Journal of Education and Health Promotion

Abstract

Abstract BACKGROUND: This cross‑sectional study aimed to evaluate attitudes and knowledge regarding 
oral health and infant oral health among pregnant women.
MATERIALS AND METHODS: The study involved 325 pregnant women in the Republic of Croatia 
who completed an anonymous online questionnaire (Google forms) from January to June 2019. The 
questionnaire was divided into three parts. The first part contained questions about the demographic 
data experience about oral health in pregnancy. The second part was related to the knowledge of 
the relationship between oral health and pregnancy. The third section consisted of questions related 
to knowledge about the oral health of children at the earliest age. The results were analyzed with 
descriptive statistics, Spearman correlation analysis, and Chi‑square test.
RESULTS: The women are mostly informed about oral health in pregnancy from their dentists (53.54%) 
and least from their general doctors (4%). In pregnancy, gingival bleeding was observed by 52.31% 
of respondents and tooth mobility by 12.31%. The Chi‑square test found that there was a difference 
in attitude regarding the age at which they should stop breastfeeding between respondents who had 
their first pregnancy and those who already had children. Only 9.23% of respondents are aware that 
breastfeeding can cause tooth decay.
CONCLUSION: Pregnant women in the Republic of Croatia do not have sufficient knowledge, and 
they are neither aware of the importance of oral health during pregnancy nor infant oral health.

Abstract BACKGROUND: COVID‑19 has led to significant morbidity and mortality globally in addition to 
unprecedented disruption in economic activities. Vaccination against it is considered to be the only 
sustainable way out of this pandemic. The study was conducted to estimate vaccine acceptance 
among doctors in India using an online survey.
MATERIALS AND METHODS: A cross‑sectional study using a purposive sampling method was 
conducted two weeks before vaccine rollout. A pretested questionnaire developed using Google 
forms was shared by social media groups targeting doctors only.The questions collected information 
regarding socio‑demographic details, knowledge, attitude and practices towards COVID‑19 
vaccination. Data was downloaded and analysed using SPSS‑v23. Chi‑square test and fisher exact 
test was used and P < 0.05 was considered significant.
RESULTS: A total of 511 records were included in the final analysis of which 340 (66.53%) reported 
to be either definitely or probably willing to accept COVID‑19 vaccine. One third of respondents were 
working in COVID‑19 designated hospitals (37.2%), 30% were posted in non COVID‑19 hospitals, 
25.1% had no direct contact with COVID‑19 patients while 7.7% doctors were involved in testing 
COVID‑19 diagnosis. Subjects who perceived a higher risk of contracting COVID‑19, those who 
perceived that vaccine would be effective against COVID‑19 and those who felt that vaccine will not 
have any serious side effects were more likely to accept the vaccine.
CONCLUSION: There is an urgent need to address any apprehensions regarding COVID‑19 vaccines. 
A tailored and intensified advocacy program for doctors is needed before the launch of vaccine.

Abstract BACKGROUND: According to the perception of majority of people, especially the elderly, it is believed 
that elderly people who are sent to old‑age homes are more prone to have depression compared 
to those who are living with the community. This study was aimed to assess the significance of the 
place of residence in relation to the presence of depression among the elderly.
MATERIALS AND METHODS: A cross‑sectional descriptive study was conducted between March 
and August 2020 to assess the depression among the elderly population residing in the Muar 
district, of Malaysia. A random table was generated of 250 house numbers in Muar where there is 
at least one geriatric person was living and a random sampling method was used for data collection. 
A questionnaire was distributed to a sample size of 250 old folks of Muar: those residing in old‑age 
homes (n = 125) and those residing in their own houses (n = 125). A standard sociodemographic and 
geriatric depression scale interview was employed for data collection. All details were keyed into the 
SPSS version 22 software Standard Gradpack 23, and simple description and inferential statistics 
such as mean, median mode, percentages, and Chi‑square tests were performed to compare the 
effects of different residences toward the mental health of the elderly.
RESULTS: The total mean age of the elderly in both the places was 73.06 ± 9.116 years. Female 
respondents of this research accounted for 52.8%. In terms of religion, Islam had the highest number 
of respondents of 46.8%, followed by Buddhist (33.6%), Christian (10.8%), and Hindu (8.8%). 
The percentage of elderly having more than three children was 45.2%. The marital status and 
employment status of the elderly in Muar area are mostly widowed (40.8%) and retired (50%). They 
are predominately literate (81.6%) and most have a monthly income less than RM 2000 (90.8%). 
We found that the prevalence rate of depression was 70.4% in the elderly residing in old‑age homes 
and 24.8% in the elderly living in the community. Females had a higher prevalence of depression 
than males (60.2% vs. 39.8%) among the elderly in old‑age homes, whereas males had a higher 
prevalence in the community than females (51.6% vs. 48.4%). Logistic regression analysis revealed 
the place of residence (P < 0.01 and employment status (P = 0.011) as the predictors of depression.
CONCLUSION: Results of this study revealed that the high prevalence rate of depression among 
the elderly is in old‑age homes compared to elderly living in the community.

Abstract BACKGROUND: To reduce the likelihood of transmission of infection to health‑care workers (HCWs), 
personal protective equipment is used. However, wearing personal protective equipment (PPE) 
increases the risk of heat stress and loss of dexterity, leads to poor compliance to PPE. To address 
the issues of poor compliance to PPE, it was necessary to gain a deeper understanding about the 
factors that influence compliance. Thus this qualitative study was planned to explore barriers faced 
by HCWs while using PPE during a pandemic situation in a tertiary care hospital, Uttarakhand, India.
MATERIALS AND METHODS: A exploratory qualitative study was undertaken among health care 
workers involved in the care of COVID patients. FGDs were done and an unstructured interview guide 
with open‑ended questions was used which helped to explore the factors which can be potential 
barriers to the HCWs while working wearing PPE.
RESULTS: Organizational and individual factors acting as barriers such as unavailability of essential 
personal protective equipment, a disharmonious work environment, lack of comfort, inadequate size, 
and quality of PPE were identified as the major barriers in the present study.
CONCLUSION: Future efforts to optimize PPE use should focus on to adequate supplies both in 
quality and quantity can help in avoidance of such barriers. Resources should be prioritized with the 
needs of the HCWs in the times of pandemic. Regular training and feedbacks are necessary for the 
satisfaction of HCWs and improving PPE compliance.

