Journal of Education and Health Promotion

Abstract BACKGROUND: The birth of a pre‑mature infant and subsequent hospitalization and separation
from the family can impair maternal and neonatal attachment and quality of maternal care. This
study aimed to assess the effect of instructing mothers in attachment behaviors on short‑term health
outcomes of pre‑mature infants admitted to neonatal intensive care units (NICUs).
MATERIAL AND METHODS: In this quasi experimental study, 80 mothers of pre‑mature infants who
were admitted to NICUs at two referral health centers in northern Iran were studied in two groups in
2018. Attachment behaviors were taught to mothers in the test group during four consecutive sessions.
Mother–infant attachment behaviors were evaluated at both the beginning and the end of this study
using a checklist derived from Avant’s Maternal Attachment Assessment Strategy. Moreover, infants’
short‑term health consequences were investigated in two groups. SPSS 18 statistical software was
used for data analysis.
RESULTS: On average, it took respectively 34.90 ± 12/65 and 31/15 ± 14/35 days for the infants in
the control and the intervention group to reach full oral feeding and 38/5 (38/4–42/11) and 37 (31/85–
42/14) days to gain the minimum weight required for discharge. Moreover, the mean length of stay
for the infants in the control and the intervention group was 41/80 ± 13/86 and 39/02 ± 16/01 days,
respectively (P > 0/05).
CONCLUSION: Instructing mothers in attachment behaviors clinically improved short‑term
health‑related outcomes. Hence, this intervention is recommended to be incorporated in the care
program for mothers with pre‑mature infants.

Abstract BACKGROUND: Organizational health (OH) is an organizational aspect in which staff is encouraged
to be clearly involved and participate in decision‑making, problem solving, and collaborating to improve
organizational climate and culture. Multilevel staff involvement facilitates strengthened relationships,
open communication, trust, and organizational commitment. The purpose of this study was to find
components of OH for small‑sized health‑care organizations.
METHODS: A systematic review across three key databases by using an extensive list of keywords
components and interventions was conducted. This survey included studies that explored various
OH elements, components and interventions.
RESULTS: It comprises 34 full‑text studies from 221 received studies. Afterward, the OH elements
were classified into three main categories (OH elements, organizational health literacy, and
organizational health interventions). Then, according to the reviewed data, 23 dimensions were
defined similarly for all groups of studies and relevant explanations related to them were reported.
CONCLUSION: The OH encompasses multiple dimensions. Empirical research is required for
designing a questionnaire according to the final extracted components and measuring its validation
in small‑sized health organizations.

Abstract BACKGROUND: This exploratory study was done to assess the multidimensional perfectionism
trends among various core and allied health care professionals in a major Indian metropolitan city of
western India. Unlike other scales, here we considered both individual and intersubjective components
of perfectionism by introducing three trait dimensions – self‑oriented perfectionism, other‑oriented
perfectionism, and socially prescribed perfectionism.
MATERIALS AND METHODS: A cross‑sectional descriptive type of study was conducted with total
sample consisting of 500 participants with the main motive of evaluation and comparison of the
multidimensional perfectionism among interns of the core and allied health care professionals from
fields of medicine, dentistry, ayurveda, and homeopathy residing in the major Indian metropolitan
cities of western India.
RESULTS: This study showed that under the self‑oriented domain, highest mean score is of medical
faculty (73.97). In other‑oriented domain, dental (62.62) and homeopathy (62.38) professionals have
almost similar mean. Lowest being of ayurveda (61.65) compared to the highest score of the medical
fraternity (67.62). In the socially prescribed domain, medical professionals (65.53) have the highest
mean though it is the lowest mean value of the medical faculty compared to other two domains.
Chi‑square test is applied to the data for the questions among all the three domains. Correlation has
been deduced by applying Pearson’s correlation to the collected data from the study. The degree of
correlation between self‑oriented with self‑oriented is 1, self‑oriented with other‑oriented is 0.763,
and that of self‑oriented with socially oriented is 0.678.
CONCLUSION: Medical professionals scoring maximum in self‑oriented perfectionism compared to
other two domains reflect their extreme personal standards. Medical professionals are followed by
dental professionals in self oriented perfectionism who are demanded of perfection in their routine
practice. Ayurveda and homeopathy professionals scored better in other‑oriented and socially
prescribed perfectionism attributing to their sentiments of fulfilling the expectations and demands
of others.

