Journal of Education and Health Promotion

Abstract BACKGROUND AND AIM: Several research works show that anxiety is more common in women,
low‑income classes, and middle‑aged and elderly populations. The present study aimed to investigate
the role of positive and negative memories in patients’ anxiety referred to the dental clinics, offices,
and schools of Kerman, Iran, in 2018–2019.
MATERIALS AND METHODS: In this cross‑sectional, descriptive, analytical study, the participants
were selected among individuals referred to the dental offices, schools, and clinics of Kerman, Iran.
In this study, 500 questionnaires were distributed among the participants (based on census method),
and of these, 482 of which were reviewed (response rate = 96.4%). The questionnaire used in this
study contained four categories of questions, including demographic information, general questions
about dentistry, Corah’s Dental Anxiety Scale, and Autobiographical Memory Questionnaire. Analysis
of variance, t‑test, and Chi‑square test were used to analyze.
RESULTS: Overall, 281 participants were female, and 201 were male. Based on the findings, dental
visits were enjoyable and pleasant experiences for 154 participants, and 165 patients were anxious
while the dentist prepared for a restorative treatment. This study showed that people with negative
memories had more anxiety. Anxiety was also significantly associated with positive memories, higher
education, and gender (female) (P < 0.05). Also, the most negative memories of dental treatments
were associated with increased anxiety about dental treatments in adults (P < 0.05), while positive
memories did not have a relationship any with decreased anxiety (P > 0.05).
CONCLUSION: The most negative memories of dental treatments were associated with increased
anxiety about dental treatments in adults, while positive memories did not have any expected inverse
relationship with anxiety.

Abstract BACKGROUND: Educational centers accommodate people of varying generations. Indeed, each
generation has its specific priorities and values that affect its performance and decisions in various
aspects, including educational aspects. Understanding the traits of members of a given generation
facilitates understanding how their performance can be improved inside and outside the classroom.
So, this study was designed to identify the non‑educational characteristics of MD students in the
universities of medical sciences in Iran.
MATERIALS AND METHODS: The present study adopted a qualitative exploratory approach.
Data were collected through face‑to‑face, semi‑structured interviews. Participants included general
medicine students who had completed at least one semester. Sampling was purposive with maximum
variation. Sampling was continued until data saturation, and a total of 32 interviews were conducted.
Graneheim and Lundman’s content analysis approach was adopted to analyze the data. Lincoln and
Guba’s reliability criteria were used to achieve the accuracy and reliability of the data.
RESULTS: A total of 32 students were interviewed (n = 18 women and n = 14 men; age range:
19–27 years). The participants had completed 2–13 semesters and had between one and six siblings.
A total of 10 major categories emerged as the generational traits of students. The main categories
included devoted parents, money as the key reference of value, non‑sexism, religious perplexity,
experiencing oneself with others, my life’s address, tunnel vision, evasion from responsibility, winning
fame, and I and nothing else.
CONCLUSION: For them, gender and religion have lost their former meaning and they believe
in more freedom. They are also one‑dimensional people, lethargic and night people, who evade
responsibility and have a strong desire to be seen, approved, and respected. They also prioritize
themselves and their peace of mind. Since these characteristics can have many direct and indirect
effects on various aspects of their lives, including the educational aspect, it can be very beneficial
for people interacting with them to identify and consider these characteristics.

Abstract BACKGROUND: The study was conducted to assess the different components of communication
skills and barriers to practicing good communication skills among resident doctors in a health care
setting.
MATERIALS AND METHODS: A web‑based cross‑sectional survey was performed, and data
were collected using a pre‑validated questionnaire with a Cronbach’s alpha (0.88). A total of 431
responses were statistically analyzed. Chi‑square test was used to associate the socio‑demographics
and communication skills. Regression analysis was conducted to analyze the association between
various communication domains and barriers, which were adjusted for potential confounders such
as age and gender.
RESULTS: Resident doctors have differential levels of competencies in each domain of communication
skills. Around two‑thirds of the residents did not practice good communication skills while breaking
the bad news and reported poor para‑verbal skills. Some of the most common barriers to practicing
good communication skills were found to be an infrastructural deficit, lack of time, and long working
hours. These barriers significantly affected the communication skills such as para‑verbal skills {[‑0.32;
P < 0.01; C.I (‑0.54 to ‑0.09), [‑0.27, P < 0.05, C.I (‑0.54 to. 004)], [‑0.32, P < 0.01, (0.07–0.56)]}, the
ability to break bad news {[‑0.42, P < 0.01, (‑0.73 to ‑0.11)], [‑0.35, P < 0.05, (‑0.75 to ‑0.35)], [0.48,
P < 0.01, (0.12–0.84)]}, and communication with patients/attendants {[0.39, P < 0.01, C.I (‑0.71
to ‑0.06)], [‑0.88, P < 0.001, C.I (‑1.2 to ‑0.48)], [‑0.88, P < 0.001, C.I (‑1.2 to ‑0.48)]} after adjustment
for confounding such as age and gender.
CONCLUSION: There is a scope for improvement in practicing good communication skills with
patients, among the residents doctors in India. Structured modules for training and evaluation should
be implemented in the medical curriculum.

