Journal of Education and Health Promotion

Abstract BACKGROUND AND AIM: Given the complexities of the health care system and the importance
of the subject and effects of health literacy in all aspects of care, defining specific health literacy in
this context seems necessary. The purpose of this research was to explain the concept of hospital
health literacy (HHL), its definition, and the related dimensions using the qualitative research method.
MATERIALS AND METHODS: An exploratory qualitative design was used. Exploratory, open‑ended,
and face‑to‑face interviews based on the interview guide were used to elicit participants’ perspectives
between July 2021 and January 2022. By using the content analysis method, researchers coded
transcripts and collated these codes into sub‑categories and then merged them into the main category
and explored the dimensions of the concept.
RESULTS: A total of 23 service providers and 25 service recipients were included in the study.
Analysis of qualitative data led to the identification of 6 categories and 25 sub‑categories including
cognitive literacy, functional (basic) literacy, communicative literacy, behavioral literacy, media
literacy, and emotional literacy.
CONCLUSION: The findings of the present study provide a deep understanding of the concept
of HHL that could be applied to develop valid and reliable measurement tools for assessing HHL
among a variety of populations. Also, it is hoped that the present attempt can be useful to guide
future research and interventions as well as to provide a clear base for planning, implementing, and
evaluating interventions aimed at promoting individuals’ health literacy in health settings.

Abstract BACKGROUND: One of the most important sensory disorders that usually occur after viral infections,
especially human coronaviruses and rhinoviruses, is anosmia or loss of olfactory sense. The aim of
the present study was to investigate olfactory disorders in children with COVID‑19 disease admitted
to Hazrat Masoumeh Hospital in Qom.
MATERIALS AND METHODS: This descriptive‑analytical study was conducted on 85 children
admitted to Hazrat Masoumeh Hospital in Qom by using a convenience random sampling method.
Data were collected using a checklist containing demographic data. The collected data were entered
SPSS 18 software and were analyzed using descriptive and analytical statistics.
RESULTS: In the present study, the results showed that the mean age of participants was
6.59 ± 3.27 years and more patients were Iranian (n = 69, 87.3%), had a history of underlying
disease (n = 51, 64.6%), had a history of vaccination (n = 78, 98.7%), and did not have contact with a
suspected patient (n = 43, 54.4%). Among the signs and symptoms of the disease, only the symptoms
of fever (n = 71, 89.9%), weakness and lethargy (n = 44, 55.7%), and anorexia (n = 44, 55.7%) were
observed in most patients. Moreover, 87.3% (n = 69) of the patients did not have olfactory. Furthermore,
no association was found between age (P = 0.803), length of hospital stay (P = 0.397), white blood
cell (P = 0.624), lymph (P = 0.638), Polymorphonuclear (PMN) (P = 0.493), erythrocyte sedimentation
rate (P = 0.507), C‑reactive protein (P = 0.085), and O2sat (P = 0.205) and olfactory disorders, but a
significant relationship was found between patient weight (P = 0.002) and olfactory disorders.
CONCLUSION: According to the results of the study, it can be said that in order to increase the
strength of the immune system of children, especially overweight children, appropriate and planned
action should be taken to prevent problems in these children.

Abstract BACKGROUND: Nursing is one of the most stressful occupations. Educational intervention regarding
stress management can play an important role in reducing occupational stress among nurses The
present study aimed to determine the effectiveness of educational intervention on reducing oxidative
stress caused by occupational stress in nurses: A health promotion approach in a hospital in western
Iran.
MATERIALS AND METHODS: The present interventional study was performed in 2019 among
92 nurses working at the Kosar Hospital located in the city of Sanandaj in the country of Iran.
Occupational stress was evaluated using the Osipow Occupational Stress Questionnaire. Oxidative
stress was measured by taking blood samples and measuring the enzymatic activity of superoxide
dismutase (SOD), malondialdehyde, and catalase (CAT) using SOD, malondialdehyde (MDA), and
CAT kits. Educational intervention was carried out in the second stage. Three months after the
intervention, data were taken again.
RESULTS: The results of the present study indicated that there was a significant difference in
occupational stress between before and after the educational intervention (P < 0.05). A significant
reduction in MDA (P = 0.038) and SOD (P = 0.048) was observed after educational intervention, but
this was not the case for CAT (P = 0.592). There was no significant correlation between occupational
stress with oxidative stress parameters before and after the educational intervention (P < 0.05). No
significant difference in occupational stress was observed between men and women. Among the
oxidative stress parameters under evaluation, MDA was higher among men compared to women
and this was statistically significant.
CONCLUSIONS: Educational intervention regarding occupational stress is effective in reducing
oxidative stress among nurses. The group meetings teach stress management to the participants
and enable them to better manage their stress by utilizing their own capabilities. Thus, attention to
this issue is vital in maintaining the mental and physical health of nurses and, in turn, improves the
quality of care rendered.