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: Natural disasters always have significant effects on social infrastructures, living
conditions, and health care systems. This study aims to explain the needs of victims in the west of
Iran for primary health care services.
MATERIALS AND METHODS: This thematic content analysis and qualitative study was done
from September 2020 to June 2021 in the west of Iran. Participants were selected using purposive
sampling method. The data were extracted through semi‑structured interviews with 17 earthquake
victims and then examined through thematic content analysis.
RESULTS: By analyzing and coding the data, the primary needs of victims post an earthquake in the
west of Iran were classified into four main categories) health services, mental health, social health,
and health management (and 14 subcategories.
CONCLUSION: Regarding the primary needs (health services, mental health, social health, and
health management), establishing a headquarters to meet the immediate and special health care
needs seems to be required. It was recommended to create institutions for monitoring and supporting
the health care needs at the level of the community and even policymaking, as well as guiding
earthquake‑stricken areas such as the eco‑village.

Abstract BACKGROUND: In the recent years, the wealth creation of educational institutions has attracted an 
enormous attention in different countries. Exploring experiences of these institutes help to improve the 
wealth creation of universities. In this regard, this study was an attempt to explain the viewpoints of 
the wealth creators of medical sciences regarding wealth creation strategies and define the general 
path of wealth creation in medical sciences universities.
MATERIALS AND METHODS: This qualitative study was conducted at Iran University of Medical 
Sciences, Tehran, Iran, in 2021. Participants were the experienced knowledgeable wealth creation 
experts. Fourteen semi‑structured interviews were conducted to reach data saturation. Interview 
guided questions were about strategies and paths of wealth creation followed by probing questions. 
Data were analyzed using conventional qualitative content analysis.
RESULTS: Data analysis showed that the most important strategies were related to nine extracted 
categories of “the productions”, “contracts and relations”, revising, predicting and foresight” ‑, 
“education”, “research”, “healthcare services”, “ interdisciplinary fields between Information 
Technology (IT) and health‑care”, “ saving and maintenance”, and “altering the procedure of the 
wealth accelerator centers.” In general, wealth creation path in medical sciences includes six main 
categories.
CONCLUSIONS: The result of this study provide an opportunity for educational policy‑makers 
and authorities to improve wealth creation in medical universities. Especially, accentuated by the 
COVID‑19 pandemic, to consider the interdisciplinary fields between IT and health‑care and integrating 
technology to the various categories of medical sciences are absolute needs.

Abstract BACKGROUND: Vaccine hesitancy presents a major challenge during the COVID‑19 pandemic. It 
is crucial to address the factors contributing to vaccine hesitancy necessary to control the associated 
morbidity and mortality. This study aimed to investigate the impact of professional medical guidance 
on the likelihood of receiving the COVID‑19 vaccine in immigrants of USA and Canada.
MATERIALS AND METHODS: A total of 92 immigrants in the USA and Canada who predominantly 
spoke Malayalam were recruited using social media platforms. An online survey was administered 
investigating participants’ confidence in receiving the COVID‑19 vaccine. Following, a short 
webinar was conducted by a medical professional explaining the efficacy and safety of the vaccine. 
A postwebinar survey was immediately given assessing the confidence and likelihood of receiving 
the vaccine. SPSS was used to generate descriptive statistics and Pearson Chi‑square analysis 
where appropriate.
RESULTS: Results revealed that participants who attended the webinar reported greater confidence 
in receiving the COVID‑19 vaccine. There was a statistically significant difference between pre‑ and 
postwebinar confidence scores for the COVID‑19 vaccine, 2 (12, n = 80) = 43.34, P < 0.01.
CONCLUSION: Results from the current study demonstrate the successful delivery of professional 
medical guidance to the general public through online small‑group sessions to help address the 
misconceptions surrounding the COVID‑19 vaccine and combat vaccine hesitancy among vulnerable 
populations. Future studies should focus on interventions addressing vaccine hesitancy in larger and 
diverse populations and analyze other barriers to vaccination.

