Journal of Education and Health Promotion

Abstract BACKGROUND: Because of the spread of coronavirus disease 2019 (COVID‑19), the preventive
measures have increased, such as focusing on the use of medicinal plants in most communities,
including Iran. The purpose of this study was to identify the knowledge, attitude, and performance of
individuals toward the use of medicinal plants and to identify the predictors of the use of medicinal
plants in the prevention of COVID‑19.
MATERIALS AND METHODS: This descriptive‑analytical study (February–April 2021) was performed
on 3840 Iranian men and women aged 20–70 years selected as a multi‑stage cluster study. At the
first stage, all provinces were divided into five regions: North, South, East, West, and Center. In the
second stage, a provincial center and a city were randomly selected from each region (North: Sari,
Babol; South: Bushehr, Bandar Genaveh; East: Mashhad, Sabzevar; West: Hamedan, Toisarkan;
Center: Yazd, Ardakan). Data were collected by a researcher‑made scale based on the Health
Belief Model (HBM). Data analysis was performed applying Pearson correlation coefficient, logistic
regression, and linear regression.
RESULTS: The results showed that people have relatively high knowledge and positive attitude toward
the use of medicinal plants in prevention of COVID‑19. The most important reason for positive attitude
was the perceived benefits with the mean of 75.06%. Also, half of the people had poor performance.
Correlation coefficient showed that the use of medicinal plants with perceived sensitivity (p = 0.000,
r = 0.3), perceived benefits (p = 0.012, r = 0.126), perceived barriers (p = 0.000, r = 0.179), and
perceived self‑efficacy (p = 0.000, r = 0.305) had a significant correlation. The strongest correlation
between perceived self‑efficacy was observed with the use of herbs in prevention of COVID‑19. The
HBM constructs can predict 26% of the variance for the use of medicinal plants in the prevention
of COVID‑19, among which perceived self‑efficacy (β = 0.230) was the most powerful predictor.
CONCLUSION: Based on the results, the predictive role of self‑efficacy constructs for the use of
medicinal plants in prevention of COVID‑19 has been confirmed according to the HBM. Therefore,
methods of increasing self‑efficacy such as training programs and providing appropriate intervention
models can be used not only as promoters of using medicinal plants in prevention of COVID‑19 but
also for improving people’s performance in the proper use of medicinal plants.

Abstract BACKGROUND: Sexually transmitted infections (STIs) have always been considered as a health
problem in the world. Also, vulnerable women (addicts, jail breakers, and prostitutes) are at the highest
risk. According to the World Health Organization’s (WHO) approach, the only effective way to prevent
and control this disease is public health education, and high‑risk and vulnerable groups should be
prioritized in educational programs. The aim of the study was to investigate the effect of health belief
model (HBM)‑based education on changing the behaviors related to STIs in vulnerable women.
MATERIALS AND METHODS: The present study is an intervention (field trial) study in vulnerable
women. Convenience sampling method was used in this study and the sample size was determined
to be 84 subjects. Through tossing a coin, the social support center was selected as the intervention
group and the drop‑in center as the control group. Quantitative data analysis was performed, and
descriptive and inferential statistical methods were used.
RESULTS: The mean scores of perceived threat, perceived benefits, perceived barriers, and
perceived self‑efficacy and changes in performance between the three measurement stages, as
well as changes in the scores of perceived threat, perceived benefits, perceived barriers, and
perceived self‑efficacy over three measurement times were significantly different between the two
groups (interaction) (P < 0.001). The mean score of performance 3 months after the intervention
was significantly higher than before the intervention (P = 0.001).
CONCLUSIONS: The present study confirmed the effectiveness of the HBM in promoting behavioral
modifiers that lead to STIs. Therefore, educational interventions with emphasis on understanding
the threats, benefits, barriers, and self‑efficacy and, ultimately, performance improvement in relation
to STIs are recommended.

Abstract BACKGROUND: Breast cancer (BC) is the most common cause of cancer‑related deaths in women
globally. Currently, many machine learning (ML)‑based predictive models have been established to
assist clinicians in decision making for the prediction of BC. However, preventing risk factor formation
even with having healthy lifestyle behaviors or preventing disease at early stages can significantly
lead to optimal population‑wide BC health. Thus, we aimed to develop a prediction model by using a
genetic algorithm (GA) incorporating several ML algorithms for the prediction and early warning of BC.
MATERIAL AND METHODS: The data of 3168 healthy individuals and 1742 patient case records
in the BC Registry Database in Ayatollah Taleghani hospital, Abadan, Iran were analyzed. First, a
modified hybrid GA was used to perform feature selection and optimization of selected features.
Then, with the use of selected features, several ML algorithms were trained to predict BC. Afterward,
the performance of each model was measured in terms of accuracy, precision, sensitivity, specificity,
and receiver operating characteristic (ROC) curve metrics. Finally, a clinical decision support system
based on the best model was developed.
RESULTS: After performing feature selection, age, consumption of dairy products, BC family history,
breast biopsy, chest X‑ray, hormone therapy, alcohol consumption, being overweight, having children,
and education statuses were selected as the most important features for prediction of BC. The
experimental results showed that the decision tree yielded a superior performance than other ML
models, with values of 99.3%, 99.5%, 98.26% for accuracy, specificity, and sensitivity, respectively.
CONCLUSION: The developed predictive system can accurately identify persons who are at elevated
risk for BC and can be used as an essential clinical screening tool for the early prevention of BC and
serve as an important tool for developing preventive health strategies.