Abstract BACKGROUND: Disaster can pose significant challenges to the health infrastructure in the
community. Hospitals are the central unit for providing health services in the disaster response
plan. With regard to the vital role of military hospitals in health response to disaster, this study was
carried out with the aim of investigating the disaster risk management (DRM) challenges in military
hospitals in Iran.
MATERIALS AND METHODS: The current study was qualitative research performed in 2020 in
military hospitals in Iran. Participants consisted of 12 managers and staff of the military hospitals in
Tehran and professionals in health in emergencies and disasters who were included in the study by
the purposive sampling technique. Semistructured individual interviews based on the interview guide
were exploited for the data collection, and a content analysis method was used to analyze them.
RESULTS: DRM challenges in military hospitals were explained in the form of six categories:
“management and leadership, planning, prevention and mitigation, preparedness, response, and
recovery” and 22 subcategories.
CONCLUSION: Managers’ awareness of DRM challenges in hospitals, particularly military hospitals,
and the design and implementation of solutions can lead to the promotion of hospital DRM and
hospital preparedness to deal with disasters.

Abstract BACKGROUND: Nowadays, various strategies are applied by governments to control costs and 
finance hospitals and the health sector. Public‑private partnership (PPP) option is one of these 
strategies. Considering the growing importance of hospitals in different communities and their 
problems, this study aimed to identify PPP challenges, opportunities and solutions in hospitals. This 
study aimed to identify the challenges and opportunities of PPP in the country’s hospitals and then 
offered an appropriate solution to overcome these challenges.
MATERIALS AND METHODS: This is a qualitative study and content analysis approach is 
undertaken. The participants were selected through purposive sampling and data were collected using 
a semi‑structured interview with experts in the public and private health sector until the saturation 
point achieved. Data analysis was performed through the thematic analysis of expert’s statements 
using MAXQDA. 10 software in this sector.
RESULTS: According to the study results, 3 main themes (challenges, opportunities, and solutions), 
10 sub‑themes, and 32 codes were identified in relation to the public and private partnership. 4 
sub‑themes on challenges of PPP, 3 sub‑themes on partnership opportunities and 3 sub‑themes 
on challenges solutions were identified.
CONCLUSION: The results of this study revealed that given the discussed challenges the most 
important challenge seems to be not evaluated outsourcings, incorrect usage of participatory models, 
and inadequate and inappropriate postoutsourcing supervision, however, it appears evaluated 
outsourcing backed with adequate supervision could solve many current hospitals’ problems.

Abstract BACKGROUND: Health‑care workers are exposed to complex types of health and safety hazards. 
A high percentage of hospital staff in Iran are women, who in addition to heavy and stressful hospital 
work, also carry the burden of the family roles. It is in these circumstances that creating a supportive 
environment for women is of particular importance. Accordingly, this study is designed to determine 
the characteristics of a mental supporting work environment in the workplace from the perspective 
of female hospital staff.
MATERIALS AND METHODS: This study was performed by a qualitative method and content 
analysis approach. Sampling was purposive and 26 women working in different wards of this 
hospital were included in the study. In this study, women with maximum diversity in terms of age, 
work experience, and employment ward were selected. The main method of data collection in this 
study was a semi‑structured interview. Interview texts were extracted and divided into meaningful 
units. To validate and confirm the results plus accuracy of the research, the criterion of data validity 
or data credibility, admissibility, data accuracy, verifiability, reliability, and transferability were used.
RESULTS: Through the data analysis, 58 primary concepts with the same features were classified 
into 10 subcategories. Then, based on common features at a more abstract level, they were converted 
into four main categories including job stressors, women’s stress management, providing women’s 
psychological‑job satisfaction, and women’s work‑life balance.
CONCLUSION: Creating supportive work environments for women, especially those operating in 
workplaces such as hospitals, which brings a lot of work pressure and workload for them, can be an 
important policy for organizations and hospital work environments.