Abstract BACKGROUND: Due to the role of education in improving anxiety and essential skills of mothers
for caring for their infants, this study aimed to investigate the effect of education based on the health
belief model (HBM) on anxiety among mothers of infants with retinopathy of prematurity (ROP).
MATERIALS AND METHODS: This randomized controlled clinical trial was performed on 67 mothers
with premature infants admitted to the ROP unit of Khatam Al Anbia Eye Hospital in Mashhad,
Iran from 2019 to 2020. Participants were randomly allocated to intervention and control groups.
Intervention was designed based on HBM during six sessions, each of 45–60 minutes duration. The
control group received routine educations according to the hospital policies. The maternal anxiety,
adherence with follow‑up examinations and the rate of neonatal retinal vascularization were evaluated
using an HBM‑ based questionnaire and State‑Trait Anxiety Inventory questionnaire and checklists,
respectively. Data was analyzed by using SPSS software, version 16, using Chi‑squared test, Fisher’s
exact test, independent t test, and Mann–Whitney U test.
RESULTS: Based on our findings, no significant difference was observed between the two groups
before the intervention regarding the mean score of maternal anxiety (P = 0.141). However, after
intervention, the mean score of maternal anxiety decreased significantly from 67.0 ± 6.3 to 38.5 ± 6.6
in the intervention group and increased from 69.8 ± 3.1 to 68.3 ± 3.4 in the control group (P < 0.001).
In the intervention group, the mean scores of model constructs (perceived susceptibility and
severity, perceived benefits, barriers, self‑efficacy and cue to action) increased significantly after
intervention (P < 0.001).
CONCLUSIONS: Education based on HBM appear to be an efficient method to improve maternal
anxiety among mothers of infants with retinopathy of prematurity. Accordingly, nurses and treatment
staff can provide interventions in the NICU based on the HBM to the parents of hospitalized and
premature infants.

Abstract BACKGROUND/AIM: The COVID‑19 pandemic has created a long period of stress for people
worldwide and has significantly affected sleep duration. The pandemic revealed new stress factors
that are likely to affect sleep. Uncertainty is a factor that leads to anxiety and depression, which
affects sleep. It should also be noted that reductions in sleep quality rather than sleep duration are
associated with negative consequences on mental health. This study aims to investigate online that
how this situation affected university students.
MATERIALS AND METHODS: This research, with a descriptive study design, was conducted in
Turkey between June 01, 2021 and July 30, 2021. The sample included 604 people who accepted
voluntary participation, chosen by the random selection method. In the study, sociodemographic
information form, Pittsburgh sleep quality index (PSQI), morningness–eveningness questionnaire
scale (MEQ Scale), Beck depression inventory (BDI), and Beck anxiety inventory (BAI) were used as
data collection tools. Pearson correlation analysis was utilized to examine the relationship between
the scales. Multiple regression analysis was performed to investigate the role of morningness–
eveningness, anxiety, depression, and insomnia severity on sleep quality.
RESULTS: Sleep quality was negatively correlated with morningness–eveningness scores (r = –0.32,
P < 0.01), and positively and significantly related with anxiety (r = 0.43, P < 0.01), depression (r = 0.40,
P < 0.01) and insomnia severity (r = 0.55, P < 0.01). According to regression coefficients, while
anxiety (ꞵ = 0.041, P < 0.001) and insomnia severity scores (ꞵ = 0.226, P < 0.001) positively predicted
sleep quality, depression did not predict it significantly (ꞵ = 0.009, P > 0.05). A significant difference was
found in sleep quality according to morning, evening, and intermediate types (F = 27.401, P < 0.001).
CONCLUSION: Events related to the COVID‑19 pandemic are associated with reduced sleep quality
in connection with increasing negative moods. Considering the importance of sleep for a healthy
life, efforts should be made to raise awareness about this issue and to provide psychological help
to affected individuals.