Abstract BACKGROUND: The coronavirus disease (COVID) is predicted to cause serious mental health 
problems among healthcare providers (HCPs) especially dentists. Also understanding the influencing 
factors of the acceptance of COVID‑19 vaccination among HCPs are important aspects in the design 
of effective strategies to improve the vaccine coverage rate. Therefore, this study aimed to assess 
the knowledge, vaccination acceptance, fear, and obsession, as well as the preventive practice 
behaviors of Iranian dentists and dental students in late 2020 toward COVID‑19.
MATERIALS AND METHODS: A descriptive, web‑based cross‑sectional survey was conducted 
among Iranian dental students and dentists (general practitioners and specialists). All Iranian dentists 
and dental students living in the Islamic Republic of Iran regardless of their city and workplace were 
invited to participate in the study. The total number of dentists in Iran was estimated to be 54,927. The 
sample size was calculated 380. The questionnaires used in this study were adapted from previously 
published studies based on the authors’ permission. The questionnaire consisted of four sections 
that sought to collect information on the respondents’ vaccination acceptance, knowledge, preventive 
practice, fear, and obsession toward COVID‑19. The relationship between the study variables was 
assessed using Pearson’s correlation coefficient and also multiple linear regression tests.
RESULTS: Overall, 394 dentists were filled the questionnaire (65 dental students, 151 general 
dentists and 178 specialists). There were no differences in terms of vaccination acceptance, 
knowledge and also fear score in different designation groups. Dentists had significantly higher 
obsession and also preventive practice scores than other designation groups (P < 0.05). The majority 
of respondents had good knowledge (more than 9), acceptable preventive practice (more than 19), 
low fear‑obsession (<2.7), and high acceptance of COVID‑19 vaccination (more than 8.8).
CONCLUSIONS: Although obsession and fear scores were low in all designation groups, dentists 
had higher obsession and also preventive practice scores than other designation groups. More than 
half of respondents preferred imported COVID‑19 vaccines. Finally, organizations such as the World 
Health Organization and the Ministry of Public Health in Iran should increase vaccine convenience 
and accessibility in terms of vaccine importing, distribution, supply, and immunization service.

Abstract BACKGROUND: Osteoporosis is mainly characterized by a low bone mineral density and a sharp
architectural and biomechanical deterioration in bone tissue required to maintain bone homeostasis.
The theory of planned behavior (TPB) can be considered as one of the leading theories when designing
an evidence‑based intervention. This study was carried out based on the TPB to determine the effect
of an educational intervention aimed at mothers on the prevention of osteoporosis in female students.
MATERIALS AND METHODS: A total of seventy mothers of lower secondary school students
in Tehran, Iran, participated in this experimental study which was conducted in 2019–2020. The
participants were randomly assigned to two groups, namely experimental and control groups. Based
on the TPB, a demographic and a researcher‑made questionnaire consisting of five sections were
used in order to collect data. The validity and reliability of the questionnaires were confirmed before
data collection. Four 45–60 min training programs were delivered to the subjects using the TPB.
Data were collected before, immediately after, and 1 month following the training program. Finally,
IBM SPSS Statistics 21 was used for statistical analysis.
RESULTS: No significant difference was observed in terms of attitude, subjective norms, perceived
behavioral control, behavioral intention, and osteoporosis prevention‑related behavior between the
experimental and control groups before proceeding with the intervention (P > 0.05). However, the
mean scores of attitude, subjective norms, perceived behavioral control, behavioral intention, and
behavior were significantly higher in the experimental group compared to those of the control group
following the educational intervention (P < 0.05).
CONCLUSION: It can be concluded that such interventions based on the TPB can, in fact, produce a
significant effect on osteoporosis prevention‑related behaviors. Thus, it can serve as a useful model
for planning educational interventions.