Abstract BACKGROUND: The health reform plan (HRP) is a plan to improve Iran’s health systems that began 
in 2014. The three main approaches of this plan include financial protection of the people, creating 
justice in access to health services, and improving the quality of services. It predicted that the level 
of health system responsiveness would increase. Achieving this goal is possible only with the correct 
implementation. The best people to measure the correct implementation are nurses, midwives, 
and physicians. Hence, this study was conducted to assess the attitude of nurses, midwives, and 
physicians about the implementation of the HRP.
MATERIALS AND METHODS: This cross‑sectional descriptive study was conducted in educational 
hospitals of Jahrom University of Medical Sciences in 2020. By convenience sampling method, 325 
nurses, midwives, and physicians participated in this study. Sampling was done in all work shifts, and 
in all wards. A researcher‑making questionnaire was used to collect data. The scoring did by the Likert 
scale from (completely agree = 4 to completely disagree = 1). Quantitative and qualitative face and 
content validity was calculated (IS: 0.84, CVI: 0.92, CVR: 0.87), and its reliability was calculated by 
Cronbach’s alpha method (0.78). The data were analyzed by SPSS software version 16. Descriptive 
statistics, Mann–Whitney U‑test, and Kruskal–Wallis test were used for the data analysis (P ≤ 0.05).
RESULTS: In the study, 90.15% agreed with the implementation of the HRP. There was no significant 
difference between the male and female (P = 0.063). There was a significant difference between the 
educational degree (P = 0.006), married and the single participants’ attitude (P = 0.003), the nurses, 
midwives, and physicians (P = 0.001).
CONCLUSION: HRP is more successful in the field of financial protection, so policymakers should 
pay more attention to justice in access to health services and improving the quality of services fields.

Abstract BACKGROUND: The emergency department is one of the most important parts of all hospitals. For
this reason, many simulation programs are performed in this department to increase the knowledge,
skills, and productivity of health‑care workers. The purpose of this study was to identify the benefits
of simulation in hospital emergency departments.
MATERIALS AND METHODS: In the present systematic study, using “AND” and “OR” operators, we
searched for the keywords “benefits,” “simulation,” and “hospital emergency department” in PubMed,
Web of Science, Scopus, Google Scholar as well as Persian language databases such SID, Magiran,
Irandoc, and Iran Medex. Then, a three‑step screening process was used to select studies relevant
to simulation and hospital emergency from 2005 to 2021 using the PRISMA checklist, and finally,
the obtained data were analyzed.
RESULTS: A total of three main groups, each with several subgroups, were extracted and identified
as the benefits of using simulation in hospital emergency departments. They included improving
the diagnosis of the disease (rapid prediction of the disease, rapid diagnosis, and patient triage),
improving the treatment process (improvement of treatment results, anticipation of admission and
discharge of patients, acceleration of interventions, and reduction of medical errors), and improving
knowledge and skills (improvement of the speed of decision‑making, staff’s acquisition of knowledge
and skills, simple, convenient, and low‑cost training, improvement of staff’s preparedness in crisis).
CONCLUSION: Based on the results of the present study, it is suggested to develop some training
programs in order to help staff upgrade their knowledge and performance as well as acquire practical
skills and also to improve the diagnosis and treatment process in hospital emergency departments.
Virtual methods are also proposed to be applied as potential and cost‑effective platforms for learning,
teaching, and evaluating the staff of hospital emergency departments.

Abstract Both natural and man‑made disasters are increasing in occurrence at the world. Hospitals and
health‑care centers are very complex and have a high potential for vulnerability depending on external
and internal factors. Unfortunately, past experiences show that health‑care centers and the health
system are vulnerable to disasters. Therefore, risk analysis and safety assessment studies of hospitals
and other health‑care centers are absolutely necessary. This systematic review study was conducted
on the basis of the Preferred Reporting Items for Systematic Reviews and Meta‑Analyses guidelines.
English language international databases (Pub Med, Scopus, Embase, Web of Science, and Google
Scholar) were searched through January 1, 2000 up to June 20, 2019. The quality of the studies was
assessed using the International Narrative Systematic Assessment tool. From 3630 titles identified in
this search, 24 studies were selected. The important findings of this study were grouped into five main
categories: risk analysis method, type of disaster, hospital safety methods, hospital components and
key outcomes of risk analysis, and hospital safety assessments. The nature of disasters is a threat
to the lives and property of the people, and therefore hospitals must be available at the incidents
and disasters and they must be able to respond to the needs of the disaster‑affected community.
The probability of an incident and its consequences can never be reduced to zero; because the
severity of many natural and even man‑made disasters is unpredictable and the probability of their
occurrence is different; however, it is possible to identify weaknesses and strengths through risk
analysis studies as well as hospital safety assessments and implement retrofitting programs based
on the type of risks and safety status and reduce the level of risk to an acceptable level.