Abstract BACKGROUND: Menopause is one of the developmental stages of women. One of the most common
problems during this period is sleep disorders. Sleep disorders can affect the quality of life of these
people. To improve sleep disorders, auriculotherapy has received less attention due to its low cost
and effectiveness, and side effects. Therefore, the aim of this study was to determine the effect of
auriculotherapy on improving sleep quality in postmenopausal women aged 45–60 years.
MATERIALS AND METHODS: The present study is a clinical trial study that was performed on
82 postmenopausal women aged 45–60 years under the auspices of health centers in Mahshahr
city, Iran from 2021–2022. Women with inclusion criteria were randomly divided into two groups
(intervention and control). The intervention group underwent auriculotherapy for 4 weeks. The St.
Petersburg Sleep Quality Questionnaire was completed by both groups at the beginning and 4 weeks
after the start of the intervention. Finally, the data were analyzed by SPSS software version 22 and
independent t‑test, paired t‑test and Chi‑square test.
RESULTS: At the beginning of the study, both groups were homogeneous in terms of demographic
variables. The results of data analysis using independent t‑test showed that before the intervention,
mental quality (P = 0.513), length of incubation period (P = 0.285), sleep duration (P = 0.121), sleep
efficiency (P=0.513), sleep disorders (P=0.685), use of sleeping pills (P=0.530), daily functioning(P=0.60),
and overall sleep quality score (P = 0.30) in the control and intervention groups were not statistically
significant.However, comparing the mean scores afterthe interventionin the control and interventiongroups
showed that mental quality (P < 0.001), incubation period (P < 0.001), sleep duration (P < 0.001), sleep
efficiency (P < 0.001), sleep disorders (P < 0.001), use of hypnotics (P=0.002), daily functioning (P=0.001),
overall sleep quality score (P < 0.001), sleep duration (P = 0.822), sleep efficiency (P = 0.889), sleep
disorders (P = 0.889), use of sleeping pills (P = 1.00), daily performance (P = 0.767), overall sleep quality
score (P = 0.69) were statistically significant between the two groups. In‑group comparison using paired
t‑test in the control group showed that mental quality (P = 0128), length of the incubation period (P = 1.00),
and before and afterthe intervention did not differ significantly in the mean scores. However, a within‑group
comparison in the intervention group showed that mental quality (P < 0.001), incubation period (P < 0.001),
sleep duration (P < 0.001), sleep efficiency  (P < 0.001), sleep disorders (P = 0.003), use of sleeping
pills (P = 0.007), daily functioning (P < 0.001), and overall sleep quality score (P < 0.001) before and after
the intervention had a significant difference in the mean scores.
CONCLUSION: The results showed that auriculotherapy has significant effectiveness in improving the
quality of sleep, and its dimensions and can be used as an effective method in this area that can be
implemented at a low cost and easily. According to reports from participants and previous studies in this
field, auriculotherapy did not have any side effects and can be used as a safe way to improve sleep quality.

Abstract BACKGROUND: A healthy pregnancy and its outcomes are highly dependent on maternal health
literacy. This is the first study that targets the association between maternal health literacy and
pregnancy outcomes of women in Afghanistan.
MATERIALS AND METHODS: This is a cross‑sectional study on 200 women who received a
prenatal care program and have given birth at Barchi National – 100 beds hospital in Kabul, the
capital city of Afghanistan. As a convenient sample, they answered Maternal Health Literacy and
Pregnancy Outcome Questionnaire with 5‑point Likert scales. We tested the correlation between
maternal health literacy and pregnancy outcome scores via the Pearson’s correlation coefficient. The
potential association of socio‑demographic and fertility variables with both maternal health literacy
and pregnancy outcome was tested via independent samples t‑test or one‑way ANOVA. All analysis
was performed with a 95% confidence level and a significant level was defined as a P value ≤0.05.
RESULTS: The maternal health literacy of Afghan women is inadequate. Maternal health literacy
is linked to pregnancy outcome, and both were associated with education level, age, number of
gravidities, number of received care, and time that onset the prenatal care. Nutshell, we found evidence
of a positive and significant correlation between maternal health literacy and pregnancy outcome.
CONCLUSION: This study brings forth the novel data on maternal health literacy of Afghan women, the
members of society that face health crises for more than half a century. This study calls for recognition
that inadequate maternal health literacy in Afghanistan significantly influences prenatal care quality
and perpetuates the biggest challenge for maternal and child health through pregnancy outcomes.

Abstract BACKGROUND: Mothers need the necessary skills to be empowered in successful breastfeeding.
This study aimed to investigate effectiveness of the distance education program on the mothers’
empowerment in exclusive breastfeeding.
MATERIALS AND METHODS: A randomized clinical trial study was done on 72 nulliparous pregnant
women 28–32 weeks with normal pregnancy. The qualified women were randomly assigned to the
intervention and control groups based on the random‑number table. The breastfeeding training
packages were sent to women in the intervention group via Telegram every week from 32 until
37 weeks of gestation. The mothers’ empowerment in breastfeeding (primary outcome) and the
exclusive breastfeeding rate (secondary outcome) were assessed by questionnaires.
RESULTS: Based on the repeated measured tests, although scores for all domains and also the
total score of the mothers’ empowerment in breastfeeding between two groups had increased
during the study period, there was a significant difference between the increasing trends of the
maternal empowerment domains in two groups (interaction P value ‹0.001). Also, the prevalence of
exclusive breastfeeding (secondary outcome) at 6 months was significantly higher in the intervention
group (81.8% and 57.1% in the intervention and control groups, respectively) (P = 0.028).
CONCLUSION: Distance education could increase all domains of the mothers’ empowerment in
breastfeeding after delivery. Also, exclusive breastfeeding at 6 months after delivery was significantly
higher in mothers who were receiving the distance education packages.