Abstract BACKGROUND: The relationship between willingness to mobile learning (m‑learning) and educational
achievement was examined in health‑care professional students.
MATERIALS AND METHODS: This is a descriptive correlative study that was conducted from
January 2020 to February 2020. A total of 295 students in Saveh University of Medical Sciences in
Iran were selected through census method. The data were collected using the standard willingness to
m‑learning questionnaire. The data collected were analyzed statistically using Pearson’s correlation
coefficient and concurrent regression analysis.
RESULTS: The mean score of willingness to m‑learning was 165.55 ± 13.4, which is an indicative
of a higher willingness level in the health‑care professional students for m‑learning. There was a
positive and significant relationship between willingness for m‑learning and educational achievement
(r = 0.77, P < 0.01). The predictive variable, i.e., willingness to m‑learning, predicted 53.8% of the
variance of educational achievement (F = 58.801, P = 0.00). Among the variables of willingness to
m‑learning, the regression coefficients of perceived ease, attitude, self‑management in learning,
educational use, and efficiency of m‑learning were significant (P < 0.05). This means that these
variables are direct predictors of educational achievement.
CONCLUSIONS: Willingness to m‑learning had a positive and significant relationship with educational
achievement. Although this study was performed just before the corona outbreak, paying attention
to the results of this study can be helpful for students, faculty members, and policymakers in filling
the educational gap during the coronavirus disease 2019 outbreak.

Abstract BACKGROUND: The concept of reflective practice is at the center of professional practice, allowing
a bridge between theory and practice and learning from our own experiences in an ongoing process.
Understanding what learners need such as regular observation of work, more responsibility, and
technical and problem‑solving with answers allows the teacher to help learners to progress to
independence in pursing their own learning needs. Therefore, it is important that medical educators
continually reflect and evaluate teaching ability to meet learners’ needs and provide evidence to
support it.
MATERIALS AND METHODS: A prospective, qualitative study was carried out using a combination
of questionnaires and observed assessments. The study participants consisted of twenty final‑year
medical students from King’s College London and took place at a hospital education center in the
UK, April 2019. Two educational sessions were delivered by a doctor to the study group and a video
recording was conducted. The educator completed a reflective portfolio using feedback questionnaires,
peer observation forms, and observation of the video recording, and the results were analyzed using
a video critique tool.
RESULTS: Twenty learner feedback forms were completed, and a peer observation form was
completed. This allowed a critical analysis of educator performance, reflection, and improvement.
This was further solidified by in‑depth analysis and critique of teaching session playback video.
DISCUSSION: This study evaluates a medical student teaching program using a reflective portfolio.
This study confirms the effectiveness of using a reflective portfolio to enhance the teaching experience.
Video analysis can be self‑critical, however this study shows how it is useful to review human
experience first‑hand, and identifying any specific techniques that create a positive or negative
change can enable educators to improve as time progresses.

Abstract BACKGROUND: The psychological impact of anxiety, stress, and depression among health care
and nonhealth‑care professionals in India contribute significantly to the global burden of mental
illness in the world. Impaired mental health and stress influence the efficiency and productivity of
work. Long‑term professional stress among individuals can lead to chronic illness, increased blood
pressure, and many systemic disorders. The aim of this study was to assess the prevalence of
anxiety, stress, and depression among the health care and nonhealth‑care professionals in India.
MATERIALS AND METHODS: This prospective survey‑based study included 200 study
participants (80 nonhealth care and 120 health‑care workers) who were asked to submit their
feedback and opinion on a questionnaire survey. Depression, stress, and anxiety were scored as
per patient health questionnaire‑4 and UCLA scale. The reliability of questionnaires was assessed
using the Cronbach’s alpha (r = 0.90). The statistical analysis was done using the Chi‑square test.
RESULTS: Higher prevalence ratio of anxiety, depression, and stress was observed among nonhealth
care compared to health‑care professionals.
CONCLUSION: Psychological disturbances were found to be higher among nonmedical when
compared to health‑care workers or professionals. Thus, psychological counseling is required to
manage the stress levels in both health care and nonhealth‑care professionals.