Abstract BACKGROUND: The outbreak of new pathogens or the resurgence of pathogens that have already
spread is a serious challenge to public health. Coronavirus is a pathogen that seems to invade the
human respiratory system in the first place. Coronaviruses form a large family and are so called
because of the presence of crown like cristae on their surface.
MATERIALS AND METHODS: This is a cross‑sectional, descriptive study conducted to assess the
status of patients with COVID‑19 who were hospitalized in an educational hospital. For this purpose,
142 patients hospitalized in this hospital were followed up 2 weeks after discharge and were inquired about
the symptoms they had upon admission to the hospital, the number of hospitalization days, the history of
underlying disease, and so on. Descriptive data analysis was done with the SPSS software version 22.
RESULTS: The findings of this research showed that overweight or obese people (about 66%)
is more likely to contract the disease. It also seems that older people (37.3% older than 60 years
old) and those with a history of diseases (69.6%) such as diabetes, high blood pressure, or heart
disease are more prone to COVID‑19. The most common symptoms of COVID‑19 patients included
fever (64.5%), shortness of breath (67.4%), and dry cough (50.4%).
CONCLUSION: it seems that high risk group (obese people, old people, and people with a history of
disease) is more likely to be infect with coronavirus so they should more careful than others. Another
important issue is that policy‑makers must play an active role in public awareness of dangers of
COVID‑19 and ways to prevent it.

Abstract BACKGROUND: Emotional intelligence and interpersonal sensitivity are known as important nursing
skills. They have significant role in the promotion of nurses working life and the health care which
they provide. The goal of this study was the determination of the relationship between emotional
intelligence and interpersonal sensitivity with quality of work life in nurses working in governmental
hospitals of Tehran city in 2019.
MATERIALS AND METHODS: This investigation was a descriptive‑analytical and correlation study
which was conducted among 256 nurses working in five governmental hospitals in Tehran. The studied
nurses were selected through in access sampling method. The instruments of research included
demographic, emotional intelligence, interpersonal sensitivity, and work life quality questionnaires.
The analysis of data was done by descriptive and deductive statistics (t‑test and Pearson correlation
coefficient) and also SPSS.
RESULTS: The conditions of emotional intelligence, interpersonal sensitivity, and work life quality
of nurses were, in turn, in average, severe, and weak levels. The correlation between emotional
intelligence and work life quality of nurses was significant (P ≤ 0.05) and they were positively correlated
with each other (r = 0.311). The relationship between interpersonal sensitivity and work life quality of
nurses was significant (P ≤ 0.05) and they were negatively correlated with each other (r = −0.43).
CONCLUSION: The development of emotional intelligence and sensitivity in reciprocally interpersonal
relations of nurses lead to fundamental changes in nurses’ attitude toward themselves, their
colleagues, patients and their profession and can promote their work life quality. Therefore, these
two skills are necessary for nurses and they should be taken into consideration by nursing schools,
faculty members, instructors, and nursing managers

Abstract BACKGROUND: Fire is one of the most important threatening factors for hospitals and needs special
attention. The present study was conducted to explain the factors affecting hospital emergency
evacuation following fire based on hospital administrators’ experiences.
MATERIALS AND METHODS: This was a qualitative study conducted employing the content analysis
approach. Participants included 22 hospital administrators in Tehran, Lorestan, Kurdistan, and Ilam
provinces. The participants were purposefully selected and included until reaching principle of data
saturation. Data were collected through in‑depth semi‑structured interviews from November 2019
to August 2020 and analyzed by the content analysis method.
RESULTS: Factors affecting hospital emergency evacuation during fire were categorized into five
main categories and 17 subcategories including response to incident (five subcategories of fire nature,
emergency evacuation, service provision, coordination and communication; and collaboration and
companionship), human factors (two subcategories of individual characteristics and competencies),
hospital preparedness (three subcategories of planning, safety and security; and information
management system), environmental factors (two subcategories of hospital design and infrastructure;
and weather condition), and finally ethical values (five subcategories of human dignity, trust, altruism,
responsibility and accountability; and empathy).
CONCLUSION: The results of this study indicated that during fire in Iranian hospitals, several factors
in addition to available standard guidelines affect the emergency evacuation process that need to
be considered. Hospital emergency evacuation during fire is a complex process and necessitates a
full and high‑level hospital preparedness, so using the results of this study can be used to develop
and practice evacuation plans and improve the hospital preparedness.