Abstract BACKGROUND: Information technology (IT) can be used by frontline health workers (FLWs) to
connect and deliver care to the community. Various studies in India have assessed the beneficial
impact of IT usage by FLWs, but for the long‑term sustainability, the attitude and belief toward IT
usage have not been adequately studied. We conducted this study to assess the knowledge and
attitude and to explore the beliefs of FLWs toward the use of IT in a rural area of Haryana.
MATERIALS AND METHODS: We conducted a mixed‑method study (qualitative and quantitative
approach) in a rural setting of Haryana, India. We included FLWs of two primary health centers (PHCs).
Data were collected from October 19, 2020 to December 31, 2020. We collected data from 75 accredited
social health activists (ASHAs), 37 Anganwadi workers (AWWs), 28 multi‑purpose workers (MPWs),
two information assistants, and two medical officers using a semi‑structured interview schedule. Their
knowledge about the benefits of IT use, past use of IT applications and devices, and self‑rating of
knowledge regarding computers or laptops were collected. We used 14 attitude statements, each with
a five‑point Likert scale to assess the attitude; a total score ≥35 was considered a positive attitude.
We conducted eight focus group discussions (FGDs) to explore the beliefs regarding IT usage (four
FGDs with ASHAs, two FGDs with AWWs, and two FGDs with MPWs). A descriptive analysis was
performed for the quantitative data, and a thematic analysis was performed for qualitative data.
RESULTS: Knowledge about the benefits of IT use was present among 77.8% of FLWs. Among
the FLWs, 79.2% self‑rated their knowledge of computers/laptops as ‘do not have knowledge’, 16%
self‑rated as ‘low knowledge’, and 4.8% self‑rated as ‘good knowledge’. The median total score for
attitude statements among all the FLWs (n = 144) was 54 [inter‑quartile range – 48–59]. Four themes
emerged for beliefs toward IT usage, namely, positive beliefs, negative beliefs, challenges anticipated
in adopting IT use, and facilitation factors. The positive beliefs were related to improvement in work
efficiency and social status, less paperwork, timely report generation, and better learning. The negative
beliefs were related to an increase in working hours, close monitoring, and feeling over‑burdened.
CONCLUSION: We found that FLWs had knowledge regarding the benefits of IT use, but they
lacked knowledge regarding laptop/computer use. They had a satisfactory level of confidence in
using smartphones, and most of them were using mobile applications. The majority of the FLWs had
a positive attitude and beliefs toward IT use and wanted to use it in the future.

Abstract BACKGROUND: The aim of this study was to perform a bibliometric analysis to assess the number
of articles published by Iranian researchers in the field of hand and microsurgery over the last four
decades.
MATERIALS AND METHODS: An online search was conducted using 685 keywords in the abstract/
title sections of articles, including carpal tunnel syndrome, wrist fractures, nerve injury and repair,
skin flap and graft in the hand, congenital disorders in the hand and forearm, tumor in the hand
and wrist, and infection in the hand and wrist. From February 1976 to May 2021, EndNote software
version 8.1 was used to search articles in PubMed and Scopus databases. Articles in which at least
one of the authors was affiliated with Iran were chosen. The name of the original institution, field of
study, total number of publications, type of study, collaboration rate of Iranian hand surgeons for
each year, and annual sharing of Iranian articles in journals with the highest cite scores in the field
of hand and microsurgery were all examined in the present study.
RESULTS: The total number of publications in the field of hand and microsurgery was 632 (an average
of 11 papers per year). Most of the Iranian hand and microsurgery papers were from the capital
city, Tehran (38.09%). There was an increasing trend in the number of publications over the years,
most which were about carpal tunnel syndrome (21.5%), tendon (9.8%), and nerve (9.6%). In total,
59.6% were descriptive articles, whereas the proportion of clinical trials was relatively small (22.3%).
CONCLUSIONS: Iranian hand microsurgeons have continued to increase their scientific output in
hand microsurgery and related fields over the last 40 years. The quality of Iranian hand microsurgeons’
scientific output, both within and outside their discipline, has greatly improved; however, they still
have a long way to go before becoming a hub of science.
LEVEL OF EVIDENCE: IV, retrospective study without control group.

