervention (2 weeks after the
last counseling session), in infertile couples in face‑to‑face training group and in telephone training
group (P < 0.0001). The score of the attitude toward adoption before counseling in the face‑to‑face
counseling group was 60.55 ± 5.5, which reached 66.76 ± 4.7 after counseling. Based on the results
of the T‑pair test, this difference was significant (P < 0.0001). In addition, in the telephone counseling
group, the score of attitude toward adoption increased from 59.53. 7.4 to 67.73 ± 7.5, which was a
significant difference in terms of t‑pair test. The mean score of attitudes toward adoption was not
statistically significant in the two groups (P = 0.653).
CONCLUSION: The results of this study showed that both counseling methods (face to face and
telephone) increase the level of awareness and attitude of couples about adoption, but neither
method was superior to the other.

Abstract INTRODUCTION: Considering the trend of reducing fertility in recent decades, the level of awareness
and attitude of health workers to fertility has an important role in achieving the country’s demographic
goals. Improving attitudes and improving the scientific level and skills of health workers are the basic
pillars to improve the quality and quantity of health‑care services. Therefore, this study was conducted
with the aim of improving the level of awareness and attitude toward fertility and fertility counseling
skills of health workers with both face‑to‑face and virtual training methods.
MATERIALS AND METHODS: This study was a randomized controlled trial of three groups and
pre‑test‑posttest experiments performed on 108 midwives and health‑care workers working in
Mashhad Health Center and Community Health Centers and Health Centers in 2015. The tools
used in this study were four researcher‑made questionnaires that were validated and reliable. Data
analysis was performed by Chi‑square test, one‑way, and independent t‑analysis of variance using
SPSS software version 16.
RESULTS: The results showed a significant increase in awareness level, attitude toward fertility,
and counseling skills in the studied groups after the implementation of interventions (P < 0.001).
Furthermore, there was a significant inverse relationship between the attitude score of the research
units at the beginning of the study and the demographic variables with only the average work
experience.
CONCLUSION: Training is effective in raising the level of awareness and changing the attitude of
health workers. The use of group discussion methods in person as well as through a webinar in
which learners think, interact, and gain experience in promoting healthy fertility counseling promotes
awareness, attitudes toward fertility, and their counseling skills in providing healthy reproductive
counseling.

Abstract INTRODUCTION: Since routine counseling does not suffice to resolve the sexual problems at
postpartum period, the present study aimed to investigate the effect of counseling based on the
Ex‑PLISSIT model on sexual function and marital satisfaction of postpartum women.
METHODS: This was a randomized controlled clinical trial that was conducted on 68 postpartum
women (within 3–6 months after childbirth) who obtained a score <28 on the Female Sexual Function
Index (FSFI). The participants were randomly assigned to the intervention and control groups.
Participants in the intervention group received counseling based on the Ex‑PLISSIT model and those
in the control group received the routine postpartum care. The required data were collected using a
demographics form, the FSFI, and the ENRICH Marital Satisfaction Scale. The primary outcomes were
the mean function and martial satisfaction score of participants 4 and 8 weeks after the intervention.
RESULTS: There was no statistically significant difference between the two groups in terms of sexual
function at baseline (P = 0.381), but it was significantly higher in the intervention group than control
group after intervention (the adjusted MD: 4.24, 95% confidence interval [CI]: 3.18–5.29, P < 0.001).
There was no statistically significant difference between the two groups in marital satisfaction before
the intervention (P = 0.433), but it increased significantly in the intervention group in comparison to
control after intervention (adjusted MD: 23.17, 95% CI: 15.10–31.24, P < 0.001).
CONCLUSIONS: The study findings suggested that sexual counseling based on the Ex‑PLISSIT
model can improve the sexual function and increase marital satisfaction of postpartum women.