Abstract BACKGROUND: Today, hospitals need managers who, in addition to having the necessary skills for
management and leadership, are accountable to stakeholders, especially the community. Accordingly,
the purpose of this study was to evaluate the social accountability of managers of public and private
hospitals in Tehran.
MATERIALS AND METHODS: The present study is descriptive‑analytical and cross‑sectional and
was performed on 155 managers of selected public and private hospitals in Tehran. The research
tools included a demographic characteristic questionnaire and a researcher‑made social accountability
questionnaire for managers. Data analysis was performed using descriptive and inferential statistics
in SPSS 22 software.
RESULTS: The situation of social accountability in the managers of public hospitals was at a
weak level and in the managers of private hospitals in Tehran was at a good level. In comparing
the status of social accountability and its dimensions in the managers of public hospitals with the
managers of private hospitals, the status of social accountability in the dimensions of human resource
management, quality improvement, executive management, and overall social accountability were
significantly different from each other (P ≤ 0.05). However, in terms of governance, the status
of social accountability of public hospital managers was not significantly different from private
hospitals (P ≥ 0.05). Overall, the results of social accountability in private hospitals were better
than in public hospitals.
CONCLUSION: The social response status of managers in private hospitals was better than public
ones. Lack of attention of managers to social accountability affects the quality of other educational,
health, and medical services. This fact raises the need for managers to pay more attention to the
issue of social accountability.

Abstract BACKGROUND: The improvement of the knowledge, skill, and attitude of nurses working at the
intensive care unit (ICU) through implementing training need assessment and holding continuous
in‑service training courses are of main requisites for providing better health services to the community.
Based on this, in the present work, we are looking for the identification and prioritization of the training
need of intensive care nurses in the Zabol University of Medical Sciences’ hospitals.
MATERIALS AND METHODS: As a cross‑sectional, descriptive study, including two phases of
identification and prioritization of training needs of ICU nurses, it was conducted by a close‑ended
researcher‑made questionnaire for collecting the data on training needs from the viewpoint nursing
officials, supervisors, and head nurses of the ICU wards in the first phase and a multiple‑choice
scientific test plus a checklist for measuring the knowledge and skill of the nurses in the ICU in the
second phase. In both phases, census method was used for collecting the data. The validity and
reliability of data‑gathering tools, mentioned above, were tested and verified before gathering data.
Data were analyzed with the descriptive statistics.
RESULTS: The results indicated that ventilator setting according to arterial blood gas sampling
and interpretation (77.81), cardiac monitoring, detecting dysrhythmia and taking immediate
intervention (73.04), ventilator setting according to patient’s respiratory status (68.61), airway
management, oxygenation and intubation (64.39), and adults cardiopulmonary resuscitation (61.77)
were the high‑priority training needs of the nurses successively.
CONCLUSION: To improve the quality of training programs and upgrading the knowledge, skill,
and attitude of nurses working at ICU, the significance and the weight of each training titles should
be determined according to the standards and the continuous in‑service training plan along with
nurses’ training needs and duties.

Abstract BACKGROUND: Induced demand is a major challenge for financing health promotion, whereby
providers exploit patients’ information gap to manipulate their demand for health care. The purpose
of this study was to identify the factors associated with induced demand for health‑care services in
hospitals affiliated with Iran University of Medical Sciences (IUMS) in 2018.
MATERIALS AND METHODS: In this qualitative study, semi‑structured interviews were conducted
with 20 participants from IUMS hospitals, including faculty members, physicians, public hospital
managers, patients, and researchers with academic and practical experience. Inductive content
analysis was used to analyze the data.
RESULTS: Overall, 24 subthemes or factors were identified and classified into the health system,
the insurer, health‑care provider, and health‑care recipient themes. Poor monitoring and control,
the fee‑for‑service payment system, limited role of insurance companies, insufficient monitoring of
insurance companies, the educational nature of our health centers, health‑care providers’ interests,
and patients’ information gap were some important factors in induced demand for health‑care services.
CONCLUSION: Our results showed that there are many factors that contribute to induced demand for
health care. Given the four levels of factors identified in this study, health policymakers and managers
must develop strategies at each level to reduce induced demand for health care.