Abstract BACKGROUND: Discrimination in health care is a common phenomenon whose complete
understanding has always been a major concern of health-care systems to control and reduce it.
This study aimed to explore the experiences of unintentional discrimination and related factors in
health-care providers.
MATERIALS AND METHODS: This qualitative study was conducted with a content analysis approach
in 2019. Data were collected through semi-structured interviews with 13 health-care providers including
two physicians, three nursing supervisors, two head nurses, four staff nurses, and two nurse aides
in two general hospitals in Tehran, Iran. Participants were selected through purposeful sampling.
The obtained data were analyzed by Graneheim and Lundman method.
RESULTS: Three main categories and eight subcategories were obtained from the data
analysis: (1) forced discrimination (superiors’ pressures and executive orders, occupational concerns,
and fear of the superiors); (2) guided discrimination (professional challenges, managers’ policymaking,
and lack of medical ethics knowledge); and (3) lack of resources (workforce shortage and lack of
medical equipment).
CONCLUSION: The results of this study suggest that health-care providers such as doctors and
nurses are unintentionally forced to provide discriminatory care on some occasions. Knowing and
managing these unwanted factors can partly counteract unintentional discrimination. Thus, preventing
the factors that lead to superiors’ pressures and occupational forces and improving the medical ethics
knowledge should be considered by health-care managers.

Abstract Although telemedicine has been used spottily in Indian health care so far, the 2020 Covid‑19 pandemic
provided the nation’s health systems an unprecedented opportunity to make a concerted effort to
increase access and coverage. Health‑care providers can incorporate telemedicine systems to reduce
doctor‑patient visits and help in breaking the chain of transmission of infections. Anticipating the
increased need of telemedicine by health‑care providers, the Medical Council of India released practice
guidelines in March 2020. In this article, the literature pertinent to telemedicine and its applications
with special reference to recently released practice guidelines were reviewed and summarized in a
historical and current context. Telemedicine is bound to grow and be adopted by more health‑care
practitioners and patients in a wide variety of forms due to ease and availability. At the same time,
it cannot replace in‑person consultation or emergency medicine.

Abstract INTRODUCTION: As a part of healthcare providers of the Health System Reform Program, midwives
are required to master the necessary knowledge and skills to meet the related demands of society.
This study was aimed to assess the knowledge and skills training needs of practicing midwives of
health and medical centers of Isfahan.
METHODS: This study is a descriptive cross-sectional study. The statistical target population was
midwifery experts working in Isfahan health centers and the samples were selected through simple
random sampling (sample size 250). Data were collected by two questionnaires to assess knowledge
and skill needs. The validity of the questionnaires was confirmed by experts of the province and
city health centers and medical education experts and its reliability was calculated by Cronbach’s
alpha (98%). Data were analyzed using SPSS 23 software and descriptive and analytical statistical
methods (frequency, mean, variance).
RESULTS: The first five knowledge training priorities of employed midwives in health and medical
centers, which comprise most of the means values, are pregnancy complications and abnormalities
(3.64 ± 1.21); mammography and its interpretation (64.3 ± 1.30); skills and principles of parenting
(3.59 ± 1.24); shortness of breath and palpitations during pregnancy (3.58 ± 1.16); and common
mental disorders (3.57 ± 1.16). The most important skills training needs were Excel (1.21 ± 3.59),
PowerPoint (27.1 ± 54.3), internet (3.52 ± 1.25), and parameters registration and reporting in the SIB
system (3.49 ± 1.28). Employed midwives of the health and medical centers displayed a significant
difference in feeling the need for training in some subjects.
CONCLUSION: Needs assessment is the foundation of purposeful training, and better training leads
to improved performance of personnel and organizations. Therefore, it is imperative that reliable
and documented data be utilized for promotion and improvement of in-service training programs
of employed midwives of the health and medical centers of Isfahan province and also for revising
university curriculums. Taking these measures would lead to the empowerment of personnel and
general development of society.

Abstract INTRODUCTION: Due to the increasing prevalence of diabetes in the world, the assessment of
the patient needs is essential. Understanding the needs of patients will play a very important role
in providing an effective training program for patients. This study aimed to explain the health‑care
needs of patients with diabetes in Iran’s health‑care system.
MATERIALS AND METHODS: The present study was conducted using a modified Delphi technique
in three rounds in 2017–2018. In the first round, patients’ needs were extracted based on qualitative
interviews and a review of the literature. Then, the second and third rounds were determined through
surveys, achieving maximum consensus and grading the importance of the patients’ basic needs.
Participants selected using purposeful sampling and included 58 diabetes patients, family, and
providers of the health system who were referred to urban health centers, rural, and one of the clinics
of Darreh Shahr, Ilam Province. For data analysis, qualitative content analysis was used in the first
Delphi round and descriptive statistics were used in the second and third rounds.
RESULTS: Regarding health‑care needs of patients with diabetes, four main themes included:
information and knowledge needs, need for reinforcement/reform of religious‑cultural beliefs, need
for health self‑management, and ultimately supportive needs have emerged.
CONCLUSIONS: According to the results, before designing and developing effective educational
programs, the need assessment to improve knowledge, correcting unrealistic attitudes and beliefs, as
well as modifying their self‑care behaviors and performance in preventing diabetes is recommended.

