Journal of Education and Health Promotion

Abstract BACKGROUND: The COVID‑19 pandemic is a major health crisis that has changed the life of
millions globally. Coronaviruses are viruses’ group that can contract animals and humans and the
cause of severe acute respiratory syndrome (SARS), Middle East respiratory syndrome (MERS),
and COVID‑19. Nurses are the primary service providers in the health care; nurses who are in close
contact with infectious patients need to get their mental health checked and supervised on a regular
basis, particularly with regard to stress, anxiety, and suicidal ideation, so that they can provide optimal
quality of life and healthy mental health to have good care for patients to assess the impact of the
pandemic on mental health status for nurses in Iraq.
MATERIALS AND METHODS: A total of sample study (1000) nurses in Iraq completed an online
questionnaire between March and May 2021. Psychological impact was assessed using the
depression anxiety stress scale (DASS21).
RESULTS: The study revealed impact COVID‑19 on mental health status (anxiety stress) and
no impact COVID‑19 on mental health status (depression) for nurses was (P value = 0.040 and
P value = 0.045, respectively).
CONCLUSION: The impact COVID‑19 on mental health status for nurses. Protecting the nursing
staff from chronic stress, anxiety, and depression, which constitutes a psychological burden on health
during the outbreak of the COVID‑19 pandemic, by clarifying the disease and how to prevent it, as
well as providing the personal protective equipment to decrease stress, anxiety, and depression
during the pandemic.

Abstract As a main pillar of the health and social welfare system, hospitals affect the public health status in two
ways: (1) Prevention, treatment, and rehabilitation services and (2) external effects on society and
the environment. The present study aimed to identify the roles and functions of future hospitals in the
world. The present study was a systematic review in which all studies about the roles and functions
of future hospitals in different countries with a time limit of 2000 to August 2021 were extracted from
foreign databases, including PubMed, Cochrane, Scopus, and Web of Science, and search engine,
Google Scholar, as well as Persian databases, including Magiran, SID, and Iran Medex. We utilized
the STROBE checklists for quantitative studies and SRQR checklists for qualitative studies to
critique and evaluate the quality of qualitative studies. We then extracted their results and classified
the content according to the main and subtopics. A total of 16 articles met the inclusion criteria of
the present study. Hospitals can play four roles: stand‑alone, dominant, collaborative, and partner.
Findings were classified into six general groups: the role and mission of future hospitals, the way
of providing care, funding, staff and patients, technology and information of future hospitals, and
the challenges and barriers of current hospitals. Health service policy‑makers need to pay special
attention to technological innovations and advances as well as changes in the roles and functions
of hospitals and seek to turn the threats arising from external changes into opportunities for better
hospital performances.

Abstract BACKGROUND: Since the field of health professions education (HPE) is an emerging trend in the
country, educationists face considerable challenges in their workplaces while proposing any changes
in the existing systems of academic institutions. The challenges affect the quality of work, hinder
innovation, and create a dysfunctional work environment, non‑conducive for both personal and
professional progress. The study was conducted to explore the various kinds of challenges faced
by educationists while bringing changes to the existing systems of academic institutions in Pakistan.
MATERIALS AND METHODS: A qualitative exploratory research design was used to explore the
challenges faced by health professions educationists in Pakistan during their efforts to bring about
changes in the existing systems and structures. Thirteen health professions educationists working
in various academic institutions of Pakistan were interviewed through one‑to‑one semi‑structured
interviews from March to May 2022. The data obtained were analyzed through manual thematic
analysis, and themes and subthemes were identified.
RESULTS: Four themes emerged after qualitative data analysis explaining the predominant
challenges faced by educationists. These included challenges related to faculty and staff, institutional
constraints, challenges from leadership, and stakeholders’ apprehension.
CONCLUSION: Challenges are inevitable at every workplace but the field of health professions
education in Pakistan faces significant challenges in institutions, leading to hindrance in positive
developments and innovations in the field. Educationists should be skilled at recognizing the
predominant challenges in the workplace and be equipped with strategies to manage conflicts to
achieve productive results and to promote the long‑overdue reforms in the field.

Abstract BACKGROUND: This study was designed to evaluate the impact of the COVID‑19 pandemic on
the learning status of students from different educational boards and universities of Nepal. An online
survey was conducted from tenth to twentieth of September 2020 to record the data.
MATERIAL AND METHODS: A self‑designed questionnaire link, using “Google form” was sent to
the students via social networks. A total of 589 participants shared their complete information. The
simple percentage distribution was employed to evaluate the learning status of the students.
RESULTS: During the lockdown period, >70% of the students were engaged in online classes, most
commonly by using the Zoom app. The majority of the students were using WIFI as an internet source
to attend online classes. Students have been suffering from various problems related to anxiety,
stress, economic crises, poor internet connectivity, deprivation of study materials, required e‑learning
accessories, and an unsuitable study environment. Mainly, students from remote areas and middle
income families suffered enormously. Among those participants, who were able to attend the online
classes, the majority of students (70%) were dissatisfied with the ongoing online classes. Only 23.3%
of the participants suggested the feasibility of online classes in the near future.
CONCLUSION: Our study recommended that training teachers and students about online classes
might create effectiveness toward e‑learning. The government needs to provide free internet
services to the remote areas and the poor students since in the current scenario, huge numbers of
the population are struggling with the economic burden.