Abstract BACKGROUND: There is a growing global movement toward quality and safety in healthcare
and quality improvement (QI) in general surgery. The first step in any QI initiative is identifying the
challenges and barriers to achieve such goals and then to define appropriate actions. This study
aims to provide an overview of the QI challenges in Iranian hospitals’ surgery‑related processes and
suggest applied solutions accordingly.
METHODS: This is a sequential (qual‑quant) mixed‑method study from November 2019 to January
2020, involving 21 face‑to‑face interviews with hospital managers, quality officers, and surgery‑related
clinicians and staff, followed by a Delphi consensus‑seeking stage to finalize solutions. MAXQDA
software was applied for organizing the concepts, and thematic content analysis was used for
analyzing the data as an inductive approach to extract the emerging themes and sub‑themes.
RESULTS: The managerial problems were classified into four groups of (I) defects and delays in
completing patient medical records, (II) irregularity and the lack of transparency in the direction of
processes in the hospital, (III) inappropriate and unrealistic operating scheduling, and (IV) poor
safety considerations. The proposed solutions included imposing stricter regulations for competing
for medical records, such as reduction of payments, development of guiding brochures or protocols
for patients on their arrival, assigning a certain number of experienced nurses and surgeons for
schedule management, rewarding the report of medical and surgical error cases, and developing a
regular monitoring program for the proper implementation of surgical safety guidelines.
CONCLUSION: There are various managerial barriers that hamper QI in hospitals’ surgery‑related
processes. Implementing simple but agreed solutions can lead to saving patients’ lives, reduction of
the unnecessary use of resources, and enhance of patient and staff satisfaction.

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: The performance of the emergency department (ED) as one of the main parts of
hospitals, have a great impact on the performance of the whole‑hospital. In Iran, the official education
program of this discipline was started in 2001 and has expanded in most medical universities. Given
the unprecedentedness of emergency medicine (EM), there are limited studies about this specialty.
Thus, this study aims to explore the status, role, and performance of Iranian EM specialists.
MATERIALS AND METHODS: This qualitative study was conducted using content analysis of 19
semi‑structured interviews with EM specialists and key informant. Purposive sampling was conducted,
and some teaching and nonstate hospitals in different geographic regions of Tehran city were selected.
Conducting interviews continued until reaching the data saturation. Thematic analysis was employed.
Extracted themes were reviewed and confirmed by some of the participants.
RESULTS: The study results were categorized within five main themes; included the role of ED
from EM specialists’ viewpoint, EM specialists’ viewpoint on their discipline, performance of EM
specialists (including medical, managerial, and economic performance), and role of EM specialists
in patient satisfaction; and opportunities and challenges of EM specialists.
CONCLUSION: Overall, the study findings highlighted the effectiveness and positive medical,
managerial and economic impacts of EM in Iran, inside and beyond hospitals. However, the
study addressed significant opportunities some solvable challenges in educational, professional
and economic domains, and interdisciplinary relationships. Further studies are recommended for
comprehensive exploring viewpoint of other disciplines and stakeholders.

Abstract INTRODUCTION: Emotional intelligence (EI) and self‑efficacy are important factors that lead to
success in work, life, and education. Various studies assessed the relationship between EI and
well‑being, performance, and self‑efficacy in educational levels, but this topic has been rarely
assessed in the occupational and administrative environments. The present study aimed to examine
the relationship between EI and self‑efficacy among administrative staffs of Kerman University of
Medical Sciences.
METHODS: The study employed a descriptive‑correlational design and was conducted in six deputies
supervised by the Kerman University of Medical Sciences in 2019, and 275 participants were selected
using a census method. The research data were collected using the Goleman’s EI framework with a
reliability coefficient of α = 0.87 and Sherer General Self‑Efficacy Scale with a reliability coefficient of
α = 0.78. Data analysis was performed through Kolmogorov–Smirnov, analysis of variance, Tukey,
and Pearson’s correlation coefficient techniques at P < 0.05 significance level.
RESULTS: The mean score of EI was 98.8 ± 11.1 and the mean score of self‑efficacy was 60 ± 7.17.
There was a significant positive relationship between the scores of EI and self‑efficacy. In addition,
the findings indicated a positive significant correlation between self‑efficacy with self‑awareness,
self‑regulation, and social skills.
CONCLUSION: The findings of the current study confirm that EI has positive relationships with
administrative personnel’s self‑efficacy. Therefore, implications of the findings can help in the selection,
training, counseling, and retention of administrative personnel to the improvement of medical sciences
universities’ occupational performance.