Abstract BACKGROUND: The World Health Organization declared vaccine hesitancy as one of the planet’s 
top 10 global health threats in 2019. With the rollout of the coronavirus disease‑19 (COVID‑19) 
vaccines, a survey was conducted to find out the hesitancy and the apprehensions that come along 
with taking COVID‑19 vaccines among health‑care workers (HCWs).
MATERIALS AND METHODS: This was an online cross‑sectional survey which was developed 
and shared through social media platforms among the HCWs of Kashmir. The survey captured 
demographic data and used a validated hesitancy measurement tool from January 2021 to February 
2021. The data were analyzed by descriptive statistics and multivariable logistic regression using Stata 
15 (Stata Corp. 2017. Stata Statistical Software: Release 15. College Station, TX: Stata Corp LLC).
RESULTS: Willingness to take the COVID‑19 vaccine when available was seen in 67.7% of the 
HCWs. Overall, 9.59% of respondents reported unwillingness to receive a vaccine for COVID‑19, 
while 22.7% were unsure. The most commonly cited reason for willingness to get vaccinated was an 
understanding of the disease and vaccination, as reported by 81.5%. Being single was significantly 
related to an increased risk of vaccine hesitancy (adjusted odds ratio = 5.27, 95% confidence interval: 
2.07–13.40). Among vaccine attitudes, concerns about the safety of the vaccine, unforeseen problems 
in children, and possible unknown future adverse effects of the vaccine were the most important 
determinants of unwillingness.
CONCLUSIONS: A significant proportion of the HCWs showed vaccine hesitancy to the COVID‐19 
vaccine. Hesitancy attitudes were almost always driven by concern around the vaccine safety. States 
and health‑care authorities need to recognize the massive trust deficit around the Covid‑19 vaccine 
and use the popular media used by people to share credible and reliable information.

Abstract BACKGROUND: Addressing good breastfeeding practices among antenatal and postnatal mothers 
is important as it helps in bringing about a positive change in the behavior, attitude, and practice 
with appropriate health education. Hence, this study was done to determine the awareness level 
of antenatal and postnatal mothers about the breastfeeding practices and benefits and identify the 
factors associated with it in rural Chengalpattu, Tamil Nadu, India.
MATERIALS AND METHODS: We conducted this community‑based cross‑sectional study among 
377 antenatal and postnatal mothers in the selected rural villages of Chengalpattu between October 
2019 and September 2020. Details regarding the sociodemographic characteristics and awareness/
knowledge about the breastfeeding were collected using pretested semistructured questionnaire. 
Knowledge adequacy was summarized as proportion with 95% confidence interval (CI), and factors 
associated with knowledge were interpreted as adjusted prevalence ratio (aPR) with 95% CI using 
log‑binomial regression.
RESULTS: About 19.6% (95% CI: 15.7%–24.0%) mothers had inadequate knowledge about 
breastfeeding. Women who were unemployed (aPR = 1.60; 95% CI: 1.02–2.51), belonging to the lower 
socioeconomic status (aPR = 2.62; 95% CI: 1.80–3.82), belonging to Muslim religion (aPR = 1.63; 
95% CI: 1.14–2.35), and living in joint family (aPR = 1.58; 95% CI: 1.12–2.21) had significant higher 
risk of inadequate knowledge about breastfeeding practices compared to those who were employed, 
belonging to upper socioeconomic status, Hindu religion, and living in nuclear family.
CONCLUSION: We found that almost one‑fifth of the antenatal and/or postnatal mothers had 
inadequate knowledge about the breastfeeding benefits and practices. Health education sessions are 
required to promote the awareness about breastfeeding during antenatal and postnatal check‑ups.

Abstract BACKGROUND: One of the most basic life events is fertility or reproduction, which, although known 
as a social phenomenon, is a complex and multidimensional concept with economic, cultural, political, 
and religious significance. The present study aims to explain the pattern of childbearing behaviors 
in couples.
MATERIALS AND METHODS: This study is a focused ethnographic qualitative research. Participants 
of this study will be 20–35 years old couples who, using purposeful sampling method, will be selected 
from comprehensive health centers, ultrasound centers, laboratories, premarital counseling centers, 
offices of obstetricians and midwives, universities, shopping centers, cinemas, parks, restaurants, 
and entertainment centers in Isfahan, Iran. Sampling will continue considering the strategy of 
maximum variation in terms of age, occupation, education, and economic status until data saturation 
is reached. Data will be collected through semi‑structured and in‑depth individual interviews, focus 
group discussions, observation, field notes, daily notes, and document analysis. Simultaneous with 
data collection, the data will be analyzed using the thematic analysis method based on Braun and 
Clarke’s approach.
CONCLUSION: This present study is expected to lead to a deep understanding and identification of 
the attitudes, beliefs, and values of couples with regard to childbearing. Moreover, by understanding 
the pattern of childbearing behaviors of couples, useful information will be provided to the policymakers 
and planners for effective planning in the field of healthy childbearing. The findings can also be used 
in reproductive health counseling for newly married couples and community‑based interventions.

Abstract BACKGROUND: COVID‑19 virus is on the rise globally, and people with the disease experience a 
variety of physical and mental problems. According to studies, depression can be a complication of 
the virus. So far, limited measures have been taken to prevent and treat emotional–psychological 
complications of COVID‑19. The aim of this study was to evaluate the effect of online cognitive 
behavioral therapy (CBT) on depressive symptoms in recovered patients with COVID‑19.
MATERIALS AND METHODS: This study was conducted in a quasi‑experimental design. A sample 
of 150 recovered patients with COVID‑19 who referred to Imam Reza Hospital in Tabriz city, were 
selected by random sampling method. The patients’ emotional–psychological status was assessed 
by the Beck Depression Inventory, and they entered the treatment process according to the inclusion 
criteria. As a therapeutic intervention, a scientific and valid approach called CBT was implemented, 
which two occupational therapists performed in eight treatment sessions in the context of a social 
communication application. Paired sample t‑test was used to analyze the time sequence of quantitative 
data due to its normality.
RESULTS: After the last session of the intervention, the effect of this therapeutic approach on reducing 
the depressive symptoms of patients was evaluated. According to the findings, the Beck score of the 
participants decreased significantly after the intervention (MD = ‒45/9, P < 0/001).
CONCLUSION: Therefore, in order to promote the recovery of patients with COVID‑19 and help 
health authorities to develop preventive measures and effective treatment of emotional–psychological 
problems caused by this virus, it is recommended to use the online CBT approach.

Abstract

Abstract BACKGROUND: Positive psychology introduce mental health as a positive psychological functioning 
and represent it as well‑being psychology. From this point of view, psychological health is more 
supposed to be known as having positive characteristics such as self‑esteem, positive social 
relationships, and satisfaction. This study was conducted to compare the effect of education in two 
methods of person‑centered and supportive group based on the PRECEDE‑PROCEED model on 
women’s psychological well‑being during menopause.
MATERIALS AND METHODS: The present study was a clinical trial. One hundred and ten 
menopausal women have been placed in two groups (tests and control). The training program 
was designed according to the PRECEDE‑PROCEED model. The educational intervention was 
implemented for two groups (person‑centered and the supportive group) and the control group did 
not receive any training. Data analysis was used by descriptive statistics and in the case of normal 
distribution of alternative tests such as Kruskal–Wallis test, Man–Whitney test, Wilcoxon, spearman 
correlation, Spearman correlation was used.
RESULTS: Results of variance analysis showed that awareness, attitude, self‑efficacy, enabling 
factors, reinforcement, support, behavioral environment, six psychological well‑being factors were 
significantly different from the individual group and control group. Furthermore, the overall score of 
the psychological well‑being was significantly higher than the control group.
CONCLUSIONS: As a result of the design and deployment of health care monitoring system, 
building and reform of community beliefs toward women’s status in decision making and their role 
in menopause, the design and development of support group meetings in women’s health care 
system and enhancing women’s access to specialist and heterogeneous health services tailored to 
the needs of the menopause.