Abstract BACKGROUND: Growing interest in issues of attachment, sociocultural, psychological, and above
all clinical perspectives is also reflected in the emergence of research on “attachment style and
parental parenting style in referrals to addiction treatment centers.”
METHODS: This was a cross‑sectional study. Three health centers were selected randomly from
among the health centers of Neyshabur city in 2015–2016 year. The sampling was done so that all
individuals who had the characteristics of the research unit and had the consent to participate in
the study were justified by the researcher and completed questionnaire form. We used Chi‑square,
one‑way analysis of variance, Mann–Whitney, and Kruskal–Wallis tests.
RESULTS: In the present study, safe attachment scores in children with healthy parents were
significantly more than children with addicted parents.
CONCLUSION: Addiction has an important role in reducing attachment to children, and because
this decrease in attachment has dangerous consequences in child’s life.

Abstract Background: Health‑care acquired infections are significant given the risks and costs
they impose. All previous studies indicate a poor level of knowledge and performance
among the nurses in hospital infections; as such, educating nurses can play an important
role in infection control. This study aimed at evaluating the effects of the health belief
model (HBM) in making nurses adopting health‑care behaviors needed to control nosocomial
infections (Nis). Materials and Methods: The participants of the study were 135 nurses from
two hospitals in Mashhad, Iran. A self‑administered questionnaire was used to collect data.
The questionnaire consisted of seven parts. The intervention group received four 45 min
educational programs, both in individual and collective forms. After a 2‑month interval, a
post‑test was conducted to see whether any difference has been resulted. Results: There
was a significant relationship between knowledge (P = 0.001), perceived threat (P = 0.004),
perceived benefits (P = 0.001), and practices (P = 0.001) in comparing to control and
experimental groups after intervention. For the experimental and control groups, the most
frequent cues to action at the preintervention stage were, respectively, related to the period
of studying at university and in‑service classes. Conclusion: According to this study,
HBM‑based education can increase knowledge, perceived threat, and perceived benefits
of nurses. Additionally, it can reduce perceived barriers and improve the control of NIs
among nurses.

Abstract Introduction: Medical errors in hospitals kill more people every year than AIDS, breast cancer and
auto accidents combined. Widespread consensus exists that health care organizations can reduce
patient injuries by improving the environment for safety from implementing different alternatives
from technical and managerial improvements to considering medical record data. Considering
the preventability of medical errors, the Agency for Healthcare Quality and Research (AHRQ)
developed patient safety indicators (PSIs). This study analyzes the PSIs calculated in Alzahra
Hospital of Isfahan. Materials and Methods: This study was conducted retrospectively using the
inpatient medical record data of hospitalized patients in a six month period, from October 2010
to March 2011. An experienced team in the fields of medical record, health management and
health information technology was involved in data reviewing. Based on a prior consultation and
reviewing, some PSIs were selected. Indicators were calculated considering AHRQ guidelines.
Excel software and hospital information system software were used. Results: Across all studied
medical records of patients, out of 25,164 discharges, below measures were calculated.
‑8 Foreign Body cases (PSI 5) (0.31 per 1000).
‑30 Postoperative Hemorrhage or Hematoma cases (PS I9) (2.2 per 1000).
‑5 Accidental Puncture or Laceration cases (PSI 15) (0.3 per1000).
‑8 Complications of Anesthesia cases (PSI 1) (2.2 per 1000).
‑96 Selected Infections Due to Medical Care cases (PSI 7) (3.8 per1000).
‑17 cases of Postoperative Wound Dehiscence (PSI 14) (3.7per1000).
‑1 Birth Trauma – Injury to Neonate case, and (PSI 17) (1.7 per 1000).
‑18 Obstetric Trauma – Cesarean Delivery cases (PSI 20) (40 per 1000) were flagged by
studied PSIs developed by AHRQ.
Conclusion: Comparing with the reported rates by other studies and AHRQ study in 2006, all
of calculated indicators have inadequate condition; i.e. these are far from empirical estimated
rates. The hospital administrators should be more sensitive to this issue and perform some
improvement programs.