Abstract INTRODUCTION: Due to the significant decrease in fertility in recent decades and the important role
of health workers and health‑care providers in providing healthy reproductive counseling, their training
is necessary using effective educational methods. Webinar and group discussion (GD) are effective
in this regard. This study was conducted to determine the most effective method and with the aim
of comparing the effect of two training methods (webinar and GD) on the attitude and performance
of health workers in providing counseling with fertility promotion approach in comprehensive health
centers in Mashhad.
METHODS: In this randomized trial study with a control group, 108 health workers working in health
centers no. 2–3 and 5 of Mashhad entered the study and were randomly divided into three groups of
training by webinar, GD, and control. Intervention groups received healthy fertility counseling skills
in three training sessions. Research tools were demographic information questionnaires, fertility
attitudes, and performance measurement checklists for fertility counseling. The questionnaires were
completed in three groups at the beginning and after the completion of the interventions. Data analysis
was performed by Chi‑square test and one‑way analysis of variance using SPSS software version 16.
RESULTS: The analysis of variance test showed that before the intervention, there was no statistically
significant difference between the three groups in terms of average scores of fertility attitude and
performance scores of fertility counseling. After the interventions, the difference between the fertility
attitude scores (P < 0.001) and the performance scores of fertility counseling (P < 0.001) was significant
in the three groups. There was no significant relationship between demographic characteristics and
attitude and performance.
CONCLUSION: Teaching by webinar and GD promotes the attitude and performance of health
workers in providing counseling with a fertility promotion approach. Therefore, it is recommended to
use new educational methods such as webinar and GD to promote childbearing counseling, which
has been emphasized in the country’s population policies. Since the mean score difference for
the webinar training method was the highest due to the mean scores, this method could be more
effective than the GD method.

Abstract INTRODUCTION: Infertility by creating a disturbing and debilitating condition is considered as an
important individual, public, and social health problem. The purpose of this study was to determine
the effect of counseling based on acceptance and commitment therapy (ACT) on mental health and
quality of life in infertile couples.
METHODS: In this randomized controlled trial, 54 infertile couples referring to the Sanandaj‑Iran
Infertility Clinic were assigned into two groups of counseling and control by random blocking with a
1:1 ratio. The consulting group received 8 weekly 90‑min sessions of group counseling based on
ACT. The General Health Questionnaire‑28 (GHQ‑28) and Fertility Quality of Life were completed
before and 1 month after the completion of the intervention. Primary outcome measures were mean
score of mental health and quality of fertility life. Independent t‑test, ANCOVA, and Mann–Whitney
U‑test were used to analyze data.
RESULTS: There was no significant intergroup difference in demographic information (P > 0.05). One
month after the end of the intervention, the mean overall mental health score in the couples of the
counseling group was significantly less than the control group (adjusted mean difference [aMD]: −8.4;
95% confidence interval [CI]: −10.4–−6.4; P < 0.001). Furthermore, the mean overall score of quality
of life in the counseling group couples was significantly more than the control group (aMD: 14.8;
95% CI: 11.8–17.9; P < 0.001).
CONCLUSION: Based on the effectiveness of counseling based on ACT on mental health and quality
of life in infertile couples, it can be used in the infertility clinics. Health‑care providers and counselors
should train in the ACT courses to improve the mental health and quality of life of infertile couples.

Abstract BACKGROUND: The most important reasons for choosing cesarean include negative attitude of
pregnant women toward natural childbirth, and it is not easy for many women to make a decision
about the choice of delivery, Midwives as responsible individuals, play an important role in providing
maternal counseling and care during pregnancy and childbirth and the postpartum period. This study
was carried out to determine the effect of individual counseling on attitudes and decisional conflict
in the choice of delivery among nulliparous women.
MATERIALS AND METHODS: This clinical trial was performed on 90 nulliparous women with
28–30 weeks of gestational age, who were referred to health‑care centers in Mashhad. They were
divided randomly into intervention and control groups. The intervention group received the counseling
program individually during three sessions, while the control group received routine care, childbirth
attitudes, and decisional conflict on choice of delivery were compared on women of 34–36 weeks
of pregnancy. Data collection tools included demographic details form, Childbirth Attitudes Scale
and Decisional Conflict Scale; data were analyzed using Chi‑square tests, Fisher’s exact test,
Mann–Whitney test, t‑test, parried t‑test, and ANCOVA in SPSS v. 16, and P < 0.05 was considered
statistically significant.
RESULTS: After consultation, there was a significant difference in attitude score between the
intervention group (86.577 ± 13.531) and the control group (69.955 ± 19.858) (P < 0.001), And there
was a significant difference in decisional conflict score between the intervention group (0.614 ± 0.626)
and the control group (1.216 ± 0.949) (P < 0.001), and there were significant differences between
the two groups in terms of preferred delivery (P < 0.001).
CONCLUSION: According to the results of this randomized control trial, individual counseling in
nulliparous women during pregnancy leads to a positive attitude toward natural childbirth, informed
decision‑making, and increase in the selection of natural childbirth.