Abstract BACKGROUND: Pregnancy may change sex life, this period may be associated with decreased sex, 
and this is due to fear of miscarriage, nausea and vomiting, fear of harm to the fetus, fatigue, and 
fear of ruptured membranes. Midwives could help them to improve their sexual life during this period. 
One of the important approaches to improving sexual life during pregnancy is cognitive‑behavioral 
therapy (CBT). This nonmedical approach could improve misconceptions about sex during pregnancy. 
The aim of this study was the effect of sexual health counseling based on CBT on sexual satisfaction 
and inefficient sexual beliefs of primigravida women.
MATERIALS AND METHODS: This was a randomized clinical trial study, the research population 
being 52 pregnant women who were randomly divided into groups, the experimental (26) and the 
control (26). Before the sexual health counseling based on CBT, the Sexual Satisfaction Questionnaire 
and the Inefficient Sexual Beliefs Questionnaire were filled by both the groups. These standard 
questionnaires were completed three times (before, immediately, and 4 weeks after intervention). 
After pretest, eight sexual health counseling sessions (90 min) were performed for the experimental 
group. The control group received routine care. Data analysis was performed by using descriptive 
statistics tests, ANOVA, and post hoc tests by Bonferroni method in SPSS version 22. P < 0.05 was 
considered statistically significant.
RESULTS: The mean score of inefficient sexual beliefs in the interventional group before intervention, 
immediately after the intervention, and 1 month later was obtained 22.85 ± 9.57, 12.92 ± 7.25, 
and 7.86 ± 13.88, respectively (P < 0.001). The mean score of sexual satisfaction before the 
study, immediately after the intervention, and 1 month later was 88.77 ± 11.89, 95.62 ± 9.27, and 
94.65 ± 8.28, respectively, in the experimental group (P < 0.001).
CONCLUSION: Sexual health counseling based on CBT could reduce inefficient sexual beliefs and 
increase the sexual satisfaction of the primigravida women during pregnancy, but most participants 
preferred fewer sessions.

Abstract BACKGROUND: Adolescence is a stressful time period. Adolescents experience new changes 
physically, mentally, emotionally, and socially. The purpose of this study was to determine the effects 
of acceptance and commitment therapy (ACT) on anxiety (primary outcome), depression, and quality 
of life (secondary outcomes) of adolescents.
MATERIALS AND METHOD: This was a quasi‑experimental study with pre and postintervention 
design. One hundred female students aged 16–18 years with mild to moderate anxiety selected 
through multistage cluster sampling from five educational districts of Tabriz. During six group 
counseling sessions, students were consulted with the acceptance and commitment approach 
according to the protocol. Beck Anxiety and Depression Inventory and the World Health Organization 
brief Quality of Life Questionnaire consultation were completed before, immediately after, and 8 weeks 
after the consultation. Data were analyzed using repeated measure ANCOVA.
RESULTS: The mean anxiety score decreased significantly immediately after the intervention (mean 
difference [MD]: −4.0, 95% confidence interval [CI]: −5.9 to − 2.0; P < 0.001) and 8 weeks later (MD: 
−3.9, 95% CI: −5.8 to − 1.9; P < 0.001). The mean depression score immediately (P < 0.001) and 
8 weeks after intervention (MD; −4.2, CI: −1.6 to − 6.8), P < 0.001) declined significantly. The mean 
overall quality of life score increased significantly after the intervention (P < 0.001) and 8 weeks 
later (MD: 4.7, 95% CI: 7.1–2.3, P < 0.001) compared to baseline.
CONCLUSIONS: Based on the effectiveness of counseling based on ACT on anxiety, depression, 
and quality of life in the female students with the mild and moderate anxiety over time, it can be used 
as a helpful method in high schools.

Abstract BACKGROUND: Burnout is a syndrome of emotional exhaustion, depersonalization, and low 
professional efficacy that health workers, especially nurses, experience the highest rates of this. 
Burnout causes stress and negative attitude towards work and feeling unable to perform tasks in 
the person. The purpose of this study was to investigate the effect of a method called compassion, 
awareness, resilience, and empowerment (CARE) on nurses’ burnout.
MATERIALS AND METHODS: This study was a semi‑experimental study with control group, the 
statistical population in this study was nurses of Kashani Hospital in Isfahan as intervention group and 
nurses of Al‑Zahra Hospital as control group. The samples were selected by stratified sampling. For 
both groups before and after and 3 months after the intervention, the burnout questionnaire (Maslach 
Burnout Inventory) was completed. The intervention was performed in 5 sessions of 90 min 1 day 
a week. Data were analyzed by SPSS version 25 software (IBM Inc., USA) and independent t‑test, 
repeated measures analysis of variance and Chi‑square test and Friedman test, significance level 
was set at P < 0.05.
RESULTS: The comparison of mean and intensity of burnout and two dimensions of emotional 
exhaustion and depersonalization showed a difference between the two groups and this difference 
was statistically significant (P < 0.05). Mean of Individual performance also had a statistically significant 
difference between the two groups (P < 0.05), but its intensity did not change.
CONCLUSION: CARE method can be effective in burnout of nurses and it can be used as a practical 
method. This training program can be implemented both preservice and in‑service for health workers.

Abstract BACKGROUND: Present study attempts to investigate health‑related quality of life (HRQoL) and its 
relation with knowledge, attitudes, and practices (KAP) of students of Tehran University of Medical 
Sciences (TUMS) during this pandemic.
MATERIALS AND METHODS: In this cross‑sectional study which was conducted between 23 may 
to 21 June 2020, 470 students in different levels of TUMS were included to the study randomly. 
participants completed validate, designed online questionnaire which assessed KAP towards 
coronavirus disease 2019 (COVID‑19) and HRQoL. All statistical tests were applied, including 
Chi‑square and Fisher’s exact test, Partial correlation, analysis of variance, multiple linear regression, 
multiple binary and multinomial logistic regression models (P < 0.05) and were performed in SPSS 
16, R 4.0.2, and GraphPad Prism 6.0 softwares.
RESULTS: A total of 470 students were included in the study. The overall correct answer rate of the 
COVID‑19 knowledge questionnaire was 74.43% and total score of the HRQoL was 72.50 (14.85). 
61.7% of the students were agreed that COVID‑19 will finally be successfully controlled, 44.3% had 
confidence that Iran can win the battle against the COVID‑19, and 92.6% agreed that Quarantine will 
reduce the prevalence of COVID‑19. Most of them adhered to health protocols and about a relation 
between HRQoL and knowledge we have a weak positive and unsignificant correlation between 
them (r = 0.05, P = 0.27).
CONCLUSIONS: TUMS students showed expected levels of knowledge, proper attitudes, and 
preemptive practices regarding COVID‑19, whereas COVID‑19 outbreak substantially affected 
the physical and mental health but, the students were in a way better physical health rather than 
mental. Therefore, motivational planning and other related intervention to improve mental health 
can be noticeable.