Abstract BACKGROUND: This study aimed to determine the perception, perspectives, and behaviors of
health‑care providers, as well as cues to action toward interprofessional education (IPE).
MATERIALS AND METHODS: The interview sessions were conducted from August 2020 to
November 2020 at the College of Pharmacy, Gulf Medical University (GMU), Ajman. The invited
participants belonged to all the colleges which are a part of GMU, providing academic and practice
support to the university. All were residents of UAE, and both genders were considered for qualitative
assessment. The sample size based on data saturation plus two as standard guidelines in qualitative
res earch. All the interviews were audiotaped for verbatim transcriptions. All the recorded interviews
were transcribed to avoid bias. The prepared transcripts were then verified for accuracy by the
relevant participant and after approval, data were analyzed. In case of an emergent theme, all the
investigators were focused on refining the analysis.
RESULTS: A total of 17 health‑care professionals (HCPs) were interviewed. The participants were
chosen from five different colleges at GMU. All the participants had similar perceptions about IPE,
as it is a collaboration between different HCPs to achieve better patient outcomes. A diversity in
perspectives toward IPE was found among the participants. Several barriers were identified during
the interview session and also highlighted the importance of choosing the right topic for IPE, as it
affects planning of the activities greatly. The participants also stressed that the lack of communication
also contributes to decreased involvement of HCPs.
CONCLUSION: This study identified inefficient implementation of IPE. The barriers were lack of team
effort, lack of communication within the institute, and administrative support, despite the availability
of resources and infrastructure in the university.

Abstract BACKGROUND: Fear of childbirth is a common problem during pregnancy, which can give rise to
sleep disorders and diminish sleep quality. This study aimed to determine the effect of cognitive–
behavioral training on fear of childbirth and sleep quality of pregnant adolescent slum dwellers who
visited the slum health centers of Zahedan city, Iran, in 2020.
MATERIALS AND METHODS: This quasi‑experimental study was conducted in 2020 on 100 pregnant
adolescent slum dwellers between 11 and 19 years old at 24–28 weeks pregnant. Multi‑stage sampling
was used and the participants were randomly divided into an intervention and a control group. The
intervention group received four sessions of cognitive–behavioral training at weekly intervals. The
control group only received routine care. The Wijma Delivery Expectancy/Experience Questionnaire
and the Pittsburgh Sleep Quality Index were filled before and 4 weeks after the training course.
The data were analyzed in SPSS 21 using independent t‑test, paired t‑test, Fisher’s exact test, and
Chi‑squared test. and covariance. A P value of < 0.05 was considered significant.
RESULTS: After the intervention, the fear of childbirth significantly decreased (P = 0.004), and sleep
quality significantly improved (P = 0.001) in the intervention group compared with the control group.
The results of analysis of covariance to control the significant effect of pre‑test scores showed that
the mean score of fear of childbirth (P = 0.03) and mean score of sleep quality (P = 0.001) in the
two groups after the intervention was statistically significant.
CONCLUSION: The results showed that in addition to reducing fear of childbirth, cognitive–behavioral
training improved the sleep quality of women in the intervention group. Therefore, this training could
be used as an easy and accessible method without complications to improve women’s health.

Abstract BACKGROUND: Graduates’ job performance has become a matter that needs urgent attention.
This is because many stakeholders are increasingly becoming interested in understanding the
extent schools are able to produce output that meets the yearnings of society. Along these lines, we
examined the contributions of alcohol intake to the job performance of higher education graduates
while treating mental stress and psychotic experiences as mediators in the nexus.
MATERIALS AND METHODS: The study's population comprised all the graduates of higher education
institutions in Nigeria between 2015 and 2020. Data were collected from a virtual cross‑section of
3,862 graduates who self‑reported to have taken alcohol in the past. These participants responded
to an electronic questionnaire that was mailed to them. The scale content validity for clarity and
relevance were 0.90 and 0.88, respectively, while the Cronbach alpha reliability estimate of the
instrument is 0.86.
RESULTS: Amongst many others, key findings indicate that alcohol intake, mental stress and
psychotic experiences jointly made a significant negative contribution to the overall job performance of
graduates (R2 = 0.256, 95% confidence interval (CI) [0.23, 0.28], P = 0.00). Mental stress (B = −0.09, β
= −0.14, z = −4.45, 95%CI [−0.24, −0.05], P = 0.00) and psychotic experiences (B = −0.26, β = −0.43,
z = −8.07, 95%CI [−0.68, −0.16], P = 0.01) have significant negative contributions to graduates’ job
performance, respectively. Alcohol intake and mental stress jointly predict the psychotic experiences
of graduates (B = −0.26, β = −0.43, z = −8.07, 95%CI [−0.68, −0.16], P = 0.01). Alcohol intake has a
positive contribution to the mental stress of graduates (R2 = 0.797, 95%CI [0.77, 0.825], P = 0.01).
Mental stress and psychotic experiences jointly mediated the relationship between alcohol intake
and graduates’ job performance.
CONCLUSION: It was concluded that high intake of alcohol and high levels of mental stress and
psychotic experiences significantly reduce graduates’ job performance generally and in specific
aspects. Alcohol intake can increase graduates’ job performance to a small extent depending on
the amount consumed.

Abstract BACKGROUND: Recognition of the factors influencing returning to work by people after heart
surgery is very significant in performing supportive interventions. Factors affecting return to work of
Iranian patients after surgery are unknown. Therefore, a qualitative study is in demand in order to
close this knowledge gap. This study was aimed to explore the facilitators and barriers of return to
work after heart surgery.
MATERIALS AND METHODS: This qualitative study was conducted during 2020–2021. People after
heart surgery were studied in this research. Nineteen interviews were performed with 17 participants.
The main participants were selected from the cardiac surgery ward of Golestan Province Hospital.
The sampling method was purposeful. Data were collected through semi‑structured interviews.
Questions were asked in an unguided and open‑ended manner. Data analysis was performed by
qualitative content analysis.
RESULTS: According to the results, “perceived psychosocial support,” “individual characteristics,”
and “occupational factors” were considered as facilitators and “effects of heart surgery” and “limited
support of public and private institutions” were introduced as barriers to return to work in patients
after heart surgery.
CONCLUSIONS: The effects caused by heart surgery and limited support of public and private
institutions were identified as barriers to return to work. Cardiac rehabilitation after surgery can
reduce the impact of heart surgery and can help people to return to work. It is recommended that
the planners of the Ministry of Labor and Social Welfare and Health, with the support of insurance
organizations, help solve the work problems of people after heart surgery.

