Journal of Education and Health Promotion

Abstract BACKGROUND: Nowadays, medical tourism reports impressive growth in terms of number of 
persons, income, and number of countries involved in cross‑border flows. It refers to people traveling 
abroad (from home to a target country) to obtain medical treatment. The present study aimed to 
identify the themes and codes of the medical tourism business in Iran.
MATERIALS AND METHODS: We searched international databases (such as PubMed, Scopus, 
Embase, and Web of Science) and Iranian bibliography thesaurus and repositories (namely, Scientific 
Information Database and Magiran) using keywords such as medical tourism, international medical 
travel, and medical tourism business in the English and Persian literature, published between January 
2000 and December 2019, identified with no restriction on the type of the studies. The data were 
analyzed based on the content analysis method.
RESULTS: Out of 1054 articles, 14 were finally selected. In the end, eight themes of the medical 
tourism business including competitive pricing, safety and security, information and communication 
technology, labor market and human resources, structure management, leading the way in medical 
tourism, infrastructure, and exchange with the international world were identified which on the whole 
contain 45 codes. Most of the articles were quantitative. Four of the themes (competitive price, labor 
market and human resources, structure management, and infrastructure) were most frequent and 
of the highest importance.
CONCLUSION: The themes and codes identified in this study helps companies and individuals who 
want to work in the field of medical tourism. According to this study, all 8 themes and 45 codes are 
of high value, but still, some themes are of higher value than others and special attention should 
be paid to them.

Abstract BACKGROUND: Nowadays, various strategies are applied by governments to control costs and 
finance hospitals and the health sector. Public‑private partnership (PPP) option is one of these 
strategies. Considering the growing importance of hospitals in different communities and their 
problems, this study aimed to identify PPP challenges, opportunities and solutions in hospitals. This 
study aimed to identify the challenges and opportunities of PPP in the country’s hospitals and then 
offered an appropriate solution to overcome these challenges.
MATERIALS AND METHODS: This is a qualitative study and content analysis approach is 
undertaken. The participants were selected through purposive sampling and data were collected using 
a semi‑structured interview with experts in the public and private health sector until the saturation 
point achieved. Data analysis was performed through the thematic analysis of expert’s statements 
using MAXQDA. 10 software in this sector.
RESULTS: According to the study results, 3 main themes (challenges, opportunities, and solutions), 
10 sub‑themes, and 32 codes were identified in relation to the public and private partnership. 4 
sub‑themes on challenges of PPP, 3 sub‑themes on partnership opportunities and 3 sub‑themes 
on challenges solutions were identified.
CONCLUSION: The results of this study revealed that given the discussed challenges the most 
important challenge seems to be not evaluated outsourcings, incorrect usage of participatory models, 
and inadequate and inappropriate postoutsourcing supervision, however, it appears evaluated 
outsourcing backed with adequate supervision could solve many current hospitals’ problems.

Abstract BACKGROUND: In this study, we attempted to assess the change of perception of postgraduate 
students on objective structured clinical examination (OSCE) in burns and plastic surgery after first 
five OSCE.
METHODS: A prevalidated feedback questionnaire was used to assess and score the perception of 
postgraduate students on OSCE in burns and plastic surgery. The opinion of postgraduate students on 
the feedback questionnaire after first and fifth assessment tests based on OSCE was analyzed. The 
results were compiled on a data sheet and analyzed using Microsoft Excel and plotted as graphical 
interpretation. The statistical analysis was done using MedCalc software.
RESULTS: The results of the study showed that there is a positive change in perception of 
students in favor of monthly assessment based on OSCE in burns and plastic surgery after fifth 
assessment. The mean students’ favorable perception score after the first assessment with was 
30.2 ± 2.828 (mean ± standard deviation [SD]) and after fifth assessment, 43 ± 2.828 (mean SD) 
with Student’s test t = 10.119 and P < 0.0001 which is highly significant statistically in favor of OSCE 
after fifth assessment.
CONCLUSIONS: We observed in our study that the monthly assessment based on OSCE is well 
accepted by the students of our subspecialty after few assessments; however, further studies are 
required to augment the evidence.