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

Abstract BACKGROUND: The current pandemic associated with SARS‑CoV‑2 has negatively influenced 
several activities, including teaching in Operative Dentistry. The aim of this study was to evaluate 
the influence of knowledge in Operative Dentistry on undergraduate students’ perception related to 
personal life and return to clinical practices classes during pandemic.
MATERIALS AND METHODS: The present research was a cross‑sectional, observational, and 
qualitative survey. The 16‑item based questionnaire was sent to undergraduate students in 2020, 
which were divided into two groups, according to the Operative Dentistry knowledge: G1‑not started 
clinical practice; G2‑already started or completed clinical practice. Questions were focused on the 
impact of the pandemic in relation to their personal lives and return to clinical practice classes. 
Chi‑square association test was performed using the SigmaPlot 12.0 software (P ≤ 0.05).
RESULTS: The response rate was 55.5% for G1 and 44.4% for G2. Regarding the questions related 
to personal life, G1 demonstrated higher percentages of fear of contracting the virus during theoretical 
classes. Same observations were found when students answered about their fear of contracting 
coronavirus during the clinical practice classes. However, G2 presented the highest agreement 
responses for the preparedness feeling to return to theoretical classroom, clinical practice classes, 
and the possibility of applying online learning.
CONCLUSIONS: In general, students’ knowledge had little influence on perception of personal life. 
However, students who have more knowledge in operative dentistry presented more security about 
returning to clinical classes.

Abstract BACKGROUND: Pregnancy causes a set of complex physiological and psychological changes that 
affect marital relationships. Mindfulness is a form of meditation that can promote person’s performance 
and perception of sexual relationships. The present study aimed to determine the effect of mindfulness 
on sexual desire and sexual satisfaction in primigravida pregnant women.
MATERIALS AND METHODS: The present study is a quasi‑experimental that has investigated 
on 72 primigravida pregnant women. The samples were selected randomly and assigned to 
experimental and control groups. The experimental group received six 90‑min sessions of mindfulness 
intervention, and the control group received the educational pamphlet. The female sexual function 
index (FSFI) was filled by the subjects of the two groups in three stages of before the intervention, a
week, and a month after the intervention. Data analysis was done by SPSS20 (Statistics 20 software;
SPSS Inc., Chicago, IL, USA) at the significance level of 0.05.
RESULTS: According to the statistical tests, there was no significant difference between the two
groups in terms of demographic characteristics and pregnancy information. The findings suggest
no significant difference between the mean pretest and posttest score of sexual desire in the two
groups (P > 0.05). However, the two groups were significantly different in terms of the mean score
of sexual satisfaction before and after the intervention (P<0.05).
CONCLUSION: By increasing the concentration on the present moment and avoiding judgment,
mindfulness can increase sexual satisfaction. However, sexual desire can be affected by various
factors such as the cultural context, the quality of marital relationships, and the pregnancy hormonal 
changes that can influence the sexual response.

Abstract BACKGROUND: One of the important challenges faced by health‑care system is to raise the level of 
knowledge of nurses about cerebrovascular accident(CVA) nursing care in the emergency department. 
Therefore, the aim of this study was comparison of two new educational techniques (noninteractive 
multimedia learning and workshop) on knowledge of nurses about CVA nursing care in the emergency 
department.
MATERIALS AND METHODS: This experimental study was conducted with a two‑group design. 
Sixty‑four eligible nurses working in the emergency department in selected hospitals affiliated to 
Isfahan University of Medical Sciences, Isfahan, Iran, were selected as the study participants. Nurses 
were randomly assigned into two groups of noninteractive multimedia (n = 32) and workshop (n = 32) 
using random number table. The data‑gathering tools including a demographic questionnaire (6 items) 
and knowledge questionnaire (24 items) were completed before and 2 weeks after the intervention in 
both the groups. Data were analyzed using SPSS 18 and descriptive (mean and standard deviation) 
and analytical statistics (ANOVA, independent t‑test, and paired t‑test). The level of statistical 
significance was P ≤ 0.05.
RESULTS: The result shows that independent t‑test showed that there was not a significant difference 
between the mean total scores of nurses’ knowledge before intervention in the two groups (P > 0/05). 
Furthermore, the results of paired t‑test showed a significant difference in the knowledge score 
2 weeks after compared to before the education in both the groups (P < 0.005). In addition, the 
results of independent t‑test showed a significant difference in the knowledge score 2 weeks after 
the intervention in the two groups (P < 0.005). The average knowledge score in the workshop group 
was significantly higher than in noninteractive multimedia learning group.
CONCLUSION: According to the result, new educational techniques such as noninteractive 
multimedia learning and workshop could improve knowledge of nurses about CVA nursing care in 
the emergency department.

Abstract BACKGROUND: Vaccine hesitancy is seen, globally, as a major factor that will determine future 
coronavirus disease‑19 (COVID‑19) spread and its effective management. This study aimed to 
identify COVID‑19 vaccine perception, acceptance, confidence, hesitancy, and barriers among the 
general population.
MATERIALS AND METHODS: This was an online survey which was developed and shared through 
social media platforms among the general population of Kashmir. The survey captured demographic 
data and used a validated hesitancy measurement tool. We analyzed the data using descriptive 
statistics and multivariable logistic regression using Stata 15 (Stata Corp. 2017. Stata Statistical 
Software: Release 15. College Station, TX, USA: Stata Corp LLC).
RESULTS: A total of 835 responses were received. Most participants were males, with females 
compromising of 19.5% participants. 65.1% of participants were in the age group of 30–50, whereas 
19.2% were below 30 years of age. 52.70% of respondents were willing to take the vaccine when 
available, while 32.5% of respondents were unsure about their decision of inoculation. The most 
cited reason for willingness to get vaccinated was an understanding of the disease and vaccination. 
41.70% felt that the vaccines developed against COVID‑19 have not been fully tested; therefore, 
concerns around the safety and its longer‑term side effects were the reasons cited. Public health 
messaging should be tailored to address these concerns.
CONCLUSIONS: Vaccine hesitancy is a global threat undermining the control of preventable 
infections. The government should take proactive steps to address the factors that may potentially 
impact the benefits expected from the introduction of a COVID‑19 vaccine in the union territory.