Abstract BACKGROUND: Disaster planning and management pose a serious challenge to most countries.
These challenges point to insufficient planning to deal with these events. Therefore, it is necessary
to pay attention to the methods and characteristics of the decision‑making approaches in these
events. In this study, we tried to identify most appropriate approaches for the Iranian health system
by studying disaster planning approaches.
MATERIALS AND METHODS: This study was conducted using mixed methods in 2020–2021
in two phases: qualitative and quantitative. First, we reviewed at the research literature. Our goal
was to identify studies that suggested approaches to disaster planning. The next step in this study
was a qualitative study using semi‑structured interviews. Participants in qualitative phase included
managers and employees from different parts of the Iranian health system from the provinces of
Golestan, Fars, Khuzestan, Lorestan, Kerman, Sistan, and Baluchestan.
RESULTS: By combining approaches taken from literature reviews and qualitative study, four main
approaches were identified. The results of our study have shown that disaster response planning
approaches include function, risk assessment, capability, and futuristic base.
CONCLUSION: This study provides complete overview of disaster planning approaches that enable
health professionals to use them to develop response plans. Our findings indicate that in complex
and large‑scale events such as floods and pandemics, it is necessary to combine the introduced
methods for operational planning.

Abstract BACKGROUND: Psychological well‑being is an important part that undergraduate students and
universities cannot neglect as it helps students lead a better study life at the university. Various
studies revealed that social support can affect students’ psychological well‑being. However, the causal
relationship between social support and psychological well‑being has received little attention in North
China. Therefore, the aim of the current study was to analyze the causal relationship between social
support and psychological well‑being among undergraduate students in North China.
MATERIALS AND METHODS: The survey approach was adopted and conducted with a total of 689
undergraduate students in North China. Data were collected using a reliable questionnaire. Data
analysis was performed with descriptive statistics, Pearson’s correlation, and structural equation
modeling at P < 0.01 significance level using Statistical Package for Social Sciences (SPSS) and
Linear Structural Relations (LISREL).
RESULTS: The overall levels of social support and psychological well‑being among undergraduate
students in North China were high. All observed variables in this study were significantly correlated.
The findings also confirmed that the causal relationship between social support and undergraduate
students’ psychological well‑being in North China fitted to the empirical data well (χ2 [22, N = 689]
= 27.69, χ2
/degree of freedom [df] = 1.26, P = 0.19, goodness of fit index [GFI] = 0.99, adjusted
goodness of fit index [AGFI] = 0.98, comparative fit index [CFI] = 1.00, standardized root mean square
residual [SRMR] = 0.02, root mean square error of approximation [RMSEA] = 0.02).
CONCLUSIONS: Undergraduate students’ psychological well‑being had been significantly affected
by social support in North China. The findings from the current study will be useful for university
administrators to develop strategies for the enhancement of undergraduate students’ psychological
well‑being.

Abstract BACKGROUND: Education and assessment have changed during the COVID‑19 pandemic so that
online courses replaced face‑to‑face classes to observe the social distance. The quality of online
assessments conducted during the pandemic is an important subject to be addressed. In this study,
the quality of online assessments held in two consecutive semesters was investigated.
MATERIALS AND METHODS: One thousand two hundred and sixty‑nine multiple‑choice online
examinations held in the first (n = 535) and second (n = 734) semesters in Birjand University of
Medical Sciences during 2020–2021 were examined. Mean, standard deviation, number of questions,
skewness, kurtosis, difficulty, and discrimination index of tests were calculated. Data mining was
applied using the k‑means clustering approach to classify the tests.
RESULTS: The mean percentage of answers to all tests was 69.97 ± 19.16, and the number of
questions was 34.48 ± 18.75. In two semesters, there was no significant difference between the
difficulty of examinations (P = 0.84). However, there was a significant difference in the discrimination
index, skewness, and kurtosis of tests (P < 0.001). Moreover, according to the results of the clustering
analysis in the first semester, 43% of the tests were very hard, 16% hard, and 7% moderate. In the
second semester, 43% were hard, 16% moderate, and 41% easy.
CONCLUSION: To evaluate the tests’ quality, calculating difficulty and discrimination indices is
not sufficient; many factors can affect the quality of tests. Furthermore, the experience of the first
semester had changed characteristics of the second‑semester examinations. To enhance the quality
of online tests, establishing appropriate rules to hold the examinations and using questions with
higher taxonomy are recommended.

Abstract BACKGROUND: Health literacy (HL) is the ability of a person to acquire the process, understand the
necessary health information, and make the health services needed for conscious health decisions.
Besides, diabetes is the most common metabolic disorder that affects patients’ quantity and quality
of life. This study focused on determining the factors that affect the HL status of patients with type 2
diabetes (T2D) through the role of the demographic variables.
MATERIALS AND METHODS: This descriptive‑analytical research survey recruited a sample
based on 280 patients with T2D at the Diabetes Research Center of Ayatollah Taleghani Hospital
in Kermanshah in 2020. This study selected patients with T2D using a simple random sampling
technique. The study applied the demographic information questionnaire and the Functional,
Communicative, and Critical HL Scale to collect data from patients with T2D. This study used the
SPSS version 23 on the received data sets to perform statistical analysis, including t‑test, analysis
of the variance, and multiple regression, to predict the factors affecting HL among diabetes patients.
RESULTS: The study results showed that the mean age of the participating patients with T2D was
55.80 ± 13.04. The results indicated the mean score and standard deviation of total HL score in patients
with T2D 2.70 ± 0.44. The findings specified a statistically significant relationship between HL, gender,
education, occupation, income, and place of residence. Results indicated that β‑coefficients of the
multiple regression analysis and the income variable (β = 0.170), age (β = 0.176), and employment
variable (β = 0.157). These are the most predictive of the HL of patients with T2D.
CONCLUSION: The results of this study specified that the HL rate of individuals with diabetes type 2
is average. The potential communicative and critical HL influence is essential for communication and
education for diabetes patients in the primary health‑care system settings. The findings indicate that
communicative and critical HL related to patients’ management and functional HL looks passable
in this study.