Abstract INTRODUCTION: With the unintended closure of classrooms following the outbreak of COVID‑19, the 
virtual education method is used as an alternative to face‑to‑face education. Virtual education is one 
of the important factors in promoting the learning of medical students and has many benefits such as 
increasing the ability of critical thinking, problem‑solving skills, and self‑directed learning. However, 
critically examining students’ perceptions of e‑learning can help improve quality and better planning.
MATERIALS AND METHODS: This research was a qualitative study. Twelve students were enrolled 
in the study based on purposive sampling. Data were collected using in‑depth semi‑structured 
interviews in 2020. All interviews were recorded and then transcribed and analyzed using a continuous 
comparison and conventional content analysis approach.
RESULTS: Data analysis revealed four main themes and ten subthemes. The main themes included 
“student concern,” “teacher barriers,” “technology weakness,” and “asynchronous virtual learning 
flexibility.”
CONCLUSION: Asynchronous e‑learning in the COVID‑19 outbreak had its advantages and 
disadvantages. By analyzing students’ perceptions in this field, some better designs and planning 
can be done to increase the quality of education.

Abstract Today, the ability of the organizations to successfully knowledge management and sharing can 
help them in better performance. Effective knowledge sharing (KS) in the clinical context provides 
better clinical decisions and improves the quality of care services. This systematic review will be 
conducted to identify the factors related to the clinical KS (CKS). This systematic literature review will 
be conducted to search the published documents about the affecting factors on the (clinical) KS. To 
this end, PubMed, Scopus, Web of Science, ProQuest, Cochrane, Embase, SID, Magiran, IranDoc, 
and ISC will be thoroughly assessed with considered keywords and search strategy. No time limit 
will be considered and all relevant documents published will be evaluated until the start date of the 
search. To the best of our knowledge, no systematic review study has been conducted on the factors 
related to CKS and our research will try to comprehensively extract the effective factors in this topic. 
Identifying the factors affecting CKS will lead to transparency in the exchange and interpretation of 
clinical knowledge in clinical care delivery and making the best clinical decisions as well as improving 
the quality of clinical care. It will also provide a condition to facilitate the delivery of more effective 
clinical education for policymakers in the field of clinical education.

Abstract BACKGROUND: Human papillomavirus (HPV) infection is the major risk factor for cervical 
cancer (CC) in women of reproductive age. Despite advances in treatment and prevention of CC by 
HPV vaccination, very few women utilize them because of a lack of awareness about HPV.
MATERIALS AND METHODS: We conducted this cross‑sectional study among Health Professions 
Students (HPS) at King Saud Bin Abdul Aziz University for Health Sciences, Jeddah. Data were 
collected using a predesigned and validated study questionnaire to assess the knowledge, attitude, 
and perception of HPS toward HPV.
RESULTS: A total of 580 HPS responded to the survey; 128 (22.1%) were male, while 452 (77.9%) 
were female with the mean age ± standard deviation 20.36 ± 1.74 years. There was no significant 
difference between males and females related to screening of HPV and CC (82.8%; 82.3%). 
A minority (30.3%) of participants thought that HPV infection leads to CC, while 38.3% did not know 
about it. Furthermore, knowledge about HPV screening and vaccination was poor.
CONCLUSIONS: Students from the college of medicine had more knowledge and awareness 
about HPV (34.9%, P < 0.001). Thus, it is important to implement effective education programs, 
curricular activities, and awareness campaigns for health professions to augment the learning 
process effectively.