Abstract BACKGROUND: Over the past few years, a growing body of evidence has allowed us to ascertain
that the initiation of periodontitis stems from the existence of oral microbial biofilm and that this
requires definitive treatment. Owing to its exceptional usability, affordability, and antibacterial
activity, the “diode laser” (DL) has increasingly become a popular and important tool in a dentist’s
armamentarium. However, there is a scarcity of scientific evidence on the utility and advantages of
using “diode laser” in periodontal flap surgery. The study aimed to determine the efficacy of 940 nm
diode laser exposure in combination with conventional periodontal flap surgery for the treatment of
chronic periodontitis to evaluate postoperative discomfort and clinical parameters.
MATERIALS AND METHODS: A total of 10 subjects (7 males and 3 females) with generalized
chronic periodontitis were recruited and completed the study without any dropouts. For this split‑mouth
study, 40 sample sites with pocket probing depth (PPD) 5–7 mm post periodontal Phase I therapy
were selected. The quadrants were randomly allocated to Groups A, B, C, and D using the fish
bowl lottery method. Kirkland flap surgery with laser and modified Widman flap (MWF) with laser
were performed in Group A and C, respectively, while Kirkland flap surgery and MWF surgery were
performed in Group B and Group D. Clinical parameters including visual analog scale (VAS) score
and gingival inflammation were determined at 3rd and 7th day postoperatively while PPD, clinical
attachment level (CAL), and sulcus bleeding index (SBI) were recorded at baseline and 6 months
following treatment. Wilcoxon signed‑rank test and Kruskal–Wallis test were used for intra‑group
and inter‑group comparison of parameters, respectively.
RESULTS: Statistically significant difference was attained with postoperative discomfort in
laser‑assisted groups on 1st and 3rd day postoperatively (P < 0.001). There was no significant difference
in the proportion of subjects with gingival inflammation. A statistically significant reduction in mean
PPD at 6 months postoperatively was seen among all study groups (P < 0.05) but the inter‑group
difference was not statistically significant. SBI score reduced significantly from baseline to 6 months
follow‑up among all four groups (P < 0.05). However, we did not find the inter‑group difference to
be statistically non‑significant.
CONCLUSION: Diode laser as an adjunct to the surgical procedure can demonstrate appreciable
benefits by increasing the CAL and minimizing the postoperative pain and the probing pocket, but
such additional effects were not observed with gingival inflammation.

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 Self‑care may help prevent pregnancy complications and mortality by informing parents. Mobile
health applications (apps) can help individuals to improve the quality of self‑care. Although it has
been claimed that mobile apps have various benefits, their functionalities in pregnancy self‑care
are still unclear. A clear understanding of current apps can help researchers, practitioners, and app
developers to identify appropriate functionalities for new development and future refinement of current
apps. This review endeavored to identify appropriate functions for pregnancy self‑care mobile apps
and user interface (UI) features. The scope of this review integrates self‑care for pregnancy apps
published in Google Play and Cafe Bazaar (an Iranian Android marketplace), popular Android app
stores, from July to October 2019 by sing the systematic search technique. All 4196 downloaded apps
were installed, and it was found that 76 of them met the inclusion criteria. This way, their features
were extracted and categorized by the conventional content analysis. Three main themes and 69
subthemes in terms of apps functionalities and their UI features were extracted as follows: 1) Training
materials (maternal and paternal) with 27 subthemes; 2) self‑care functionalities (consultations, fetus
tracking, clinical examination, supportive assistance, and reminders) with 26 subthemes; and UI
features with 16 subtheme. The findings underlined the mHealth solutions for pregnancy self‑care
and the need for development of the apps regarding the extracted functionalities and UI features;
however, controlled trials are needed. It is recommended that transparent reporting of mHealth
interventions needs to be prioritized to enable effective interpretation of the extracted data.

Abstract BACKGROUND: Student absenteeism is a major concern for undergraduate medical education
training in India. Regular class attendance helps students have a proper understanding of the topic
of discussion. This study explores the pattern of absenteeism among medical students and whether
absenteeism is associated with their academic performances.
MATERIALS AND METHODS: A record‑based, cross‑sectional study was done by reviewing
departmental attendance registers, item cards and marks obtained in exam by 190 students in the
community medicine department who had passed their 3rd professional part 1 examination in 2018.
The data was entered and analyzed using SPSS version 16. A descriptive analysis summarizes the
pattern of absenteeism and their marks obtained in the semester and professional exam of community
medicine. The primary outcome indicator was the 3rd professional exam marks. The correlation
between class absenteeism and other predictors and exam result was analyzed. Regression
analysis was done to predict dependence of outcome variable on class attendance and formative
examination marks.
RESULTS: Overall, female students had better class attendance than male students. There was a
positive correlation of lecture class attendance (r = 0.369) and marks obtained in the 6th semester
exam (r = 0.717) with the final exam result. Further regression analysis showed final marks had a
higher dependence on the 6th semester examination score (B = 0.669) when compared to lecture
class attendance (B = 0.051).
CONCLUSION: Although lecture class attendance is an important predictor of final result, this
study showed that the 6th semester marks were a better predictor. This may be due to multiple
factors (alternate source of learning, student’s motivation, etc.) which require further exploration.