Abstract BACKGROUND: Voluntary counseling and testing (VCT) is one of the main efforts for the prevention
of high‑risk sexual behavior, including HIV/acquired immunodeficiency syndrome (AIDS). The aim of
this study was to determine cognitive determinants related to voluntary counseling and HIV testing
among Iranian adults based on the integrative model of behavioral prediction (IMBP).
MATERIALS AND METHODS: This cross‑sectional study was conducted in 2018 among Iranian
adults with high‑risk sexual behaviors, including drug abuse and unprotected sex, in western Iran.
A total of 300 adults were randomly selected to participate voluntarily in this study. Participants filled
out a self‑administered questionnaire, including the background data and IMBP constructs. Data were
analyzed by SPSS version 21, using statistical treatments, such as bivariate correlations, Chi‑square
test, t‑test, and logistic regression at a 95% significant level.
RESULTS: Almost 73.3% of the participants had a history of VCT. The highest probability of VCT
use was in participants who were in high level of VCT skills (odds ratio: 9.635; 95% confidence
interval [CI]: 3.255, 28.514]), following environmental constraints (odds ratio: 6.274; 95% CI: 2.166,
18.171). Furthermore, the IMBP constructs accounted for 85% of the variations in the outcome
measure of the VCT use intention.
CONCLUSIONS: Based on the result, it appears that the design and implementation of educational
programs to improve upon skills and environmental constraints toward VCT use among adults with
high‑risk behaviors could be useful to the promotion of VCT.

Abstract CONTEXT: Measures related to birth preparedness and complication readiness (BPCR) during
pregnancy play an important role in producing better pregnancy outcome. If the pregnant females are
properly counseled during antenatal visits, it could help in bringing out desirable behavior changes.
AIMS: This study aims to study BPCR‑related awareness and practices among the pregnant females
and the effect of focused and structured birth preparedness counseling on complication readiness
among pregnant females.
SUBJECT AND METHODS: A facility‑based follow‑up study was conducted from July to December
2016, and a total of 130 pregnant females were enrolled. All study participants were initially assessed
for various domains of BPCR index consisting of seven key indicators. The index reassessment
was done again, after 1 month, during follow‑up visit. Information regarding any pregnancy‑related
complication in due course and behavior was also recorded during successive follow‑up.
STATISTICAL ANALYSIS USED: The difference in pre‑ and postcounseling mean BPCR index was
assessed using paired t‑test, and McNemar’s test was used for paired categorical data analysis.
P < 0.05 was considered to be statistically significant.
RESULTS: The postcounseling BPCR index  (70.65 ± 19.18) was found to be significantly much
higher as compared to pre‑counseling baseline BPCR index (41.12 ± 11.34). Knowledge about
danger signs of pregnancy, transportation services provided by government, financial assistance
provided in Government schemes, identification of skilled birth attendant, mode of transportation,
and arrangement of emergency blood donor was found to increase significantly after counseling.
Abortion was found to occur significantly higher (about thrice) among those who had postcounseling
BPCR index below average, i.e., <50% (P < 0.05).
CONCLUSIONS: The results of the present study revealed that focused birth preparedness
counseling on complication readiness could play an important role in increasing the baseline
knowledge of pregnant females regarding pregnancy‑related complications and bring out desirable
ideal health‑seeking behavior changes during pregnancy.

Abstract BACKGROUND: Hypertension is an important treatable public health problem both globally and in
India with an increasing prevalence significantly in both urban and rural population. It is one of the
leading causes of adult mortality and morbidity, but poorly controlled hypertension remains a major
health problem.
OBJECTIVE: The objective of this study was to find out awareness, treatment, and control
of hypertension among study population and association of hypertension awareness with
sociodemographic factors, if any.
MATERIALS AND METHODS: This study was conducted from May 2013 to April 2014 in the rural
community of Singur block, West Bengal. Data were collected with respect to sociodemographic
characteristics as well as records related to hypertension such as awareness, treatment, and control
of hypertension. Blood pressure (BP) measurement of individuals aged 20 years and above of both
sexes was done. Pearson’s Chi‑square test was performed to find out the association between the
categorical variables. SPSS 19.00 software was used for analysis.
RESULTS: Nearly 48.2% of the participants were aware of their elevated BP; 47.1% of the participants
were taking pharmacological treatment, mostly allopathic and only 8.8% had their BP under control.
A  statistically significant association was found between age, education, and socioeconomic
status (per capita income) with awareness of hypertension.
CONCLUSION: Lack of awareness of the disease and very low rate of control of hypertension
among those who were treated became the major issues. These findings emphasize the need for
dissemination of knowledge about the disease and counseling of the patients during treatment
continuation.