Abstract BACKGROUND: Hospitals in developed countries allocate itself about 40% of health‑care costs
and in developing countries up to 80%. In this study, researchers reviewed the related article in the
field of the hospitals’ performance evaluation due to the identification of common indicators used
in different models with the aim of providing simple list for evaluating hospitals’ performance to the
researchers who are interested to these issues.
METHODS: The databases for the search included Medline, Google Scholar, and Scopus. A search
strategy leads to the extraction of 403 related articles that after the removal of inappropriate and
duplicate articles, 42 studies were selected for the scoping review.
RESULTS: This scoping review showed that 9 of 42 selected articles use data envelopment analysis
model, 6 of them Pabon Lasso model, 3 of them balanced scorecard, 3 of them organizational
excellence model, and the remaining articles used key performance indicators to evaluate hospital
performance. A process approach was used to categorize the common indicators  because the
literature review indicated that common indicators mainly evaluate data, process, output, or impact of
performance. The findings included 36 input, 39 process, 27 output, and 8 impact common indicators
for evaluating performance.
DISCUSSION: This scoping review of related literature indicated that despite differentiation in the time
and place of past studies in the field of performance evaluation models, there are some indicators
that are common in most popular performance evaluation models. These simple lists can apply for
evaluation of hospitals’ performance instead of complicated models.

Abstract INTRODUCTION: Protection against financial risks is one of the important goals of the health
system. The present study aims to determine the rate of exposure to catastrophic expenditures in
the insured inpatients.
METHODS: The present study was cross‑sectional one which is conducted in 2016. The statistical
population comprised all the insured patients presenting to a private hospital in Qom who presented
to the hospital within 4 months from December 2015 to March 2016. Random convenience sampling
method was used, and the sample size was estimated at 267 people using Cochran formula.
A questionnaire was employed for data gathering. Data were analyzed using Chi‑square test and
logistic regression using SPSS software version 20.
RESULS: Patients exposed to catastrophic expenditures of treatment accounted for the 54.8% of
the cases. The highest rate of being exposed to the catastrophic expenditures was related to the
insured patients of the Universal Health Insurance Fund (UHIF). People with rural insurance, on
average, paid the highest cost of treatment in the hospital. The surgical ward and critical care unit
accounted for the biggest percentage of the patients who incurred catastrophic expenditures. Being
rural, longer length of stay, lower education of the head of the household, lack of supplementary
insurance coverage, and being in UHIF coverage have a substantial relationship with being exposed
to catastrophic expenditures.
DISCUSSION: The socioeconomic status of the insured people in the UHIF and the Rural Insurance
Fund was worse than other funds in terms of less utilization and higher rate of exposure to catastrophic
expenditures, and this issue requires the adoption of specific targeted policies for these groups in
respect with reducing out‑of‑pocket payments through mechanism such as stepwise copayments,
maximum out‑of‑pocket limit, fee exemptions or waiver and providing supplementary insurance to
reduce the exposure to catastrophic expenditures.

Abstract INTRODUCTION: Hospitals as the first place for injuries have to keep up and increase activities in
emergency and disasters. Therefore, any hospital necessarily requires disasters plan to improve its
preparedness. The aim of this study is to investigate the effect of education and implementation of
“National Hospital Disaster Preparedness Plan (NHDPP)” on  Vali Asr Hospital preparedness in Iran.
METHODOLOGY: In a pre‑ and post‑intervention study, NHDPP educated in five sessions, and it
was used as a guide in the promotion of Vali Asr Hospital preparedness in Iran. The Iranian version
of “Hospital Disaster Preparedness (HDP) assessment tool” was used to measure the hospital
preparedness score. Finally, the quantitative data analyzed by using IBM SPSS Statistics for Windows,
Version 22.0. Armonk, NY: IBM Corp.
RESULTS: Before intervention, the HDP score was measured in total and in the nine dimensions
of preparedness. But after the intervention, it increased, 33% in command and control dimension,
33% in communication, 21% in safety and security, 26% in triage, 36% in surge capacity, 24% in the
continuity of vital services, 27% in human resources, 13% in support and supplies management, and
7% in post disaster recovery dimension. Furthermore, the total HDP score increased about 24.5%
after the intervention.
CONCLUSION: This study demonstrates that the “Iranian HDP plan” leads to improve the Vali
Asr HDP score. Therefore, by planning and implementation of effective educational programs, it is
possible to improve the hospitals’ preparedness in Iran.