Abstract BACKGROUND: The world is worsely hit by the COVID‑19 pandemic resulting in increased morbidity 
and mortality. Increased mortality has been observed in older adults with multiple comorbidities. 
Six‑minute walk distance (6MWD) at admission can help us to guide the requirement of oxygen 
during hospital stay that can be used to determine which patient can be managed at home.
MATERIALS AND METHODS: This study was a prospective observational study conducted on 
COVID‑19 patients admitted at AIIMS, New Delhi, from October to December 2020. Patients aged more 
than 60 years were included in the study and underwent 6‑min walk tests. Polypharmacy and multimorbidity 
were also assessed along with dyspnea which was measured on BORG scale. P < 0.05 was considered 
statistically significant. Statistical software STATA (version 14.2) was used for all the analyses.
RESULTS: The mean age of the study population was 68.76 (7.4). Oxygen saturation prior to 
the 6‑MWT was normal and has significantly higher than the post test (P ≤ 0.001). 6MWD was 
significantly correlated with pre values of oxygen saturation. 6MWD was observed more in patients 
who did not require oxygen during hospital stay. Self‑reported dyspnea, pulse rate, oxygen saturation, 
and systolic blood pressure were significantly associated with the patients who had an oxygen 
requirement during the hospital stay.
CONCLUSION: Self‑reported dyspnea after 6MWT was found to be associated with oxygen 
requirement during hospital stay. Patients who have covered more distance in 6‑min walk test have 
less oxygen requirement during hospital stay hence can be managed at home. This will reduce the 
health‑care burden and will help to tackle the outburst during the ongoing pandemic.

Abstract BACKGROUND: Capturing the baseline information on awareness, practices, and prevailing 
myths related to the ongoing coronavirus disease‑19 (COVID‑19) pandemic in rural India will help 
in planning interventions to improve the health literacy on COVID‑19. The aim of the study was to 
assess the level of awareness, practices, and myths regarding COVID‑19 among rural population 
of Kolar district in South India.
MATERIALS AND METHODS: A concurrent mixed‑methods study with a quantitative 
community‑based cross‑sectional analytical design and a qualitative phenomenological design 
was conducted in five randomly selected villages during June 2020. A prevalidated and pretested 
semi‑structured questionnaire was administered to one adult in the households selected using 
systematic random sampling to capture the sociodemographic details and their awareness, practices, 
and myths related to COVID‑19. The supervisors additionally and concurrently used a nonparticipant 
observation technique to record the real‑time behaviors and preventive practices adopted by the 
villagers. Quantitative analysis was done using STATA and included multivariable regression 
analysis, and the association was reported using prevalence rates along with their 95% confidence 
intervals (CIs). Qualitative analysis was done manually as per discussion and concordance among 
supervisors and reported as categories along with supporting statements.
RESULTS: Among the 298 respondents, “poor awareness” was seen in 128 (43.0%, 95% 
CI: 37.5%–48.6%). Among the responders, 89 (29.9%) believed in the myth that “Corona disease is due 
to God’s wrath or curse.” The field observations were categorized under three categories – “avoidance 
of masks,” “nonexistent social distancing,” and “rampant spitting.”
CONCLUSION: About two in five villagers were found to have “poor awareness” to COVID, and 
practices related to COVID were found to be largely unsatisfactory. Lower level of education and 
belonging to nuclear family were associated with “poor awareness.” Various myths were identified 
that has to be debunked on priority basis by the government, especially targeting the people having low level of education in rural India.

Abstract BACKGROUND: The Government of India and State Government authorities are trying their best to 
provide adequate mental health services through various mental health policies and programs. To 
reduce the burden in psychiatric hospitals, Government has decentralized mental health services. 
Although Government has provided mental health services, the utilization has always been low due 
to many reasons. In the present study, an attempt was made to assess the accessibility and the 
barriers to utilizing mental health services with various community stakeholders.
MATERIALS AND METHODS: This is a qualitative study wherein data was collected from youth, 
women, geriatric groups, community key leaders, and Anganwadi workers. The primary data were 
collected through focused group discussions and interview methods. The collected data were 
analyzed using thematic coding.
RESULTS: A total of twenty‑five factors have been identified in the study, which were categorized 
under eight themes. (a) Lack of awareness and misinformation on mental health, illness, and 
available services, (b) Perceived causes for mental illness, (c) Reasons for not approaching health 
professionals, (d) Treatment adherence‑related issues, (e) No multidisciplinary team in private 
hospitals and lack of involvement in government sector (f) Manpower issues, (g) Quality of service 
issues and building confidence among community people, and (h) Belief system and stigma.
CONCLUSIONS: Inadequate mental health services, lack of awareness of mental health, and 
illness are still persist. The District Mental Health Program and other service providers need to reach 
communities, especially in remote areas. Periodical evaluation should be carried out to improve the 
utilization of mental health services.

Abstract BACKGROUND: Fruits and vegetable (F.V) consumption is the most pivotal strategy of preventing 
cardiovascular diseases, obesity, diabetes, and cancers. The present study aims to evaluate the 
effect of educational intervention based on social cognitive theory (SCT) on consumption of F.Vs 
among female high schools’ students in Rafsanjan (South of Iran).
SUBJECTS AND METHODS: This quasi‑experimental study was carried out among 272 
students (intervention = 134 and control group = 138) using a multistage sampling method. The 
instrument used in this study included demographic characteristics, the students’ F.V consumption 
during the past 7 days and its determinants based on the theory. Educational interventions were 
made in three sessions for students and two sessions for parents, teachers, and school officials. 
The data were analyzed by SPSS version 18 using the statistical tests of Chi‑square, independent 
samples t‑test, paired‑samples t‑test, and univariate model at a significant level of 0.05.
RESULTS: Three months after the educational program, mean scores and standard deviation 
of F.V consumption and constructs in the intervention group increased significantly (P < 0.001). 
Respectively, 22.2% and 36.1% of the changes in the average unit of F.V consumption were the 
result of the present educational intervention.
CONCLUSION: The intervention based on SCT with an emphasis on the interaction between student, 
family, and school has had an effect on F.V consumption behavior. Therefore, in forming behavior, 
attention is paid to the interaction of individual and interpersonal factors.

Abstract BACKGROUND: It is necessary to assess the level of preparedness to reduce the side effects 
of disasters, so regarding to the role of nurses in responding to the disasters, this is of particular 
importance. Holding a maneuver and exercises is one of the ways to increase the level of capability 
and assess the level of readiness, so the aim of the current study was to investigate the impact of 
the implementation of the operational exercises program on the competency of nurses in disaster 
response in 2020.
MATERIALS AND METHODS: The present study is a quasi‑experimental study in two groups, 
in which seventy nurses of hospitals affiliated to Shahrekord University of Medical Sciences 
were selected by census and randomly divided into two groups. Before the intervention, a native 
questionnaire to assess the competence of nurses in the disaster response was completed. Then, the 
empowerment program including educational workshop, tabletop, and operational maneuvers were 
performed. Immediately and 3 months after the intervention, the questionnaires for both groups were 
completed, and the data were analyzed using SPSS 21 through descriptive‑analytical statistical tests.
RESULTS: The results showed that the mean score of nurses’ competence in all domains of 
management, ethics, personal, team work, and technical immediately and 3 months after the 
intervention in the intervention group increased significantly (P = 0.001), while in the control group, 
these changes were not significant (P > 0.05).
CONCLUSION: According to the results of a recent study, the implementation of the empowerment 
program and the implementation of maneuvers as a part of the process of preparing nurses to deal 
with disasters have been effective. Therefore, it is suggested to use periodic maneuvers in in‑service 
training programs to improve the level of competence of nurses.