Abstract BACKGROUND: All health care workers including nurses are working in the frontline against
coronavirus disease 2019 (Covid‑19), which keeps them at high risk of getting infected. This study
was conducted to identify risk factors for Covid‑19 infection and compliance to Covid appropriate
behavior among nurses.
MATERIAL AND METHODS: A cross‑sectional study was conducted on 150 nurses in a tertiary
care hospital attached to a medical college in Mumbai, from April 2020 to December 2020. Data
were collected telephonically using an interviewer‑administered pre‑validated, semi‑structured
questionnaire. Data entry and analysis were performed using SPSS version 21.0.
RESULTS: The mean age of the nurses was 38.19 ± 12.14 years. The majority (80.7%) were exposed
to Covid‑19 while taking active care of Covid patients; a total of 108 (72%) were symptomatic at
the time of testing; dietary modifications because of fear of Covid were performed by 121 (80.2%);
92.77% used the appropriate personal protective equipment (PPE) category according to the
workplace; 121 (80.77%) followed all steps of donning and doffing at all times, and 19 (12.77%)
reported a breach in PPE. A greater proportion of nurses working in Covid duties opted for hospital
isolation than home isolation (p = 0.003). Risk factors such as sleep, shift duty, shift pattern, food
timing, mode of travel, and type of PPE during travel were also found to be significantly associated
with work type – Covid versus non‑Covid (p < 0.05).
CONCLUSIONS: Use of workplace appropriate PPE, proper donning and doffing facilities, duty shifts
with a fixed duration, adequate hand hygiene practices, and regular food intake with adequate sleep
can prevent Covid‑19 infection at the workplace among nurses.

Abstract BACKGROUND: In recent decades, the prevention of domestic violence against women (DVAW)
has been considered a priority for women’s health in many countries. Identifying factors related to
DVAW by their husbands or intimate partner can promise prevention and decrease in prevalence.
The objective of this study was to examine and compare associated factors of domestic violence
based on demographic characteristics and some life skills.
MATERIALS AND METHODS: This cross‑sectional study was conducted in Abadan, Iran. 640
couples completed questionnaires including demographic characteristics, communication skills,
anger management, and problem‑solving skill. In addition, women completed the questionnaire on
domestic violence. Data were analyzed using descriptive statistics (t‑test and one‑way analysis of
variance) and multiple linear regression.
RESULTS: Approximately 57% of the women in this study have been subjected to psychological
violence in their lifetime by their husbands. The result of multiple regression indicated that demographic
characteristics had a very small contribution to explaining domestic violence (R2 = 0.03) and only
the education level of women was identified as a key predictor of domestic violence. The result of
multiple regression based on life skills among couples demonstrated that communication skills and
anger management of couples were inversely and significantly associated with domestic violence
and these variables explained 51% of the variance in domestic violence.
CONCLUSIONS: Empowering couples with anger management and communication skills can play
an important role in decreasing domestic violence. Therefore, developing and planning educational
interventions by policymakers and health care providers seems necessary for couples.

Abstract BACKGROUND: This study aimed to investigate how medical students perceive their educational
environment, as well as the implications of motivation, learning strategies, and the factor of emotional
intelligence on academic achievement.
MATERIALS AND METHODS: In a cross‑sectional study, 3384 undergraduate students were
recruited from randomly selected Egyptian medical colleges. Students from second to final year, taking
fundamental and clinical courses and, at a minimum, three professional exams, were enrolled and
subjected to the Dundee Ready Educational Environment Measure scale, the Motivated Strategies
for Learning Questionnaire, and Emotional intelligence questionnaire.
RESULTS: The overall mean age of the studied students was 21.42 ± 1.61 years. Females
represented 63.5%, rural residents were 52.2% and students with enough income represented 88.0%.
The traditional system adopted 28.4% of the students versus 71.6% in the integrated system. Linear
regression using path analysis was conducted to study the predictors of academic achievement, and
it revealed that motivation was the highly significant predictor of academic achievement (β = 2.68,
CI95%:2.35–3.05, P < 0.001), followed by learning (β = 1.09, CI95%:0.80–1.41, P < 0.001), emotional
intelligence (β = 0.92, CI95%:0.87–0.97, P < 0.001), and the educational environment (β = 0.14,
CI95%:0.13–0.15, P < 0.001).
CONCLUSION: The study’s findings have implications for medical educators trying to understand the
personal factors that influence learning and performance in medical school. Students’ motivation was
the highly significant predictor of academic achievement followed by learning, emotional intelligence,
and educational environment. Perception of the learning environment had improved because of
the integrated student‑centered system, which fosters motivation and emotional intelligence. To
improve learners’ EI, optimal learning, and educational outcomes, the EI components can be taught
and fostered.

Abstract BACKGROUND: Case‑based learning is a modern learning approach, aims to prepare students
for practical skills. In the present study, we aimed to determine the effectiveness of case‑based
e‑learning (CBEL) on the academic performance and problem‑solving ability of nursing students.
MATERIALS AND METHODS: In this pre‑ and post‑test study, census sampling method was used
to select 128 nursing students who had nutrition courses during 2015–2017 at (blinded). Before and
after the educational intervention, the students completed the problem‑solving inventory including
problem‑solving confidence (PSC), approach‑avoidance style (AA), and personal control (PC) and a
scientific test for evaluating academic function. Continuous variables before and after the intervention
and categorical variables were analyzed using paired t‑test and Chi‑square test, respectively.
RESULTS: The mean scores of PSC, AA, and PC decreased after the intervention (P < 0.001). The
mean scientific score of the students improved after the intervention (P < 0.001).
CONCLUSION: This study showed that the CBEL method had a positive effect on the ability to solve
the learning problems and the academic performance of the students and can be used to train nurses
to improve their ability to confront clinical problems in the future.