Abstract BACKGROUND: Some risk factors that would lead to therapeutic abortion do even exist before
pregnancy and could be resolved or corrected through appropriate interventions. The present study
was conducted to evaluate the condition of preconception care among therapeutic abortion applicants.
MATERIALS AND METHODS: This research was a descriptive, cross‑sectional study that was
conducted on 200 applicants for therapeutic abortion at the Forensics Medicine Center of Isfahan (Iran)
who were selected convenience sampling from October 2014 to March 2015. Data were gathered
using a researcher made checklist. Data were analyzed using SPSS version 16 through descriptive
statistics and Chi‑square and independent t‑test.
RESULTS: Eighty‑five percent of the participants were applicants for therapeutic abortion due to
fetal problems, and the other 15% were due to maternal issues. About 41.7% of participants with
fetal problems and all of the participants with maternal issues had not received preconception care.
In 93.3% of the applicants with maternal issues, the disease existed before the pregnancy. About
48.2% of participants needed genetic counseling, but 28.6% had not received any.
CONCLUSIONS: Results showed that in most of the participants, the risk factor for therapeutic
abortion existed before the pregnancy. Providing preconception care along with the elimination
of risk factors before the pregnancy could prevent some of the pregnancies with the indication of
therapeutic abortion.

Abstract Background: Appropriate family planning counseling for informed choice, the right and
responsible use of contraceptive methods is very important. Various barriers such as social
barriers can have the effect on family planning counseling. In addition, investigation of those
barriers from the perspective of managers, staff and clients, who are major members in
health care system, has great importance. The present study was conducted with the goal
of comparing managers’, employees’, and clients’ viewpoints about social barriers in family
planning counseling in health care centers in Isfahan in 2012. Materials and Methods: This is a
cross-sectional one-step three-group comparative descriptive study conducted on 295 subjects
including 59 managers, 110 employees, and 126 clients in medical health care centers
in Isfahan in 2012. Managers and employees were selected by census sampling and the
clients were recruited through convenient random sampling. The data collection tool was a
researcher made questionnaire, which was designed in two sections of fertility and personal
characteristics and viewpoint measurement. Descriptive and inferential statistical test were
used to analyze the data. Results: The obtained results showed significant difference between
mean scores of viewpoints in three groups of managers, employees, and clients concerning
social barriers in family planning counseling (P = 0.001). In addition, most of the managers
and employees reported social barriers as the barriers in process of family planning in a large
level and clients reported it in moderate level. Conclusion: The results express the necessity
of health services managers’ planning to modify or delete social barriers, especially the agreed
barriers from the viewpoint of managers and employees that effect on family planning counseling
and quality of service provided by them.

Abstract Background: Majority of HIV/AIDS patients who are on Highly Active Anti Retroviral Therapy
(HAART), are not aware about drug adherence and its importance which is the most important
factor for drug adherence. Objectives: To study the level of drug adherence in patients accessing
antiretroviral therapy (ART) through the National program and factor influencing drug adherence.
Materials and Methods: In present study, we enrolled 102 newly diagnosed patients, among
them in 79 patients, ART was started. To study the drug adherence a pretested, semistructured
questionnaire was formed and patients were followed up for 6 months of the study. Pretest and
posttest counseling was done to all such patients. Results: A total of 28 patients missed the
dose in 1st follow-up, nine patients missed in 2nd follow-up, eight patients missed in 3rd follow-up.
Three patients lost follow-up in 2nd follow-up, three patients further lost follow-up in 3rd follow-up.
Running out of pills (40.0%), side effect (15.5%), and family problem (13.3%), poor transport
facility for taking drug (8.9%) and forgetfulness (11.1%) are five major causes related to miss
dose. In females patients, drug adherence (69%) was initially less than male patients (76%) but
latter on female patients (96.3%) had better adherence than males (95.2%). Conclusion: This
study suggest that drug adherence can be increased by proper counseling and close monitoring
of the patients which may have a great role in preventing the drug resistance and ART response.

Abstract Background: Tobacco addiction is an important public health issue. It is important
for health professional to counsel the tobacco users for cessation. Aim: To enhance
communication skills of MBBS (Bachelor of Medicine and Bachelor of Surgery) students
in counseling of tobacco users by using interactive teaching methods and examine it
by using OSCE. Materials and Methods: It was a before and after comparison study.
Communication skills of students were examined by standardized patients (investigators)
by objective structured clinical examination (OSCE) method before and after intervention.
All the students were trained to enhance the communication skills by role play, interactive
session, anecdotes. Statistical analysis was done by using Paired t‑test. Results: The
difference in scores at all the 3 stations before and after the intervention and also global
scores before and after the intervention was statistically highly significant (P = 0.0001).
Conclusion and Recommendation: Communication skills of students in counseling
tobacco users improved after they were given role play, interactive session, anecdotes.
Similar model can be used to improve the communication/counseling skills in other
important health hazards.