Abstract BACKGROUND: COVID‑19 is a contagious disease without any treatment, vaccine, or immunity,
which the only way out is the practice of preventive measures. This article assessed the perception
and factors influencing the practice of preventive measures to COVID‑19 among nurses in Anambra
State, Nigeria. The study objectives include to determine the perception of nurses toward COVID‑19
and to determine factors that influence the practice of preventive measures to COVID‑19 among
nurses in tertiary hospitals in Anambra State.
MATERIALS AND METHODS: The design for the study was descriptive cross‑sectional survey
conducted among 344 nurses in the two tertiary institutions.
RESULTS: Three hundred and three (88.1%) nurses had no formal training on COVID‑19 protocol.
They have a good perception of the disease as, among others, they (165 [48.0%]) see it to be highly
contagious, 207 (60.2%) can recognize symptoms easily, 168 (48.8%) believed that COVID‑19 could
be handled professionally based on their experience, 155 (45.1%) responded that there is no vaccine
yet for the disease, and 200 (58.1%) responded that patients should not hide their symptoms and travel
history to avoid infecting other people. The result on the false benefits has 323 (93.9%) who responded
that COVID‑19 preventive measures will predispose one to the disease, 319 (92.7%) who responded
that the preventive measures will not slow the spread of the disease, 288 (83.7) who responded
that it is independent of normalcy returning to areas affected, and 327 (95.1%) who responded that
COVID‑19 preventive measures are among the effective ways to mitigate the disease and enhance
life sustainability. Some work‑related/institutional and disease‑specific factors influence their practice
of preventive measures to COVID‑19. Such factors include the time to use personal protective
equipment (PPE) in an emergency (170 [49.4%]), remembering to use PPE (158 [45.9%]), insufficient
nursing staff during a shift (158 [43.0%]), and too many responsibilities during a shift (178 [51.7%]).
CONCLUSION: With the increasing death as a result of COVID‑19, of which health workers are not
immune to, it is essential to annihilate all negative factors that may impede the accurate practices
of the preventive measures and also support the nurses with the necessary tools and knowledge to
mitigate their exposure to the disease.

Abstract BACKGROUND: nongovernmental organizations (NGOs( are the hidden system of promoting public
health and the symbol and mediator of people’s participation. The aim of the present research was
to assess the status and recognize the performance of various NGOs in providing health‑oriented
services as opportunities in promoting community health.
MATERIALS AND METHODS: The present study was a descriptive–analytical (cross‑sectional)
study, which was conducted on the position and function of all NGOs in Kerman from February 2014
to the end of January 2015. A researcher‑made checklist was used to collect the data, which was
designed based on the statutes of NGOs. The information was collected from a total of 150 NGOs.
To analyze the data, in addition to descriptive statistical tests (frequency, percentage, mean, and
standard deviation), other tests were also used (Chi‑square test and Fisher’s exact test). Moreover,
all data analysis was done using SPSS (ver. 16).
RESULTS: There was a significant relationship between the levels of prevention and field of activity
and the objectives and methods of implementation of these objectives (P < 0.001). There was a
significant relationship between health prevention levels in the target community of the NGO and
initial assets (P = 0.02), licensing organization (P < 0.001), management type in terms of the board
of trustees or membership availability (P < 0.001), relevance of members’ major with organizational
goals (P = 0.02), and activeness or inactiveness of the organization (P = 0.007).
CONCLUSION: The results showed that there was a relationship between NGO’s target population
in terms of levels of prevention and the studied factors. The relationship between the services of
these organizations and the levels of prevention is a very important and effective role in community
health promotion.

Abstract BACKGROUND: The novel coronavirus (COVID‑19) has infected nearly 9.5 million people in 216
countries, areas, or territories in the world. The fight against the COVID‑19 has become a very serious
international challenge. The aim of this study was to determine the predictors of COVID‑19‑preventive
behaviors using the health belief model (HBM).
MATERIALS AND METHODS: This cross‑sectional study was conducted with the participation of
558 samples from the adult population of Iran. The online convenience sampling was conducted
in this research. The online 68‑item questionnaire link was published all over Iran through social
networks including Telegram and WhatsApp, which are common in Iran. The data were analyzed
using SPSS software version 19. Descriptive statistics, bivariate Pearson’s correlation test, and
multiple linear regression were used to analyze the data.
RESULTS: The mean age of the subjects was 33.3 ± 10.01 years. The participants were often
female (61.3%), married (57.9%), and resident of the city (81.0%) with university educational
level (78.8%). The results showed that the HBM structures predicted 29.3% of the preventive
behaviors of COVID‑19 in the subjects. The perceived benefits, perceived barriers, and self‑efficacy
significantly predicted the preventive behaviors, but the perceived susceptibility and perceived
severity were not significant in the regression model. The internet and virtual social networks (49.8%),
broadcast (33.5%), and healthcare providers (15.8%) were the most important sources of information
related with COVID‑19. In response to COVID‑19‑related internal cues to action, 36.6% did not
pay attention and 34.7% tried to self‑medicate. Only 28.5% of the subjects referred to the hospital,
healthcare center, or physician.
CONCLUSION: Self‑efficacy, perceived barriers, and perceived benefits were the key determinants
of COVID‑19‑preventive behaviors in the subjects. It can be concluded that the HBM is a good tool
to predict COVID‑19‑preventive behaviors in Iranian population.