Abstract BACKGROUND: Depression among elderly is an emerging public health concern. Along with other
comorbidities, depression affects the quality of life and functional ability of the geriatric population.
This study aimed to assess the depression and quality of life among elderly and compare these
parameters among the inhabitants of old age home and in the community.
MATERIALS AND METHODS: A cross‑sectional study was conducted among the elderly of the
community and old‑age homes in the urban areas of Raipur, Chhattisgarh between March and
July 2016. Hundred elderly (50 in each group) participated in the study. Geriatric Depression Scale
15 (GDS‑15) and Older People Quality of Life (OPQoL)‑35 scale were used to assess the geriatric
depression and quality of life, respectively. Association between depression and demographic
variables were analyzed by Chi‑square/Fisher’s exact test. Pearson’s correlation coefficient was
calculated between GDS‑15 and OPQoL‑35 scale.
RESULTS: The prevalence of geriatric depression was 59%. Quality of life was better among the
old‑age home elderly participants than that of community elderly when compared for score of life
over all (11.78 vs. 13.56), health (12.8 vs. 14.0), social relationship (10.48 vs. 13.9), control over
life (11.92 vs. 14.08), home and neighborhoods (9.38 vs. 12.36), psychological and emotional
wellbeing (10.96 vs. 13.7), financial circumstances (14.5 vs. 16.7), and leisure and activities (13.86 vs.
15.28). Moderate positive correlation was observed between depression and quality of life.
CONCLUSION: The higher prevalence in our study emphasizes the need to delineate the actual
burden in the elderly population and provide necessary supportive measures. It needs to be addressed
adequately through a coordinated primary care approach and community and social support. Timely
and adequate management of depression can improve the quality‑of‑life outcomes.

Abstract BACKGROUND: Social participation and group interaction are the basic and expected indicators of
serving in the job of the faculty. Some improvements are needed for universities and professors in
this area, which they can be better identified by studying the main beneficiaries. In this regard, this
study was aimed to identify strategies to increase social capital and interaction of medical universities’
faculty members.
MATERIALS AND METHODS: This qualitative study which was a qualitative content analysis type
was performed on 22 faculty members of Isfahan, Mashhad, Tabriz, Iran, Army, Shahrekord, Sabzevar,
Arak, and Khomein universities through semi‑structured interviews and purposive sampling. Data
were analyzed using qualitative content analysis.
RESULTS: According to finding, in order to improve the social interactions of medical universities’ faculty
members, there were 2 factors and 8 main categories including organizational factors (“organizational
dynamics,” “organizational security,” “standardization of selection and evaluation,” “value creation,”
and “establishing a compensation system”) and individual social factors (“education and social
programs,” “personal skills and beliefs promotion,” and “personality and learning”).
CONCLUSIONS: The obtained strategies in this study to improve social capital and group interactions
and group participation of medical universities’ faculty members can be planned and implemented
by managers and can be used for faculty members themselves.

Abstract BACKGROUND: The impact of Coronavirus Disease‑19 on peoples’ life has become evident.
Recently, sport activities are important in improving individual health and their well‑being. The aim of
this study is to investigate the effect of using mobile phone fitness applications on some characteristics
of physical fitness and psychological well‑being of female university students.
MATERIALS AND METHODS: A descriptive study design was implemented using a survey which
was adapted to collect data from a sample of 50 female participants within the age of 18 to 19 years.
As for the results, the participants indicated that they used physical fitness application by smart
phone regularly during COVID‑19.
RESULTS: The results also illustrate that there was a significant difference on the study variables
based on the study groups and test time. The study results extend literature concerning sport activities
participation and promoting positive well‑being during COVID‑19 pandemic.
CONCLUSION: The study indicated a significant difference of the application on physical fitness
and psychological well‑being among the participants. Based on the results, the study recommended
to organize several sport activities among students and encourage them to use smart phones for
positive purposes. Finally, practical implications are outlined.

Abstract BACKGROUND: Although older people are at a higher risk of COVID‑19 infection, there is a lack of
research that focuses on COVID‑19 in older people in Malaysia. Therefore, the aim of this study was
to assess the level of knowledge and attitudes related to COVID‑19, and to identify the association of
sociodemographic background with knowledge and attitudes towards COVID‑19 among older people.
MATERIALS AND METHODS: This is a cross‑sectional study involving 382 older people living
in the community in Malaysia. Data was collected using convenience sampling through an online
questionnaire that consisted of three parts: sociodemographic details, knowledge, and attitude
related to COVID‑19.
RESULTS: The overall correct rate of knowledge was 77.3%, indicating that participants had slightly
good knowledge related to COVID‑19. The participants showed a positive attitude with a mean
score of 26.0 (SD = 5.0). There were significant associations between knowledge and education
level (P = 0.00) and marital status (P = 0.02). Marital status was significantly associated with
attitude towards COVID‑19 (P = 0.03). A weak positive correlation was found between knowledge
and attitude (r = 0.17, P = 0.00) suggesting that an increase in knowledge will increase the positive
attitude among older people.
CONCLUSION: Older people reported good knowledge and positive attitudes towards COVID‑19.
The Malaysian government should provide relevant health education for those with lower education
levels and divorced or widowed to improve knowledge and attitudes towards COVID‑19.

Abstract BACKGROUND: The outbreak of COVID‑19 pandemic has made it difficult for older adults to utilize
ordinary elder services. This cross‑sectional study investigated the status of feeling the need, seek,
and utilization of health promotion services among older adults in Ardabil, Iran, covered by the
country’s comprehensive health system during the pandemic.
MATERIALS AND METHODS: This descriptive‑analytical and cross‑sectional study was conducted
on 739 elderly people in Ardabil province. Cluster random sampling method was used for sampling.
Data were gathered by referring trained individuals to the place of residence of the selected older
adults Questionnaires were consisted of three parts: demographic information, household’s economic
status, and feeling the need, seek, and utilization from health promotion services. Multivariate logistic
regression was used to separately model the need, seeking for, and utilization of health promotion
services in STATA ver. 14.
RESULTS: The mean age of the older adults in this study was 68.88 ± 4.72 years. The results
indicate that men showed significantly greater need, seek for, and utilization of health promotion
services during COVID‑ 19 than women. According to the results, people over the age of 80 had
4.08 times (95% confidence interval [CI]: 1.99–12.60) more need and utilization of health services
than the older adults under 65 years. The results also indicate that use of health promotion services
was significantly associated with being married (3.74, 95% CI: 1.22–2.62), having primary insurance
and supplementary insurance (1.92, 95% CI: 1.21–3.12), and obesity (2.05, 95% CI: 1.13–3.76) in
P < 0.05 level. Based on the results, people with chronic disease and obesity were more likely to
utilize health promotion services.
CONCLUSION: Findings suggest that the access and utilization of inpatient and outpatient health
services by the elderly in the COVID‑19 pandemic has somewhat decreased, which could be due
to the fear of the disease being referred to health centers by the elderly. Hence, enabling conditions
such as parental health care were major factors affecting health‑seeking habits among the Iranian
elder population.