Abstract

Abstract BACKGROUND: With the emergence of COVID, we are forced to use e‑learning in form of arranging 
online classes for students. Medical educators all over the world are conducting online classes for 
students. This study aimed to evaluate the perception of online learning among MBBS students and 
teachers through a questionnaire‑based survey.
MATERIALS AND METHODS: A cross‑sectional study was done in the AIIMS, Bhopal. The study 
was based on questionnaire (online Google form) response received from 43 number of faculty and 
156 number of students.
STATISTICAL ANALYSIS USED: Chi‑square test and unpaired t‑test were used for statistical 
analysis using statistical software Systac 13.2.
RESULTS: Handling software, technical issues, and lack of face‑to‑face interaction were more 
significant problems in students compared to faculty. The desire for the social site which causes 
disturbances in learning was a significant problem in the students compared to faculty. Giving 
and taking assessment problem was reported by 60% and 63.8% of faculty and students, 
respectively (P = 0.67). Both groups preferred the Google Classroom platform (P = 0.16). 
Students (65.3%) preferred audiovisual recording, while faculty (72%) preferred PowerPoint with 
narration. PowerPoint presentation without narration was the least preferred (10.8%). Both groups 
stressed the importance of training (P = 0.17) and infrastructure development (P = 0.85). Students, 
as well as faculty, strongly discouraged e‑learning for practical/clinical teaching.
CONCLUSIONS: Students, as well as faculty, have mixed reactions toward e‑learning. Most 
importantly affected in the present scenario is practical/clinical teaching and assessment. Every 
attempt needs to be done to strengthen infrastructure and impart training to students and faculty.

Abstract BACKGROUND: Stress and burnout syndrome are more common for people who work in professions 
that include direct contact with humans, such as education and the medical field. To contribute to 
the prevention of this syndrome, the Maslach Burnout Inventory-Student Survey (MBI-SS) has been 
validated and used in different countries worldwide except for Morocco. The main purpose of this 
study is to develop and validate a special version of the MBI‑SS scale to assess academic burnout 
among Moroccan trainee teachers during their training period.
MATERIALS AND METHODS: A self‑administered questionnaire was carried out to assess the 
sociodemographic factors and certain stressors of the interviewees as well as the MBI‑SS. Two 
hundred fifty‑five trainee teachers of the CRMEF (Regional Centre for Education and Training) 
participated to assess the validity of the MBI-SS scale in its French version and its three components 
during the academic year 2020/2021 of the Rabat-Salé-Kénitra region. The inferential method of data 
analysis was used by Cronbach’s alpha to determine the overall reliability of the instrument as well 
as the three components of the assessment. After that, exploratory factor analysis was carried out.
RESULTS: Sixty five percent of the participant were male, and most of them were between the ages of 
20 and 30 years. The results demonstrated a satisfactory psychometric characteristic for its dimensions 
and validated the 3-dimensional structure of the MBI-SSM, yet they indicate the necessity to remove 
two items to guarantee their reliability. The Cronbach’s alpha value of the MBI‑SSM was greater 
than (0.7). The Cronbach’s alpha also showed a good homogeneity for the three dimensions of the 
MBI‑SSM, (0.853) for emotional exhaustion, (0.570) for cynicism, and (0.776) for academic efficacy.
CONCLUSIONS: It is concluded that the MBI-SSM is determined to be an objective and a valid 
instrument and can be used to assess academic burnout in the Moroccan context.

Abstract BACKGROUND: Health literacy (HL) enables a person to make good decisions regarding health 
care, disease prevention, and health promotion to maintain and improve health. In Thailand, most 
existing studies focus on adults’ HL rather than children. This research aimed to determine the 
influence of sociocultural and health knowledge on HL among children ages 9–10 years in Thailand.
MATERIALS AND METHODS: A cross‑sectional study was conducted among 1650 children aged 
9–10 years. The respondents were recruited using multistage random sampling from 39 primary 
schools of 13 provinces in all four regions of Thailand. A self‑administered structured questionnaire 
was used to collect the required data. The multilevel analysis was used to determine the association 
between sociocultural, health knowledge, and HL while controlling the effects of covariates. The 
result was presented as adjusted odd ratios and its 95% confidence interval (CI).
RESULTS: Of the total 1650 respondents, 86.24% (95% CI: 84.49%–87.82%) had adequate and 
excellent levels of HL. The multivariable analysis indicated factors that were significantly associated 
with adequate and excellent levels HL including adequacy of per diem (adjusted odds ratio [adj. OR] 
= 6.78; 95% CI: 3.54–12.97) and had good relationship with teachers (adj. OR = 2.19; 95% CI: 
1.55–3.09). Sources of health education which were received health education from parents (adj. 
OR = 3.51; 95% CI: 2.39–5.14), from teachers (adj. OR = 2.03; 95% CI: 1.43–2.89), and from the 
Internet (adj. OR = 1.83; 95% CI: 1.12–2.99) were also significantly associated with HL. Another 
significant factor was had good level of health knowledge (adj. OR = 1.86; 95% CI: 1.30–2.66) when 
control clustering effect of region, provinces, school, and classroom size.
CONCLUSIONS: More than 85% of children ages 9–10 years in Thailand had adequate and 
excellence levels of HL. Sociocultural and health knowledge had influence on children HL.