Abstract INTRODUCTION: Hospitals are the main axis of health‑care reforms or national health plans;
therefore, accurate recognition of hospital costs based on operational indexes to these plans is
necessary. The impact of implementing national health plans on the performance of health systems
is ambiguous and misleading; therefore, the aim of this study was to assess the impact of Healthcare
Reform Plan (HRP) on the micro level (e.g., educational or university hospitals).
METHODS: This study was a descriptive retrospective study that research variables are checked
in 1 year before and mean of 3 years after implementation of HRP by self‑administrated checklist in
selected public‑educational hospitals covered by the medical universities in Tehran. The final analysis
of the data was performed using cost–performance ratio and independent t‑test for comparing the
variables’ changes before and after HRP.
RESULTS: Unlike adjusted hospitalization costs, most operational indexes were not significant.
The per capita cost adjusted of hospitalization in first and mean of 3 years after HRP increased
49.49% and 16.31%, respectively (P < 0.001), the adjusted cost per day was increased by 24.48%
and 21.46% (P < 0.001), and adjusted cost per bed was increased 47.06% and 20.07% compared
to before HRP (P < 0.001).
CONCLUSION: Given the lack of alignment in adjusted cost changes in exchange for functional
indicators, certainly, it cannot be argued that HRP had a favorable or undesirable effect on the
hospitals.

Abstract BACKGROUND: Providing the high‑quality services in hospitals depends on to minimize conflict
between all members within a health team. This study aimed to identify the causes of conflicts
experienced by clinical and administrative staff in hospitals.
METHODS: A cross‑sectional study was carried out in 2018. The sample included 320 clinical
and administrative staff from six hospitals affiliated to Ardabil University of Medical Sciences that
were selected using two‑step clustering sampling method. Data collection was accomplished by
self‑administered questionnaires. Descriptive statistics, t‑test, and ANOVA were used for data
analysis.
RESULTS: Total conflict score revealed that clinical staff had higher levels of perceived conflict than
administrative staff. In terms of organizational position, the study results showed a significant difference
in the reported conflict between nurse groups and other groups (physicians and paramedical,
administrative, financial, and logistic staff). The most important causes of conflict in the viewpoint of
clinical staff were organizational and job characteristics (3.54 ± 1.28), poor management (3.51 ± 1.12),
and inefficient communication system (3.42 ± 1.33). For administrative staff, on the other hand,
poor management (3.18 ± 1.33), inefficient communication system (3.17 ± 1.36), and attitudes and
perceptions (3.06 ± 1.41) were shown to be paramount factors.
CONCLUSION: Clinical and administrative staff of hospitals are like parts of a train track. The
irrational relationship between them will result in distortion and lower quality of services. Therefore,
effective strategies to decrease staffs’ experience of conflict need to be developed. This might create
a healthier and more productive work environment which positively affects the care quality.

Abstract BACKGROUND: Although the World Health Organization has emphasized the need for reorientation
of hospitals toward health promotion (HP), HP in hospitals of Iran is a new concept. This study
investigated the concept of HP among health‑care professionals working in educational hospitals
of Isfahan, Iran, 2015.
METHODS: A descriptive exploratory qualitative approach was employed in this study, with
semi‑structured interviews to investigate HP concept. The study settings included four selected
educational hospitals affiliated to the Isfahan University of Medical Sciences. A purposive sample
consisted of 15 health‑care professionals who were participated in the study.
RESULTS: Most of the participants perceived HP as a concept synonymous to health education and
disease prevention. Other meaning attributes to HP were improved quality of life and well‑being,
clinical practice, individual and group approach to increase health, and holistic view to health. Some
empowerment strategies were described by participants, but most of the participants rarely went
beyond traditional health education strategy aimed at an individual target. A sizeable number of
participants used interchangeably the terms “health promotion” with “prevention,” “health education,”
and “hygiene”.
CONCLUSIONS: It seems that participants of this study had limited knowledge about HP. Health‑care
staff have a decisive role for reorienting hospitals toward HP; thus, there is a need for ongoing
in‑service training for health‑care professionals of hospitals to focus on HP.