Abstract BACKGROUND: Work in informational technology (IT) professionals is highly competitive and stressful,
leading to job stress. This can lead to burnout, effort‑reward imbalance (ERI), and poor sleep quality.
MATERIALS AND METHODS: The present study examined associations of ERI, burnout, and
poor sleep quality among IT professionals using data from 200 software engineers (mean age of
29.3 ± 4 years, 32% women). ERI and overcommitment were assessed using Siegrist’s “effort‑reward”
questionnaire. The Oldenburg Burnout Inventory (OLBI) was used to assess burnout and Pittsburgh
Sleep Quality Index (PSQI) to assess sleep quality.
RESULTS: ERI, burnout and poor sleep quality were present in 72%, 60%, and 70%, respectively.
Females had higher ERI, burnout, and poor sleep quality compared to males. ERI is significantly
associated with burnout (r = 0.45, P < 0.01) and poor sleep quality (r = 0.31, P < 0.01).
Linear regression to assess the ability of ERI to predict levels of burnout yielded a statistically
significant (R2 = 0.206, P < 0.01) indicating ERI to be a unique incremental predictor of burnout
(b = 0.454, t = 7.16, P < 0.01). ERI tends to be a predictive factor of poor sleep quality with Odd’s
ratio = 3.5, 95%CI (1.81–6.73), P < 0.01.
CONCLUSION: In summary, Intervention programs both at the individual and at the organization
level have to be designed to combat ERI, burnout, and poor sleep quality among IT professionals.

Abstract BACKGROUND: Midwifery services help maintain and improve the health of the community. However,
a comprehensive examination reduces students’ psychological well‑being by creating anxiety. For this
purpose, the present study was conducted to determine and compare the effect of two educational
methods based on mindfulness and cognitive emotion strategies on psychological well‑being and
anxiety of eighth‑semester midwifery students before the final clinical trial.
MATERIALS AND METHODS: This study was a quasi‑experimental three‑group study with available
sampling method that was performed on 30 eighth‑semester midwifery students of the School of
Nursing and Midwifery of Isfahan University of Medical Sciences in 2020–2021. Data collection tools
were psychological well‑being and Test Anxiety Questionnaire. Two intervention groups were trained
for eight sessions. The control group did not receive any training program. The data collected by
SPSS version 22 software were analyzed by analytical statistical tests of ANOVA and least significant
difference post hoc test.
RESULTS: The results showed that there was a statistically significant difference between the three
groups in terms of components of test anxiety and psychological well‑being. Furthermore, emotion
regulation training and mindfulness‑based training reduced test anxiety and increased students’
psychological well‑being before the comprehensive test (P = 0.001).
CONCLUSION: It is recommended that educational programs be considered before the comprehensive
examination to promote the mental health and success of these students.

Abstract BACKGROUND: The corona virus disease (COVID‑19) pandemic has caused widespread effect on
the lives of health care professionals. The postgraduate medical students, who are the major pillars
of medical institutions had to bear multitude of setbacks due to the pandemic involving academic,
research and well‑being issues.
MATERIALS AND METHODS: This was a cross sectional feedback based online survey done in the
month of October 2021 to study the effect of COVID‑19 pandemic induced changes in the postgraduate
medical education; amongst 78 students pursuing MD/MS degree in all departments of a tertiary medical
institute in Himalayan foothills of North India. The questionnaire consisted of ten questions; each of which
needed to be answered on a five point Likert scale ranging from strongly disagree to strongly agree. Results
were assessed for the most common answers of each question (represented by mode) and association
between various components of the questionnaire analyzed by Spearman’s rho correlation coefficient.
RESULTS: The internal consistency of the questionnaire as tested by Cronbach’s Alpha (0.82) was
good. Most number or respondents were from surgical branches (n = 31, 39.74%). There was a
generalized agreement towards preference of resumption of onsite education (75.64%), the lack of
variety of cases causing hampering of thesis work (88.46%) and increased mental stress during the
pandemic (58.9%). While more time for self‑study was seen as the only consensual positive aspect
of online teaching (64%), most students opined that technical glitches are a major roadblock in
online education (80.76%). Significant positive correlation was seen between disciplinary ease and
punctuality in online teaching (R = 0.543, P < 0.001), lack of interaction and its effect on learning and
mental health (R = 0.471; P < 0.001) and the lack of diversity in cases and difficulties in dissertation
work (R = 0.351; P < 0.05). Negative correlation was observed between the satisfaction from overall
learning through online teaching and the desire of resumption of offline classes (R = −0.491; P < 0.001).
CONCLUSION: COVID‑19 pandemic and its effects on medical education are long lasting.
A comprehensive approach is required to rebuild the medical education curriculum, inculcating both
traditional and newer virtual methods of education. A consistent support in academics and overall
growth needs to be provided to medical postgraduate residents who have been the first line fighters
in face of the massive disaster compromising their basic needs and education.

Abstract BACKGROUND: Osteoporosis, the fourth most common disease in the world, affects the elderly
and postmenopausal women and imposes a great financial and social burden on individuals and
society. Furthermore, it has a significant impact on the quality of patients’ life. This study tries to
take an effective step toward improving the quality of patients’ life by developing and evaluating the
self‑care program of women with osteoporosis.
MATERIALS AND METHODS: In this research, a hybrid sequential design of quantitative and
qualitative type consisting of three phases is used. This mixed‑method study aimed to develop and
evaluate a self‑care program for women with osteoporosis.
CONCLUSION: Familiarity with the needs of these patients and the use of self‑care programs and
considering social, cultural, and psychological factors could be effective steps to improve the health
of women with osteoporosis. These steps can improve the quality of life and reduce the costs of
treatment for this group of women.