Abstract BACKGROUND: This study was conducted on accountability, aiming to design components for 
monitoring the curricula of universities of medical sciences.
MATERIALS AND METHODS: This study was a developmental one, conducted in Isfahan University 
of Medical Sciences with the document and literature review, a focus group, and a survey from 
2018 to 2020. The first version of the components was designed by the library research and content 
analysis method. Following developing the initial tool, its validity was evaluated with a focus group, 
and the questionnaire was prepared according to face and content validity.
RESULTS: In this study, 73 components were designed in eight domains for curriculum supervision, 
including requirements (12), needs and goals (6), content (10), teaching–learning strategies (10), 
educational materials and resources (5), educational time (2), educational setting (10), and 
evaluation (18).
CONCLUSION: The components of curriculum supervision were designed due to their importance in 
the evolution and innovation of medical sciences, particularly accountability in the education system, 
and lack of relevant research. With these components, the current and optimal status of curricula 
can be determined in universities.

Abstract BACKGROUND: As pediatric surgeries are rising and current methods to reduce perioperative 
anxiety are lacking in preschool children. The purpose of this study was to determine the effect of 
video games on preoperative anxiety in 3‑ to‑6‑year old of a sample of Iranian children undergoing 
elective surgery children.
MATERIALS AND METHODS: In the current quasi‑experimental pretest posttest design, after 
standard translation, the modified Yale preoperative anxiety scale was administered to 102 children 
undergoing surgery from December 2016 to August 2017 in Kermanshah, Iran. Children are assigned 
to an intervention or control group. Each child’s anxiety was measured at two points at the time of 
arrival and after waiting for 20 min in the holding area. Data were analyzed by SPSS, version 22. The 
Chi‑square, independent t‑test, and paired t‑test at the significance level of P < 0.05 were performed.
RESULTS: There was no significant difference between the mean anxieties in control 
group (42.58 ± 18.54) and intervention group (46.11 ± 14.09) before the game (P = 0.282). However, 
after playing the video game in control groups (53.26 ± 18.00) and game groups (34.88 ± 10.81), 
there was a significant difference in favor of the video game (P < 0.001).
CONCLUSION: Findings of the present study suggest that approved video game by experts 
to decrease mean preoperative anxiety in 3‑ to‑6‑year‑old children. Therefore, video games 
recommended to be implemented at the preventive level in hospital.

Abstract BACKGROUND: Maternal knowledge is one of the indirect causes of maternal mortality in Indonesia. 
Maternal knowledge that mothers must possess includes knowledge about pregnancy, childbirth, and 
postpartum. Maternal knowledge should be provided during pregnancy. The aim of this study is to 
identify maternal knowledge in postpartum women who have a history of the frequency of pregnancy 
visits according to the minimum standard.
MATERIALS AND METHODS: A descriptive quantitative design was performed by assessing 
maternal knowledge to postpartum mothers using an online questionnaire which conducted in 2020 
at two public health centers of Surabaya, Indonesia. A sample of this research involved postpartum 
mothers who completed inclusion criteria, namely physiological postpartum mothers and had regular 
pregnancy at least 6 antenatal care (ANC) visits. In contrast, the exclusion criteria were postpartum 
mothers who were not included in the target areas of research. It uses random sampling techniques 
and performs an analysis using descriptive statistics.
RESULTS: Three research questions showed a large percentage of wrong answers, namely 
preparation to face complications (64%), contraceptive methods in breastfeeding mothers (50%) and 
the first time using contraception during childbirth (42%). Meanwhile, all the correct results (100%) 
are exclusive breastfeeding and supplementary feeding for babies.
CONCLUSION: Completing minimal standards of ANC visits cannot ensure adequate maternal 
knowledge, particularly crucial health information that influences maternal and neonatal health status.