Abstract BACKGROUND: Health communication is a field that uses social and behavioral models to improve
health outcomes and raise awareness on major health risks that threaten human well‑being.
Low‑income countries (LICs) suffer from the effects of communicable and noncommunicable diseases
that are exacerbated by weak health‑care systems, lack of awareness campaigns, and ineffective
communication tactics. This work aims to explore health communication research in LICs to find
strategies that help improve health outcomes in the future.
MATERIALS AND METHODS: The PubMed database was explored systematically for publications
related to health communication from LICs between January 1, 1960, and January 1, 2020.
Publications were categorized according to country of origin and were analyzed with respect to
population size, gross domestic product (GDP), and primary school enrollment of each state as
obtained from the World Bank Open Data.
RESULTS: Collectively, LICs published 796 contributions, comprising 1.08% of the total biomedical
research published by LICs and 0.27% of the world’s health communication research. Malawi had
the highest number of publications per GDP, with 32.811 publications per billion US$. Uganda had
the most contributions per population, with 9.579 publications per million persons. Ethiopia had the
highest amount of contributions per primary school enrollment with a ratio of 2.461 publications per
%gross. The role of health communication in promoting HIV awareness and prevention was the most
common theme explored. Other infectious diseases, such as malaria, tuberculosis, and Ebola, were
also highlighted. Improving communication in health education was also explored.
CONCLUSION: Health communication is a rising field in LICs, with research focusing on disease
prevention. Efforts to amplify research are key to effectively utilize the health communication models
and improve health outcomes in LICs.

Abstract OBJECTIVE: There is increasing evidence for declining the onset age of drug abuse worldwide. This
study was conducted to investigate the effectiveness of four educational methods including lecture,
presentation of poster and leaflet, presentation of video clip, and group/class discussion for life skills
training and changing in knowledge and attitude of adolescents toward drug abuse.
MATERIALS AND METHODS: In a pretest–posttest design, a sample of 897 girl and boy high
school students from the first grade (14–15 years old) were involved in this cross‑sectional study
conducted in Isfahan, Iran. After collection of pretest questionnaires, each educational method was
implemented separately for one class in one session (3 h) in each high school, and evaluation was
carried out immediately after intervention through posttest questionnaires by the same students.
RESULTS: According to paired t‑test, the video clip‑ and lecture‑based methods were significantly
efficient in changing the attitudes toward drug abuse in boy and girl students, respectively. Analysis
of covariance showed significant differences between girls and boys in pretest–posttest attitude
scores using group discussion‑based and video clip‑based methods.
CONCLUSION: Life skills training program through lecture‑based and video clip‑based educational
methods was considerably effective in changing the high school students’ attitude toward drug abuse
and addiction.

Abstract INTRODUCTION: White spot lesions (WSLs) are common adverse effect of orthodontic treatment,
which can be prevented and treated by orthodontists. This study was conducted to assess Iranian
orthodontists’ practice regarding the prevention and treatment of WSLs in their patients.
METHODS: In this cross‑sectional study, 109 Iranian orthodontists were selected from the Iranian
Association of Orthodontists’ directory by cluster sampling. For data collection, a questionnaire was
designed and its validity and reliability was confirmed (Cronbach’s α =0.85). The questionnaire
included eight general questions and eight questions about practice with regard to the prevention
and treatment of WSL. Data were analyzed by descriptive tests, ANOVA test, and t‑test in SPSS 20
software. P < 0.05 was considered statistically significant.
RESULTS: The mean score of orthodontists’ practice was 7.62 (range: 0–8), and 94.4% of the
participants were rated as good, while 3.7% and 1.9% were rated as moderate and weak, respectively.
Women’s score was significantly higher than that of men (P = 0.001). With increasing participants’
age, their practice has been improved (P = 0.001), but there was no significant relation between years
of experience and their practice (P = 0.230). Nearly 94.4% of the orthodontists prescribed fluoride
products. Toothpastes and fluoride mouth rinses were the most common prescribed products (34%).
CONCLUSIONS: With regard to Iranian orthodontists’ practice, it was fortunate to note that majority
of the respondents were taking care of their patients with regarding to the prevention and treatment
of WSLs. For enhancing their competencies, it is recommended to plan educational courses which
are useful for promoting their knowledge and practice about new products and procedures used for
the prevention and treatment of WSLs.