Abstract BACKGROUND: Psychological disorders, such as depression and anxiety, are common among
individuals who have experienced coronavirus disease 2019 (COVID‑19); however, diagnosis may
be challenging and subjected to invalidity. This study aimed to examine agreement between online
self‑assessment and psychiatric telephone interview among COVID‑19 survivors.
MATERIALS AND METHODS: This cross‑sectional descriptive study was carried out from March
to June 2021 in Afzalipour Hospital, Kerman, Iran. The inpatients confirmed with COVID‑19 were
contacted within the first week after discharge and were asked to fill the Hospital Anxiety and
Depression scale (HADS) and socio‑demography questionnaire. They were later interviewed using
Hamilton Depression Rating Scale (HAM‑D) and Hamilton Anxiety Rating Scale (HAM‑A). Agreement
between the data extracted from self‑report and telephone interview was analyzed using Cohen’s
kappa coefficient, sensitivity, and specificity.
RESULTS: Out of 200 post‑COVID patients, 60 participants completed all assessments. Prevalence
of depression was observed to be 88% via telephone interview and 45% via self‑assessment.
Moreover, 83% of the participants were diagnosed with anxiety according to the telephone interview,
in comparison to 31% diagnosed with anxiety using self‑report questionnaire. The agreement between
online self‑assessment and telephone interview for depression and anxiety was not significant
(κ = 0.08 and κ = 0.1, respectively).
CONCLUSION: The discordance between online self‑report and clinician’s assessment via phone
contact interview indicates that using self‑report evaluations is not sufficient as the single assessment
tool for mental health monitoring and reflects the need to employ multiple assessments for diagnosis
of psychiatric problems in pandemics.

Abstract BACKGROUND: Demonstration‑Observation‑Assistance‑Performance (DOAP) and Video‑Assisted
Learning (VAL) are small‑group teaching/learning methods (TLM) in medical education. Comparison
studies between the two are scanty. There is a gap in knowledge, skills, and attitude among medical
interns toward Advanced Cardiac Life Support (ACLS). The author studied the effectiveness of DOAP
and VAL in training ACLS using mannequins and automated external defibrillator (AED)-simulators
among interns in 2021.
MATERIALS AND METHODS: This descriptive study was done in the Emergency Department of
a tertiary teaching hospital in South India. Out of 80 medical interns, 39 and 41 were allocated to
ACLS training by DOAP (Group 1) and VAL (Group 2), respectively, by convenient sampling with
random allocation, with the use of mannequins and AED‑Simulators (10 interventions in each small
group; three‑five participants in each session). Pre‑validated pre‑test and posttest multiple‑choice
questionnaires (MCQs) and attitude questionnaires, OSCE by two blinded assessors, and perception
by Likert‑based questionnaire were analyzed with appropriate statistical analysis.
RESULTS: The mean pretest and posttest MCQs and Attitude and OSCE scores of DOAP and VAL
showed no statistically significant difference between them (MCQ pre‑test 44.51 (11.43); 42.54 (6.56);
p = 0.350 and MCQ posttest, 78.97 (8.59); 77.22 (11.29); p = 0.438; OSCE 40.51 (2.43) and
40.63 (1.92); p = 0.804; Attitude: 11 (3), 11 (2); p = 0.567; 14 (2), 14 (3); p = 0.095). MCQ post‑tests
showed improved scores (p < 0.001) in both the methods and the standardized mean difference
based on the MCQ scores for the DOAP group was 3.02, and for the VAL group 3, showed the
effectiveness of both methods. Perception scores showed learners’ interest and positive feedback
to both methods and ACLS.
CONCLUSION: Both DOAP and VAL were equally effective TLMs in imparting knowledge, skills, and
attitude to medical interns with positive feedback. In DOAP, the learner performs under supervision
and clarifies doubts. As repeatable and cost‑effective, VAL is useful in resource‑limited settings.
Both can be used as complementary methods in training ACLS. The attitude of learners towards
ACLS improved with training.

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

Abstract BACKGROUND: Modern competency‑based medical education emphasizes student‑centered
teaching‑learning strategies where students take responsibility of their own learning. Student‑centered
approaches facilitate multifaceted learning such as observation, critical evaluation, analysis, deeper
understanding, and application of knowledge. The current study aims at assessing the students’
perception on utilization of clinical case problem‑solving approach (CCPS) to promote their lifelong
learning.
MATERIALS AND METHODS: The present cross‑sectional study was conducted at College of
Medicine and Health Sciences (CoMHS) during the year 2021‑2022. MD3 students of the academic
year 2021‑2022 were the study participants. The study was approved by institutional Ethic and Review
Committee. Students’ performances were assessed through pre‑test and post‑test performances.
Students’ feedback was collected through a predesigned questionnaire on a 3‑point Likert scale.
Cronbach’s alpha coefficient test was used to assess the reliability of the questionnaire. The data was
entered to Microsoft Excel and analyzed using SPSS software version 22. Paired t‑test was used to
compare pre‑test and post‑test scores and the data was expressed as numbers and percentages.
RESULTS: In total, 103 participants were included in the study. Post‑test scores were significantly
higher compared to pre‑test scores (p < 0.05). Questionnaire results showed that CCPS approach
was accepted as an effective learning strategy. Majority (>90%) of the students expressed CCPS
approach was interesting, motivated to learn, encouraged peer discussion, enhanced knowledge,
and clarified their topic‑related doubts. More than 80% students opined that CCPS enhanced their
critical thinking, problem‑solving ability, deep learning, and lifelong learning skills. Nearly 90% of
the students suggested for including such sessions for more topics in immunology course in future.
CONCLUSION: From our study results, it can be concluded that CCPS is an effective learning
strategy to encourage students’ engagement and promote their deep learning skills.