Abstract BACKGROUND: Coronary artery bypass graft (CABG) plays an important role in reducing coronary 
heart disease mortality, but patients are still at risk after surgery. Consequences can be avoided if 
threatening behaviors are soon detected and lifestyles are promoted. Therefore, the present study 
aimed to evaluate, follow‑up, and promote a healthy lifestyle in the patients.
MATERIALS AND METHODS: The present research was a quasi‑experimental pre‑ and 
postintervention single‑group study on 35 patients under the CABG at two hospitals affiliated to the 
Baqiyatallah University of Medical Sciences in Tehran from August 2020 to April 2021. The samples 
were selected using the purposive sampling method and the educational content was determined 
by creating an expert panel. We utilized the Health‑promoting Lifestyle Profile II to collect data, and 
SPSS 22 to analyze them.
RESULTS: There was a significant difference between mean total scores of health‑promoting lifestyle 
before and after the intervention and they reached from 138.7 ± 20 to 157.2 ± 18 (P < 0.0001). There 
was also a statistically significant difference between mean scores of nutrition (P < 0.003), physical 
activity (P < 0.0001), health responsibility (P < 0.0001), and stress management (P < 0.0001) before 
and after the intervention, but there was no statistically significant difference between mean scores 
of interpersonal relationships, and spiritual growth before and after the intervention.
CONCLUSIONS: The program had a positive effect on the health‑promoting lifestyle scores of 
patients after CABG. It is possible to increase scores of healthy lifestyles in the patients by combining 
face‑to‑face and virtual training methods as well as involving family members and relatives of patients 
in training and follow‑up programs.

Abstract BACKGROUND: Exercise self‑efficacy has been identified as one of the primary determinants of 
physical activity in people with multiple sclerosis (MS). Therefore, assessment of exercise self‑efficacy 
is important to be measured with valid and reliable scale to provide tailored interventions.
MATERIALS AND METHODS: The English version of the exercise self‑efficacy scale was translated 
into Persian using a forward‑backward translation approach. Factorial validity was conducted using 
the expletory factor analysis (EFA) and the confirmatory factor analysis (CFA). In addition, construct 
validity was performed using convergent and known‑group validity. Reliability was evaluated by internal 
consistency and test‑retest reliability. Participants were recruited from two hospitals (MS clinics).
RESULTS: Expletory factor analysis identified a single factor structure which explained 64.7% variance 
in exercise self‑efficacy scale (EXSE). CFA supported a single factor structure with a good model fit. 
Average variance extracted = 0.60 and composite reliability = 0.93 values confirmed the convergent 
validity. The known‑group validity was verified with significant differences between subgroups. The 
Cronbach’s alpha coefficient = 0.93 and intraclass correlation coefficient = 0.85 supported reliability 
of EXSE scale.
CONCLUSIONS: Our findings provided sufficient evidence of validity and reliability for EXSE scale 
in people with MS. This measure can utilize by researchers and health‑care providers in studies and 
clinical practice as a robust measure to assess exercise self‑efficacy and to develop interventions 
in people with MS.