Abstract BACKGROUND: Nurse educators require to exhibit specialized behaviors that demonstrate the beliefs
of the nursing profession. The aim of the study is to explore the factors influencing professionalism
among nurse educators in the selected nursing educational institutes of Indian States.
MATERIALS AND METHODS: Qualitative approach was adopted where multiple focus group
discussions were planned and conducted. The study was carried out among nurse educators from
the Northern Indian states. Thematic analysis, using the argumentative interactions approach was
used. The consolidated criteria for reporting qualitative research (COREQ) guide were followed.
RESULTS: Three types of factors, that is, individual (micro‑level), organizational (meso‑level), and
external professional occupational (macro‑level) were explored, where individual factors emerged as
having a strong positive impact on nurse educators’ professionalism as compared to other factors.
Poor organizational infrastructure, privatization of educational institutions, and other related factors
were reported as having a negative influence on nurse educators’ professionalism.
CONCLUSION: Most of the educational institutions included in the present study, lacked basic
infrastructure/facilities for the professional development of nurse educators and professionalism.

Abstract BACKGROUND: Neonatal intensive care unit (NICU) is one of the accident‑prone settings in
the health‑care system. There is a series of structural and process threats to the safety of infants
hospitalized in this unit, which can be prevented by taking the right actions. For this purpose,
developing standards based on current knowledge, available resources, and the context that provides
care can determine patient injury prevention requirements. Likewise, it can be a source for national
development and application of related guidelines and protocols. This study aims to develop patient
safety standards in the NICUs of Iran.
MATERIALS AND METHODS: This mixed‑methods study will apply the exploration, preparation,
implementation, and sustainment framework to develop patient safety standards. In each phase of
this framework, a set of activities take place. Exploration is based on the world health organization
model to develop standards. Determining the validity and applicability of standards will be done in
Phase 2 (Preparation) and Phase 3 (Implementation), respectively. Since the long‑term effects are
not desired, the fourth phase (Sustainment) will not be considered.
DISCUSSION: Patient safety standards from this study will contribute to efficient and effective,
equitable, and high‑quality health‑care delivery. The application of them will further promote patient
safety and the quality of medical care in Iranian NICUs.

Abstract BACKGROUND: Workplace causes tress which negatively affects the physical as well as the
emotional well‑being of individuals. However, it is widely reported in the literature that a number of
factors have received significant attention in the professional life, stressing their significance to the
individual’s psychological, social, and professional life.
MATERIALS AND METHODS: The research is a descriptive that study adopted a quantitative
method, involving 40 female teachers. A survey method was randomly distributed to teachers who
are identified to have worked with students with disability using randomly sampling, and data were
then exposed to the descriptive statistics and Pearson correlation.
RESULTS: The results showed that respondents had good psychological resilience level with
moderate occupational stress level. Furthermore, a significant correlation between psychological
resilience and occupation stress is supported.
CONCLUSION: The present study indicated that the participants have acceptance level of
psychological resilience which helps them to reduce their stress when performing their work. The
study, therefore, encouraged decision academicians to regularly organize several positive counseling
and psychological training to the teachers.

Abstract BACKGROUND: COVID‑19 virus continues to be an international concern, challenging psychological
resilience in all areas, especially virtual education, making the psychopathology and problems more
evident.
MATERIALS AND METHODS: The present study is a qualitative study of conventional content
analysis, in which 24 participants (14 parents, 5 teachers, and 5 principals) were selected by purposive
sampling from primary schools in Zahedan. Data collection tools included semi‑structured interviews
with open‑ended questions. Interviews continued until reaching data saturation. The transcripts of
the interviews were coded according to Graneheim and Lundman’s 5‑step approach, and then, the
codes were classified according to the specified axes. For accuracy and exactness of information,
the researchers used the criteria of validity, verifiability, reliability, and transferability.
RESULTS: The results of this study include two categories, “e‑learning infrastructure” and
“psychopathology,” indicating the importance of creating, using, and strengthening cyberspace
infrastructure for the use of education in primary schools during COVID‑19 pandemic.
CONCLUSION: The results indicated that identifying these cases and attempting to eliminate them
can reduce psychopathology and improve the quality of virtual education for students. Moreover, this
can help principals and educational planners have new insights so that they can focus on solving
psychological problems in e‑learning and provide their supportive planning.

Abstract Osteoporosis is a systemic skeletal disease that is associated with negative physical and psychosocial
consequences, so understanding the effective strategies that can be used in the prevention of
osteoporosis is especially important. The aim of this study was to integrative review the published
interventional of nonpharmacological studies regarding the prevention and treatment of osteoporosis
among menopausal women. In this systematic review, databases such as PubMed, PsycInfo, Web
of Science (ISI), Scopus, ScienceDirect, EmBase, Cochrane library, Google scholar, and Iranian
databases, such as Scientific Information Database and Magiran, were searched. The latest search
was performed between “November 2020 and December 2020” separately by two researchers and
then double‑checked by them. The quality of the included studies was assessed using the Jadad
score calculation tool. Twenty eight randomized controlled trials and quasi‑experimental studies were
included in this current study. The quality assessment indicated that 19 studies had acceptable (good)
methodological quality and also 9 studies had weak methodological quality. The main results of this
study were classified in three main categories such as exercise or physical activity training (n = 15),
educational sessions (n = 11), and other interventions (n = 2). The results of most included studies
showed that nonpharmacological strategies such as physical activity and educational interventions
are considered as the appropriate actions to prevention of osteoporosis among menopausal women
so implementing these strategies can be a good alternative for women with contraindication of
hormone therapy or therapeutic treatment.