Abstract BACKGROUND: For any effective vaccination strategy, the willingness of the beneficiaries and its 
contributing factors are important. This study was conducted among the health‑care workers (HCWs) 
and community members to find the perceptions regarding the COVID‑19 vaccine and understand 
the influencers and the barriers of vaccine acceptance.
MATERIALS AND METHODS: A qualitative study was conducted from October 2020 to December 
2020 in two primary care settings in an urban area. Eighteen in‑depth interviews (IDIs) after taking 
consent were conducted with the help of IDI guide developed and validated beforehand by the experts. 
IDIs were done among the ten community members and eight HCWs selected conveniently. Data 
collection were continued till data saturation when no new information yielded from the interviews. 
Thematic analysis was performed.
RESULTS: All the participants were hopeful about availability of the vaccine. The key influencers 
identified for promoting willingness to accept the vaccine among both the groups were opinion of the 
health‑care providers, colleagues’ and other people’s acceptance of the vaccine, effectiveness of 
vaccine on other people, and perceived risk of the disease. Fear of adverse reactions was the most 
important barrier among all the respondents. The prevalent perception was that other preventive 
practices and vaccine together can only be the best solution to prevent COVID‑19 illness. The 
HCWs perceived that acceptance of vaccine among the community members would be good overall 
but apprehended some initial difficulties. Mass campaign to promote COVID‑19 vaccination and 
sensitization events are the need of the hour.
CONCLUSIONS: Since opinion of health‑care personnel emerged as an important influencer of 
vaccine acceptance, mass campaign and sensitization programs spearheaded by the health‑care 
providers can bring about change by increasing the vaccine acceptance among the beneficiaries 
at large. Re‑enforcement regarding practice of preventive measures should be made among the 
population irrespective of the vaccination status.

Abstract BACKGROUND: Colorectal cancer is the most common cancer of the gastrointestinal tract. Health 
beliefs play an important role in the development of health behaviors. In this study, the effect of 
educational intervention based on Health Belief Model on colorectal cancer screening behavior was 
investigated.
MATERIALS AND METHODS: This study was performed as a randomized controlled intervention. 
The study population was 50–70‑years old in Khosf city. Initially, 120 eligible populations were 
randomly divided into intervention and control groups (60 people in each group). The data collection 
tool was a standard colorectal cancer screening questionnaire that was completed before, immediately, 
and 3 months after the intervention. The intervention consisted of eight 60‑min training sessions. 
The collected data were analyzed using SPSS19 software and statistical tests.
RESULTS: The mean age of the intervention and control groups was 63.53 ± 5.67 and 
57.73 ± 5.77 years. In terms of mean scores of knowledge, perceived susceptibility, perceived severity, 
and perceived barriers were homogeneous before intervention. After the intervention, the mean score 
of the model constructs showed significant changes, which was statistically significant (P < 0.05). 
The rate of occult blood test in stool 3 months after training reached 90% in the intervention group 
and 15% in the control group.
CONCLUSIONS: The results of this study showed that by taking measures to reduce perceived 
barriers as well as increase knowledge, perceived susceptibility, severity, benefits and self-efficacy, 
the rate of participation in occult blood testing in feces can be significantly increased.

Abstract BACKGROUND: To control blood sugar and prevent complications related to diabetes, eating fruits 
and vegetables in standard amounts is recommended. The aim of this study was to investigate the 
factors affecting the consumption of fruits and vegetables in diabetic patients based on the Pender 
health promotion model.
MATERIALS AND METHODS: This cross‑sectional study was conducted on 260 diabetic patients in 
Sirjan; one of the cities of Kerman in Iran in 2020. To collect data, a researcher‑made questionnaire 
of Pender’s Health Promotion Model and a standard Behavioral Risk Factor Surveillance System 
questionnaire were used to measure fruit and vegetable consumption. Data were analyzed using 
SPSS24 software. Data were analyzed using t‑test, Pearson correlation coefficient, linear regression, 
and path analysis. Significance level <0.05 was considered.
RESULTS: The study showed that 71.5% of patients consumed fruits three or more times and 52.3% 
consumed vegetables per week. Employment, income, education, and gender were significantly 
associated with fruit and vegetable consumption (P < 0.05). Perceived barriers (P < 0.0001, β =0.23), 
self‑efficacy (P < 0.0001, β =0.32), and commitment to action plan (P = 0.002, β =0.20) were the 
main predictors of fruit and vegetable consumption.
CONCLUSION: In this study, self‑efficacy was the strongest predictor of fruit and vegetable 
consumption in diabetic patients. Therefore, it is necessary to consider health education as well as 
health promotion interventions based on these variables is considered to increase the consumption 
of fruits and vegetables for diabetic patients.

Abstract BACKGROUND: The advent of the pandemic COVID‑19 has resulted in a global crisis that resulted 
in the closure of universities and educational institutions worldwide. This study aims to explore the 
determinants of students’ intention towards e‑library services usage amid the challenging time of the 
COVID‑19 pandemic. This paper reviews the technology‑oriented individual attitude based on four 
dimensions of the technology readiness 2.0 index factors, which affect medical students’ perspectives.
MATERIALS AND METHODS: The authors provided a self‑administered questionnaire to medical 
students to investigate their e‑library adoption attitude during the COVID‑19 crisis. The authors 
distributed 542 questionnaires, received 361 complete responses and analyzed the data through path 
modeling/partial least squares structural equations modeling technique (PLS‑SEM) with the smart 
PLS software version 3.3.3. The structural equation‑modelling tool permits the estimation of results.
RESULTS: The main finding revealed that medical students have a positive and explicit approach 
to use the services available at the e‑library. Technology use and online services helped students 
continue their educational needs in the advent of the current pandemic COVID‑19. Attitude and 
subjective norms have significant influence and are strong predictors of intention. However, due to 
inadequate support for the government side, the perceived behavioural control has an insignificant 
impact on intention. This paper indicated one of the pioneers investigating the determinants of e‑library 
adoption among medical students based on technology‑oriented personality traits, employing the four 
dimensions of the technology readiness 2.0 index during the challenges of the COVID‑19 outbreak.
CONCLUSION: The study’s findings provide useful insight that offers valuable insights to implement 
specific strategies from the government officials to address medical students’ uncertainties and 
increase the technology adoption amid the COVID‑19 pandemic in medical education for developing 
nations.