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

Abstract BACKGROUND: The role of medical undergraduates is limited while interacting with the community 
related to issues involving human behavior. Since qualitative research seeks to build a holistic 
understanding of social phenomena, we designed this project to expose them to the basics of 
qualitative research in a real‑world setting of experiential learning. The aim of this study is to sensitize 
the medical undergraduates to the basics of qualitative research and able to apply it in the context 
of experiential learning in the community.
MATERIALS AND METHODS: In this current educational intervention, a structured teaching 
program was designed and applied for the first time, to our students to effectively sensitize them 
to qualitative research in a natural community setting, intended to provide them a solid base for 
experiential learning. A batch of students (n = 50) was selected by convenient sampling method 
who had their clinical postings with us. At first, a “session planning guide” was drawn on the plan of 
conduction of this program. We followed the “facilitators reference manual by research consortium on 
educational outcomes and poverty (RECOUP) for our teaching sessions. The framework of our study 
was executed in the following sequence: sensitization of the learners, exposure to structured quality 
experience, systematic debriefing sessions with evaluation of learner experiences, and the process 
and outcome feedbacks from the learners. The students were monitored by trained facilitators. The 
various study tools used in the structured teaching program included, the teaching sessions using 
the RECOUP manual, didactic lectures and short group interactive sessions to teach qualitative 
research and photographs and video clips to facilitate the sessions, mock demonstrations and role 
plays on interviewing techniques, use of case vignettes on the theme “perception of psychosis” 
for interviewing the community, structured debriefing guide, and various self‑reflective exercises. 
Learners’ perspective of community perception, debriefing sessions, and self‑reflective responses 
were transcribed, and manual content analysis was done to identify the codes and interpret the results.
RESULTS: Majority could appreciate the uniqueness of qualitative research over the quantitative 
counterpart. They could enumerate the attributes of a good qualitative researcher. The debriefing 
exercises made them summarize their experiences and the self‑reflective exercises enabled them 
to identify their abilities and critique their ideas. It was a different experience to our learners as they 
could identify themselves with the sentiments of the community. To them, the facilitating points 
were the interviewing skills and confidence gained in facing the community. However, they felt time 
constraint for exploring the sensitive issues during the fixed posting schedule.
CONCLUSIONS: The experience of learning beyond the boundaries of a classroom setting sensitized 
them to various community perceptions and reactions. The students perceived the qualitative methods 
well and could apply the lessons learnt in the facility. They also felt that this learning exposure gave 
them community orientation and confidence in dealing with community issues.

Abstract BACKGROUND: Coronavirus disease (COVID‑19) and resulting restrictions have impacted 
populations’ lifestyles and posed a challenge regarding their behaviors, including physical 
activity (PA). This study aimed to evaluate PA patterns of university students during the COVID‑19 
outbreak. We also analyzed the association of participants’ characteristics, including their level of 
anxiety, under the pandemic conditions, with adherence to the world health organization (WHO) 
recommendations for PA.
MATERIALS AND METHODS: This cross‑sectional study comprised 717 Moroccan university 
students recruited during the COVID‑19 pandemic. The Global Physical Activity Questionnaire (GPAQ 
V.2) was used to evaluate PA. Data on sociodemographic characteristics and anxiety levels were 
also collected. Anxiety was assessed using State‑Trait Anxiety Inventory (STAI). Descriptive and 
inferential statistical analysis was carried out. The association between participants’ characteristics 
and PA was studied using regression models.
RESULTS: Of all participants, 33.2% did not achieve the recommended levels of PA. The daily 
median (25th–75th percentile) time spent in PA was 34.3 min (12.7–98.6), whereas the median time 
of sedentariness was 10 h per day (6–14). Multivariate analysis showed that female sex (OR = 0.63; 
95% CI: 0.44–0.90; P < 0.05) and high level of state anxiety (OR = 0.43; 95% CI: 0.20–0.92; P < 0.05) 
were negatively associated with the achievement of the WHO recommended PA.
CONCLUSION: The reported PA patterns of university students during the current outbreak should 
be taken into account and evoke the necessity of encouraging this population to adhere to the 
recommended PA levels. Targeting state anxiety related to the conditions we are facing may have 
a promising effect on the promotion of PA.