Abstract BACKGROUND: The family is one of the important social institutions and the function of childbearing
is one of the important functions of the family. The decision to have children depends on the
individual’s attitude about the consequences of having another child and their perceived norms.
Therefore, this study was conducted to determine the relationship between attitudes toward fertility
and childbearing and the value of children with attitudes toward fertility control in married women
aged 15 to 45 years in Isfahan.
MATERIALS AND METHODS: This study was a cross‑sectional correlational study that was
performed on 500 married women with at least one child in health centers affiliated to Isfahan
University of Medical Sciences. Data collection tools in this study were standard questionnaires.
The data were analyzed by SPSS software version 22.
RESULTS: The mean score of attitude toward fertility control was 40.43 ± 9.03. The area of security
in old age and the area of procrastination had the highest mean values of children and attitudes
toward fertility and childbearing, respectively. Analysis of data by Spearman test showed that there
is a significant relationship between all dimensions of child value and attitudes toward fertility and
childbearing with attitudes toward fertility control (P < 0.05).
CONCLUSION: A positive attitude toward the child increases the likelihood of having children and
believing in the negative impact of the child on freedom reduces the likelihood of having a desire
for fertility. Changing attitudes of societies toward childbearing and less desire to have children
should not be sought only in material, economic, or social reasons but also cultural factors should
be considered in this area.

Abstract BACKGROUND: Heat wave adaptation is a new concept related to experiencing heat. The present
study aims at investigating a conceptual definition, that is, the mental framework of heat wave
adaptation and its strategies.
MATERIALS AND METHODS: A phenomenological study was performed to explain the mental
concept. At the same time with the data collection process, data analysis was also performed using
Colaizzi method. Semi‑structured interview method and purposeful sampling with maximum variety
were used. Interviews were conducted with 23 different subjects in the community. The accuracy of
the data was guaranteed using Lincoln & Guba scientific accuracy criteria.
RESULTS: The two main themes of the adaptation paradigm as well as its strategies were divided
into the main categories of theoretical and operational concepts, as well as personal care measures
and government measures. Under the category of individual measures, we obtained “clothing,
nutrition, building, place of residence and lifestyle,” and under the category of governance actions,
the “managerial, research, health, organizational” subcategories were obtained.
CONCLUSION: According to the results of the conceptual‑operational definition, heat wave adaptation
is an active process and an effort to reduce the adverse effects of heat waves on individual and
social life, and striking a balance that will not only result in individual awareness and actions that
will lead to lifestyle changes, but also mostly requires integrated and comprehensive planning in the
community. On the one hand, heat waves could not only be regarded as a threat or danger, but can
also become an opportunity for the development of a community through identification and smart
measures, and for adaptation, the community must take it as a risk. The community should have a
plan in advance, apply the necessary rules and training, and use the new facilities and rules where
necessary. This practical concept definition includes the main features of heat wave adaptation.

Abstract BACKGROUND: Currently, the use of the internet is one of the most important tools, which may
lead to negative or positive impact on college or school students. The excessive use of electronic
media may lead to change in the mood, an inability to resist internet usage, a diminishing social
life, withdrawal symptoms while unengaged, affecting self‑esteem, and adverse work or academic
consequences. The main objective of this study is to explore Internet use and its impact on selected
psychological parameters such as depression and insomnia among undergraduate (UG) nursing
students.
MATERIALS AND METHODS: A total of 385 college students selected by purposive sampling
technique were included in the study. Young’s Internet Addiction Test (YIAT20) for Internet
addiction (IA) assessment, and Beck’s depression inventory Scale to assess level of depression,
and insomnia severity index (ISI) scale to measure insomnia were used.
RESULTS: Among 385 participants, 175 and 210 were male and female, respectively. Demographic
variables such as pursuing course, study year, use of Internet/day; and the purpose of Internet
use such as social networking, games, entertainment, pornography, and news were significantly
associated with IA. Depression and insomnia were found to be correlated with IA.
CONCLUSION: Internet usage more than the normal limit has a profound effect on college or school
students, in particular, depression and insomnia. At times, it ends up in problems in their social and
family relationship.

Abstract BACKGROUND: Hypertension is a worldwide health issue. Increasing aging has given rise to the
prevalence of this problem. Disease management using educational intervention based on theoretical
frameworks is effective for influencing self‑care behavior. The goal of this study is to investigate the
effects of educational intervention on self‑care behaviors that influence hypertension control among
the elderly population during 2020 based on the health belief model.
MATERIALS AND METHODS: A quasi-experimental study was conducted on rural older people in
Ardestan, Iran. Assessments were done before and after three educational intervention sessions
with a control group. The random sampling has done on 99 hypertensive elderly people in two rural
centers of Ardestan from 2019 to 2020. Awareness variables, components of the health belief model,
and blood pressure were assessed before and three months after the intervention. Data analysis
was done using descriptive and analytical statistics.
RESULTS: The study groups did not differ significantly in terms of the variables studied at the
beginning of the study. After three months, the variables of awareness, self‑care, and perceived
sensitivity constructs, perceived severity, perceived benefits, and guide to action showed a significant
rise in the experimental group compared to the control group. In addition, the effectiveness of
educational intervention significantly increased self‑care behavior in the experimental group.
CONCLUSIONS: Educational intervention based on the health belief model can be effective to
reduce the barriers of self‑care behaviors. In order to have a lasting change in behavior, the use
of behavioral change patterns that ecologically take into account interpersonal, organizational, and
social factors is suggested too.