Abstract INTRODUCTION: Knowledge about cancer, treatment, and likely treatment outcomes is critically 
important for decision‑making regarding adherence to the treatment. Hence, it seems imperative to 
find out the attitude and belief of cancer patients to determine the efficacy of cancer diagnostic and 
treatment available along with assessing the efficacy of prevention. The purpose of this study was 
to determine the level of knowledge, belief, and attitude of cancer patients who came to our facility.
MATERIALS AND METHODS: The present study was a descriptive cross‑sectional study which 
was conducted at All India Institute of Medical Sciences, Rishikesh, from July 2020 to December 
2020. One hundred fifty‑six newly diagnosed cancer patients were recruited. The participants were 
provided with a validated 44 key questionnaire divided into four different categories including the 
sociodemographic profile, knowledge, belief, and attitude subheading. Mean, frequency, percentage, 
and Chi‑square test were calculated to do data analysis using SPSS version 23.0.
RESULTS: Out of the total of 156 newly diagnosed cancer patients, only 130 patients provided 
responses so the overall response rate was 84.3%. Most of cancer patients had moderately adequate 
knowledge (79 [60.5%]), poor belief (111 [86%]), and neutral attitude (69 [54%]) regarding cancer. The 
Chi‑square test revealed a link between educational level and cancer knowledge (P = 0.01). Males 
showed a more positive attitude than females, and this difference was statistically significant (P = 0.02).
CONCLUSIONS: Cancer patients need to be made more aware of the red flag signs of cancer 
and improvise their attitude toward cancer. Cancer care programs should not only involve cancer 
patients but also involve their caregivers because the understanding of family members is of utmost 
importance to fight this disease.

Abstract BACKGROUND: Students on campus are exposed to drug abuse and mental health disorders due 
to various challenges and motivating factors. This issue requires attention to interventions based on 
coping skills training. The present study was conducted with the aim to investigate the effect of an 
assertiveness program on the drug use tendency, mental health, and quality of life in clinical students 
of Shahrekord University of Medical Sciences in 2020.
MATERIALS AND METHODS: This is a quasi‑experimental study. Seventy clinical students (nursing, 
midwifery, and intern students) attending Ayatollah Kashani and Hajar teaching hospitals of Shahrekord 
were included into the study and randomly assigned into an intervention group and a control group. 
The assertiveness training program was implemented for eight 1‑h sessions (one session per week 
for 2 months) for the intervention group, while the control group received no programs. Both study 
groups completed drug tendency questionnaire, depression, anxiety and stress scale, and quality of 
life questionnaire in pretest, posttest, and 2‑month follow‑up. The data were analyzed using SPSS 
software (v22), analysis of variance repeated measures, and t‑test.
RESULTS: The mean scores of drug use tendency (P = 0.26), stress (P = 0.31), anxiety (P = 0.29), 
depression (P = 0.43), and quality of life (P = 0.33) showed no statistically significant difference
between the intervention and control groups in the pretest, but the scores of the drug use tendency, 
stress, anxiety, and depression were statistically lower and the score of quality of life was statistically 
higher than that of the control group in the posttest and 2‑month follow‑up (P < 0.05).
CONCLUSION: The findings of the study showed that assertiveness skill training as a preventive
program can reduce the students’ tendency to addiction and improve their mental health and quality 
of life. Considering the effectiveness of the program, planners and policymakers can use it to plan 
for reducing the youth tendency to drugs.

Abstract BACKGROUND: Health‑promoting behaviors can affect the psychological and physical consequences 
of hypertension. For the prevention and control of hypertension, lifestyle modification has been 
recommended. This study aimed to investigate the health‑promoting behaviors of patients with 
hypertensive heart disease in Iran and compare them with those of healthy people.
MATERIALS AND METHODS: This was a descriptive comparative study with cross‑sectional 
design. Participants were 141 patients with hypertensive heart disease (mean age = 39 ± 10.2 years) 
referred to the cardiac clinic of Madani Hospital in Khorramabad, Iran, and 141 healthy people 
selected from those referred to the hospital. The Persian version of the revised Health‑Promoting 
Lifestyle Profile‑II (HPLP‑II) was used to evaluate the health‑promoting behaviors of participants. 
After collecting data, they were analyzed in SPSS v. 22 software using descriptive statistics and 
statistical tests including independent t‑test and one‑way ANOVA.
RESULTS: The overall HPLP‑II score was 142.34 ± 30.48 in patients and 150.52 ± 37.07 in 
controls. The highest and lowest HPLP‑II dimension scores in both groups were related to health 
responsibility and stress management dimensions. There was a significant difference between 
groups only in dimensions of nutrition (P = 0.017) and physical activity (P = 0.016), and in the overall 
score (P = 0.044), whose scores were lower in patients compared to controls. The difference in 
HPLP‑II score of patients with different demographic characteristics (marital status, place of residence, 
gender, age, educational level, and occupation) was not statistically significant.
CONCLUSION: Patients with heart disease caused by high blood pressure in Iran have poorer diet 
and physical activity compared to healthy people. Educational interventions with a focus on the 
importance of dietary regime and exercise are recommended for them.

Abstract BACKGROUND: Ineffective health communication could cause the increase of COVID‑19 cases 
in Indonesia. Medical students can involve in efforts in health communication on social media to 
positively impact prevention behaviors during a pandemic. This study aims to identify and analyze 
medical students’ and internship doctors’ perceptions toward health communication related to 
COVID‑19 through social media.
MATERIALS AND METHODS: A mixed method with exploratory sequential used. A qualitative study 
was done using phenomenology approach through deep and semi‑structured interviewing. After data 
analysis, the draft of the instrument prepared. Items in the draft selected based on the respondents’ 
answer. Then, a quantitative cross‑sectional study was used. The data obtained from 399 medical 
students and doctors at a University in Indonesia using Google Form on October 14 to October 20, 2020 
through media social. Data were analyzed using Pearson Correlation and Chi‑square (alternative: Fisher’s 
exact test) and logistic regression analysis with P < 0.05 and 95% confidence interval, respectively.
RESULTS: Based on interview, respondents communicate health on social media because the 
condition of COVID‑19 in Indonesia is dangerous, feel vulnerable to COVID‑19, understand the 
benefits, obligations, or responsibilities as a candidate and/or medical personnel and believe they
can create content/find valid sources. Meanwhile, the perception of limited knowledge is their biggest
obstacle in conducting health communication. There were a relationship between gender (P = 0.028, 
PR = 0.657), perceived severity (P = 0.044, PR (Prevalence Ratio) =4.844 [0.725–32,354]), perceived 
susceptibility (P = 0.005, PR = 1.803 [1.182–2.750]), perceived barrier (P < 0.001, PR = 2.543 [1.908–
3.388]), and self‑efficacy (P = 0.012, PR = 1.810 [1.120–2.926]) with health communication behavior. 
The perceived barrier (P < 0.001, RR = 4.278 [2.709–6.754]) and perceived susceptibility (P = 0.004, 
PR = 2.304 [1.302–4.077]) were the most influenced behavior.
CONCLUSIONS: This study showed that perceived severity, perceived susceptibility, perceived 
barrier, and self‑efficacy are predictor factors of health communication behavior related to COVID‑19
on social media with perceptions of susceptibility and perceived barriers as the most influential
variables. It is necessary to provide communication learning on social media as effectively and 
applied directly to reduce perceived barriers and increase self‑efficacy.