Abstract BACKGROUND: The coronavirus disease‑2019 (COVID‑19) crisis has changed many aspects of 
frontline nurses’ lives. Nurses caring for patients with COVID‑19 reported experiencing significant 
psychological distress and work‑related anxiety. This study aimed to assess the perceived stress 
and quality of life among frontline nurses fighting against COVID‑19.
MATERIALS AND METHODS: This web‑based cross‑sectional study was conducted on 322 
frontline nurses fighting against COVID‑19 in hospitals affiliated to Mazandaran University of Medical 
Sciences. Data were collected using the two following online questionnaires: the Perceived Stress 
Scale and World Health Organization Quality of Life-Brief. Data were compiled from October 23, 
2020, to November 25, 2020. Data were analyzed using the independent sample t‑test, Pearson’s 
correlation test, and regression analysis test in the SPSS‑21.
RESULTS: Average perceived stress scores was 30.27 (standard deviation [SD] = 7.01). Average 
quality of life subscale scores consist of physical health, psychological health, social relationships, and 
environment were 57.71 (SD = 12.74), 44.3 (SD = 15.58), 45.61 (SD = 16.99), and 47.6 (SD = 18.11), 
respectively. There was an inverse significant association between all the subscales of quality of life 
and perceived stress (P = 0.008). Based on the multiple linear regression analysis, the variables 
of age, gender, marital status, and perceived stress were the significant predictors of quality of life 
subscales.
CONCLUSIONS: Paying serious attention to addressing the concerns of frontline nurses, especially 
those who are at high risk, is necessary. It is recommended to take action as soon as possible to 
reduce the perceived stress and improve quality of life on nurses who care for patients with COVID‑19.

Abstract BACKGROUND: Since poor communication with the patient has a negative impact on the quality of 
nursing care, taking the necessary measures to strengthen the relationship with the patient seems 
necessary. This study was conducted to determine the effect of spiritual intelligence training on 
nurses’ skills for communicating with patients.
MATERIALS AND METHODS: This experimental study with the control group and the pretest‑posttest 
design was conducted on 70 nurses working in Imam Khomeini Hospital, Mahabad, in 2019. 
Randomized stratified sampling was used to recruit participants. Then, participants were randomly 
assigned to the two groups of control and intervention. The demographic information form and the 
patient‑nurse communication skill questionnaire were used to collect the data. For the intervention 
group, 7 spiritual intelligence training sessions were held as a workshop in 2 months. Two weeks 
and a month after the intervention, both groups completed the questionnaires. Data were analyzed 
with the SPSS software version 17.0.
RESULTS: The findings showed that the mean communication skill scores in the intervention group 
before training were 44.71 ± 7.62, which significantly increased to 66.22 ± 8.43 2 weeks after training. 
Bonferroni multiple comparisons showed the mean communication skill scores significantly increased 
before, 2 weeks later and in the follow‑up phase in the intervention group (P < 0.001).
CONCLUSION: Spiritual intelligence training is effective in improving the communication skills of 
nurses. It is recommended that the prepared content can be provided to in‑service training units; 
consequently, nurses can improve their communication skills by individual and group learning.

Abstract BACKGROUND: Patient‑centered care (PCC) is a key component of high‑quality care. Given the 
different effects of cancer on patients, patient‑centeredness is very important in oncology nursing 
care. The aim of this study was to explore nurses’ perceptions of the patient‑centered in oncology 
nursing care.
MATERIALS AND METHODS: This descriptive qualitative study was conducted in 2018–2020, Iran. 
Data collection methods included observation and semi‑structured interviews. Patient, family, and nurse 
behaviors were observed (total: 318 h). In addition, interviews were conducted with nurses and nursing 
managers (12 interviews). Data analysis was performed using Graneheim and Lundman’s approach.
RESULTS: Data analysis resulted in the emergence of four themes: “Organizational structure as 
a barrier to the PCC,” “Lack of institutionalization of PCC in nurses,” “Understanding and paying 
attention to the patient as PCC,” and “Situational PCC.” The final theme of this study is “PCC in the 
shadow of paternalism.”
CONCLUSIONS: The paternalism approach in the context of oncology nursing care has made the 
realization of PCC difficult. The first step to promote PCC is increasing nurses’ awareness of the impact 
of paternalism on patient‑centeredness. Providing patient‑centered oncology nursing care requires 
changing attitudes, values, and behaviors at individual, professional, and organizational levels.