Abstract BACKGROUND: Video‑based teaching has become rapidly popular during the coronavirus disease
2019 (COVID‑19) pandemic. The current study aimed to assess the efficacy of a hybrid video‑based
teaching module of oxygen therapy and critical care troubleshooting in nursing professionals managing
COVID‑19 patients in our institute.
MATERIALS AND METHODS: A retrospective analytical study (pretest and posttest design) was
conducted in our medical education department in March 2022 using the data from a workshop
conducted on oxygen therapy and critical care area troubleshooting during COVID‑19 patient
management for 296 nursing professionals. A hybrid video‑based teaching module was used. Pretest
and posttest data were compared along with subgroup analysis. P value <0.05 was considered
significant.
RESULTS: Posttest scores were significantly higher than the baseline scores in the overall group
as well as in all subgroups (P < 0.001). Subgroup comparisons revealed no significant difference
in mean baseline pretest and posttest scores in male versus female participants. Baseline pretest
scores (P = 0.02) and posttest scores (P = 0.08) were lower in the nurses of the noncritical areas
compared to critical area nurses. Mean improvement in posttest score compared to baseline score
was similar between all groups.
CONCLUSION: Hybrid technique involving both video aspects and in‑person teacher presence
for demonstration or troubleshooting improves perceived knowledge in nursing professionals with
some prior formal training and may be superior to the conventional only didactic/lecture‑based
demonstrations, especially in the context of imparting rapid training during pandemics or similar
urgent situations.

Abstract Infertile couples experience a lot of psychological stress due to the inability to achieve the desired
social role. Couples who decide to continue assisted reproductive therapy (ART) during the epidemic
also experience the psychological impact of the COVID-19 epidemic, which affects their daily lives
due to social isolation, quarantine, travel restrictions, and cancellation of treatment. Therefore, the
purpose of this study was to assess the mental health of infertile couple pausing or delaying their
treatment due to the COVID-19 pandemic. PubMed, Scopus, Cochrane, Embase, Web of Science,
ScienceDirect, Google Scholar, Research Gate, and the World Health Organization databases and
websites were systematically searched for original studies concerning abortion in the era of COVID-19
pandemic published by August 15, 2021. We used the following keywords: “COVID-19 Corona
virus, infertility, reproductive technique, fertilization, assisted reproduction, pregnant termination,
psychological, in vitro mental status, depressive symptoms, and anxiety.” In sum, after automatically
and manually search and excluding duplicates, 269 articles were found. In final, after screening, 18
articles were selected. Most patients experienced negative emotions during the COVID-19 epidemic.
When reproductive services were re-established, participants showed higher levels of anxiety and
lower quality of life than before quarantine. Women who thought pregnancy was more important
than getting COVID-19 had higher levels of anxiety than women who thought otherwise (P < 0.05).
The COVID-19 pandemic has negative impacts on the mental health and quality of life of patients
seeking fertility services and coping with it requires timely and appropriate psychological intervention,
accurate information, and social and organizational support.

Abstract BACKGROUND: Research in universities requires systematic and participatory processes that
integrate teachers, contents, strategies and tools, and students and their own interests. Therefore,
the main objective of this study was to establish the relationship between the perception of the
teaching‑learning process (TLP) and the attitude toward scientific research among midwifery students.
MATERIALS AND METHODS: Descriptive cross‑sectional study, conducted on 250 students from
second to fourth year of study selected by convenience sampling. The data were collected with two
self‑administered Likert‑type scales that were validated in content and construct, both with high
reliability. Descriptive statistics were carried out; the Spearman correlation test was used prior to
the application of the Kolmogorov–Smirnov test and Kendall’s tau‑b test.
RESULTS: The favorable perception of the TLP was greater among second‑year students (42.6%),
in addition, 15.2% agreed that the advice of teachers contributes to the elaboration of the research
protocol. The attitude of indifference toward research was more frequent in third‑year students (58.2%)
and 28.4% were deemed in disagreement to be able to identify and operationalize the variables. In
the analysis of dimensions, the role of the student had a moderate relationship with the research
design (rho = 0.536; P < 0.001), while a weak relationship was demonstrated between media and
techniques with ethical and scientific value (rho = 0.104; P < 0.001).
CONCLUSION: The TLP perceived by midwifery students and their attitudes toward scientific research
had a direct and significant correlation. The proportion of students with favorable perception was
greater among those with a favorable attitude.