Abstract BACKGROUND: In the coronavirus disease 2019 pandemic era, clinical programs and mandatory 
hands‑on activities have been supplanted by remote teaching to maintain the fundamental capabilities 
of medical training and to furnish medical students with quality education. Nonetheless, the satisfaction 
of faculty members with this training method in the current pandemic has yet to be assessed. The 
aim of this study was to design a Persian questionnaire with appropriate validity and reliability on 
cardiology professors’ satisfaction level with virtual education.
MATERIALS AND METHODS: In this cross‑sectional study, a questionnaire was devised drawing 
upon scientific sources and Iranian medical educators’ expertise. Seventeen faculty members 
in various specialties evaluated the questionnaire concerning face and content validity. Content 
validity was assessed through the calculation of the content validity ratio (CVR) (values >0.62 
were considered acceptable) and the content validity index (CVI) (values >0.79 were considered 
acceptable), construct validity was evaluated through principal component factor analysis by the 
Kaiser–Meyer–Olkin (KMO) statistic and Bartlett’s sphericity test, internal reliability was measured 
through the calculation of Cronbach’s alpha coefficient, and consistency was appraised through the 
use of test‑retest reliability at two different time points.
RESULTS: The questionnaire had a reliability rate of 95%, indicating high internal validity. Concerning 
test‑retest reliability, the intraclass correlation coefficient was 0.96 (P < 0.001), demonstrating relatively 
good stability. The CVI was 0.81, and the CVR was 0.85. The KMO measure of sampling adequacy 
was 0.954, indicating the acceptability of the degree of common variance among the all items.
CONCLUSIONS: This Persian questionnaire on virtual education aimed at cardiology faculty members 
in the current pandemic with its low question count and appropriate domains had high reliability 
and validity. By knowing the level of professors’ satisfaction with the new method of education, it 
is possible to take steps to better provide specialized medical education to cardiology residents.

Abstract BACKGROUND: Infertility and the use of assisted reproductive therapies affect infertile couples quality 
of life. Infertile couples face many physical, psychological, and financial challenges due to having a 
higher level of spiritual intelligence and resilience will help the infertile couple to adapt to infertility 
conditions and achieve their therapeutic goals. This study was aimed to determine the relationship 
between fertility characteristics and spiritual intelligence and resilience in infertile couples.
MATERIALS AND METHODS: This was a cross‑sectional study that was conducted in 2020 on 
162 infertile couples referring to infertility centers in Isfahan who met the inclusion criteria. Samples 
were selected by convenience sampling method. Information was gathered using a questionnaire 
consists of three parts: demographic and fertility characteristics, spiritual intelligence, and resilience. 
Data were analyzed using descriptive and inferential statistical methods (t‑test, Pearson’s correlation 
coefficient, and Chi‑square). P < 0.05 was considered statistically significant.
RESULTS: Pearson’s correlation coefficient showed that there was no significant relationship 
between resilience score and spiritual intelligence score with age, duration of marriage, and 
duration of treatment (P > 0.05). There was no significant relationship between resilience score and 
spiritual intelligence score and its dimensions with the level of education and economic status of 
the family (P > 0.05).
CONCLUSIONS: There was no significant relationship between demographic and fertility factors 
with spiritual intelligence and resilience.

Abstract BACKGROUND: Coronavirus pandemic puts healthcare workers (HCWs) at high risk and challenges 
the abilities of healthcare systems to respond to the crisis. This study aimed to assess the level of 
knowledge of HCWs and associated factors in West Guji zone public health facilities in southern 
Ethiopia.
MATERIALS AND METHODS: A health facility‑based quantitative cross‑sectional study was 
undertaken from June 10 to July 10, 2020. Two hundred and eighty‑three HCWs were involved in 
the study using a systematic sampling method. The instrument was pretested on 5% of the sample 
in Yabello Hospital. Data were analyzed using bivariate and multivariate logistic regression.
RESULTS: The HCW who had good knowledge was 84.7%. HCWs who had degree holders, 
masters and above holders, work experience of 2–4 years, and >4 years of experiences, had 
training on Coronavirus, and medical diseases were significantly associated with good knowledge 
of Coronavirus.
CONCLUSIONS: This study indicated that HCWs’ knowledge about the Coronavirus was good. 
Improving the educational status of HCWs and giving updated training on the Coronavirus will improve 
HCW’s knowledge of the Coronavirus.

Abstract BACKGROUND: Purpose: The success of any educational system depends on the fitness of the 
curriculum components with the characteristics of its audience. The students of the present generation 
are different from the previous ones due to the changes resulting from the changes that have taken 
place in society, media, technology, and communication as we entered the 21th century. Hence, 
this study was conducted to identify the characteristics of MD students in universities of medical 
sciences in Iran.
MATERIALS AND METHODS: This qualitative study was conducted on 32 MD students among 7 
universities of medical universities of Iran. The participants were selected through purposive sampling 
method, and the data were collected via semi‑structured interviews after getting informed consent. 
Then, the data were analyzed using conventional content analysis method.
RESULTS: Technology as a Double-Edged Sword, in digital age, Quick access, Reasoning the basis 
of acceptance. Evaluation ambiguity, Seeking independence,get involved in problems, desirable 
teaching qualities, my favorite teacher, features of content, Role models traces,my favorite teacher, 
The rest are unchanged.
CONCLUSION: MD students are interested in using various teaching methods and technologies, 
applying methods that are similar to their future job and learning by doing; they also tend to use 
visual materials and shortening the time and memorizing content. They prefer professors who love 
to teach and are good role models for them. What motivates them is to be involved in the classroom, 
to be active, to be respected, and not to be ignored.

Abstract BACKGROUND: Health is a complex structure and has physical, psychological, and social 
approaches. The importance and impact of health assessment have caused considerable attention to 
be paid to the employees of the health system and the determining factors of this relationship. Hence, 
the main purpose of this study was to find out the bio‑psycho‑social health situation in prehospital 
emergency technicians as the research question staff.
MATERIALS AND METHODS: The present study is a systematic review and data have retrieved 
through extensive search in Scopus, Web of Science, PubMed (including Medline), Cochrane 
Library, Irandoc, Magiran, MedLib, and SID databases with a combination of keywords of “Health, 
” “Assessment, ” “Social,” “Psychological,” “Biological,” “Emergency,” and “prehospital,” according 
to the search strategy, between 2000 and 202111 studies were reviewed; then, they were entered 
based on the objectives of the study and narrative analysis was performed by the researcher.
RESULTS: After analyzing the articles, a total of 4 factors affecting bio‑psycho‑social health in 
prehospital emergency technicians have been extracted and identified, which included health 
management, bio‑psycho‑social factors, occupational factors, and behavioral factors.
CONCLUSION: This research showed four factors, namely health management, bio‑psycho‑social 
factors, occupational factors, and behavioral factors which could be effective in Bio‑Psycho‑Social 
health. Since prehospital emergency services have an important role in maintaining the health of the 
community, which requires attention to the bio‑psycho‑social health of emergency personnel, more 
studies have focused on health management among the four mentioned factors, but the need to 
examine the other three factors for a more accurate assessment of the health of emergency personnel 
seems necessary. Therefore, prevention and response strategies based on bio‑psycho‑social health 
assessment models are proposed to promote the health of prehospital emergency technician staff.