Abstract BACKGROUND: The outbreak of COVID‑19 pandemic has led to a paradigm shift from the
traditional classroom setting to online education and webinars. We could not identify any published
multidisciplinary studies from Indian institutions that have explored the perception of online learning
among health sciences students from different faculties.The study aimed to explore the perception
of health sciences students regarding their experience, satisfaction, and challenges with online
learning compared to offline learning.
MATERIALS AND METHODS: An explanatory sequential (QUAN–qual) mixed‑methods study was
conducted between November 2020 and June 2021 among 474 medical, nursing, physiotherapy, and
dental students attending online classes. All the students were invited to participate in the study using
Google Form questionnaire. Quantitative data was analyzed using MS Excel. For qualitative data,
focused group interviews were conducted with a group of six to eight students from each discipline
on an online platform for 45 min to 1 h and transcripts were thematically analyzed.
RESULTS: Totally 474 students responded to the survey questionnaire. Nearly 56.3% (267) of the
students were not satisfied with the online learning program. Around 62.2% (294) of the students
felt that online learning could not retain their interest. Students reported that learning the assigned
syllabus was difficult during online lectures. They agreed that online learning could be distracting,
time‑consuming, and did not provide an adequate pace of learning.
CONCLUSION: Though online learning is an effective learning strategy, it needs to be further
improved considering the valuable inputs given by students.

Abstract BACKGROUND: Health policymakers use a variety of policy tools. These policies are either based
on external factors or are based on paternal considerations; people may need to have help in the
selection of items that may be regretted about them in the future. However, recent research on
behavioral economics shows that major decision‑making mistakes are not only limited to vulnerable
groups but also are ubiquitous and systematic. The purpose of this study was on health policy making
with a behavioral economics approach in health promotion.
MATERIALS AND METHODS: The eligible studies were obtained from Medline (PubMed), Web of
Science, and Scopus databases. The search strategy uses a combination of keywords in the titles. The
keywords of behavioral economics along with the keyword of health have been used to find related articles.
RESULTS: After deleting duplicate articles, a total of 38 articles were identified. After reviewing
the title and abstract, 13 studies were omitted because they did not meet the inclusion criteria. Ten
articles were removed from the found articles due to the unavailability of the full text and four articles
were excluded because their method was quantitative. Finally, a total of 11 articles were eligible for
including this review study.
CONCLUSION: Recent research on behavioral economics shows that decision‑making errors are not
limited to vulnerable groups but are ubiquitous and systematic. Forgotten income or negligible income
is very high and is reasonably explained by transaction costs. Educational interventions often have
little effect and do not benefit from basic cost‑benefit tests. In addition, the seemingly insignificant
aspects of choice‑frameworks and assumptions‑often have a profound effect on behavior.

Abstract BACKGROUND: Transformation of education to virtual mode during COVID‑19 pandemic was a
major challenge for a clinical specialty like dentistry.
MATERIALS AND METHODS: A sequential explanatory mixed method was adopted with quantitative
dominant design. A self‑reported questionnaire on attitude and perceptions toward online learning
were distributed among dental undergraduate students. The qualitative arm explored perceptions of
online teaching among various stakeholders and thematic content analysis was performed.
RESULTS: A total of 141 responses were obtained, about 21% of them felt online classes to be
highly useful and 78% felt it was moderately useful. About 80% of the students were satisfied with
the online education. About 40% of participants felt internet connectivity was a frequent issue. The
qualitative data analysis revealed five emergent themes of lecture content and delivery, instructional
control, resource management, interaction, and evaluation exploring the perceptions of various
stakeholders toward online learning and provided several insights.
CONCLUSION: Though online education cannot be compared to traditional education in a clinical
specialty like dentistry, it does have its advantages and a portion of student learning can be conducted
through this mode.

Abstract BACKGROUND: The staff of health and dentistry schools can play an important role in encouraging
students and their clients to adopt health and preventive behaviors. The aim of this study was to
compare health‑promoting behaviors in staff and students of health and dental schools in Ardabil
University of Medical Sciences (ARUMS).
MATERIALS AND METHODS: This cross‑sectional descriptive‑analytical study was conducted in
2021. The research population was staff and students of health and dental schools. Staff sampling
was by census and students were sampled by simple random sampling. The data collection tool was
a questionnaire whose validity and reliability had been confirmed in previous studies. Data analysis
was performed using descriptive and analytical statistics tests using SPSS version 20 software.
Linear regression was performed using stepwise method.
RESULTS: The results showed that the mean score of the individuals was 99.2 ± 20.24. In the leveling,
the behaviors of 33 people (17.55%) were appropriate, desirable and good, and the health‑promoting
behaviors, 154 people (82.45%), were moderate and low. The correlation between age, gender,
marital status, and workplace of the individuals with health‑promoting behaviors was not statistically
significant (P > 0.05). The output of stepwise regression analysis showed that the variables were
significant and could predict the scores of health‑promoting behaviors.
CONCLUSIONS: Health‑promoting behaviors in <20% of students and staff are desirable, and in
more than 80% of them are moderate and poor. Therefore, educational administrators should use
these results in curriculum planning to increase health‑promoting behaviors of students and staff. The
score of health‑promoting behaviors is related to the above‑mentioned areas, but the relationship
may not be linear.

Abstract BACKGROUND: Augmented reality (AR) is capable of facilitating constructive learning through the
provision of a learner‑centered environment, making for more flexible learning and providing a more
distinct experience of learning. AR technology has a significant influence on the teaching approach
provided to students with learning disabilities, particularly on their level of self‑regulation, and this
premise is what motivated the present study.
MATERIALS AND METHODS: The research is a quasi‑experimental study that adopted a pre‑ and
post‑test control group design, involving 24 students who have disabilities. The students were divided
into AR group and control group, and data were then exposed to the descriptive statistics and paired
sample t test.
RESULTS: The results showed that AR technology has a significant effect on the enhancement of
the self‑regulation of students with learning disabilities.
CONCLUSION: The study indicated a significant effect of AR app on the self-regulation skills
of students. The study, therefore, encouraged decision academicians to implement technology
approaches in the disability setting.