Abstract BACKGROUND: Despite the implementation of various cervical cancer preventive strategies by 
the Government of India, there is a scarcity of knowledge and consequent low utilization of cervical 
cancer screening services among women in India. This contributes to the burden of cervical cancer 
among Indian women. This study was conducted to assess perceived threat‑regarding cervical cancer 
among women and to identify its explanatory factors in a slum area of Kolkata.
MATERIALS AND METHODS: A cross‑sectional study was conducted among 192 adult women 
from May to September 2019 in Kolkata. The multistage sampling technique was used using a 
structured schedule. Perceived threat to cervical cancer was measured using a composite score 
including perceived susceptibility and perceived severity constructs of the health belief model. Data 
were analyzed by descriptive statistics and multivariable logistic regression model using SPSS 
software version 16.
RESULTS: Overall, 22.9% of the participants had satisfactory levels of perceived threat to cervical 
cancer. Statistically significant association was found between unsatisfactory levels of perceived 
threat with reproductive age group (adjusted odds ratio [AOR] = 3.01; P = 0.036), education level up 
to primary (AOR = 2.89; P = 0.026), and unsatisfactory knowledge (AOR = 2.94; P < 0.001) among 
respondents. The multivariable regression model was of good fit.
CONCLUSION: The study population had very unsatisfactory levels of perceived threat to cervical 
cancer. Thus, to increase cervical cancer screening uptake among women, it is necessary to tailor 
robust behavior change communication campaigns to increase the perception of susceptibility and 
severity, thereby increasing the perception of threat of cervical cancer among women.

Abstract BACKGROUND: India today is home for the largest youth population in the world. Youth is a 
formative phase transitioning from childhood to adulthood. Relationship is fundamental for a healthy 
and satisfactory life. Relationships assume importance and maturity during adolescence and youth. 
Relationships and mental health have a bidirectional effect. The effect of relationships on mental 
health is stronger than vice versa.
MATERIALS AND METHODS: Two‑year case record analysis of 8595 beneficiaries aged 15–35 years 
attending youth guidance centers (Yuva Spandana Kendras) in Karnataka, India, was undertaken 
to understand factors affecting relationship issues among them. Multivariate logistic regression was 
performed with any beneficiary having a relationship issue as outcome.
RESULTS: Being a student (adjusted odds ratio [AOR] = 1.49; 95% confidence interval [CI] = 
1.18–1.89), occupation (AORbusiness/
salaried = 3.04; 95% CI = 2.10–4.40 and AORothers = 1.72; 95% 
CI = 1.22–2.44), marital status (AORmarried = 1.42; 95% CI = 1.06–1.90 and AORothers = 3.44; 95% 
CI = 1.45–8.15), having health and lifestyle issues (AOR = 3.61; 95% CI = 3.05–4.27), personality 
issues (AOR = 2.88; 95% CI = 2.43–3.41), safety issues (AOR = 6.28; 95% CI = 5.01–7.87), 
gender, sex, and sexuality issues (AOR = 3.10; 95% CI = 1.93–4.98), suicidality (AOR = 1.82; 
95% CI = 1.17–2.85), alcohol use (AOR = 5.43; 95% CI = 3.92–7.41), and different emotions 
experienced (AOR ranging from 0.37 to 3.50), had significant association with relationship issues.
CONCLUSION: Investing in health promotion interventions focusing on these precursors of 
relationship issues among youth seems strategic. Our findings have implications for other states in 
India and other low‑middle‑income countries like India.

Abstract BACKGROUND: Urinary tract infections (UTIs) are more common in females than males and 
predominantly based on their unhealthy practices in their day to day lives. This study is trying to 
assess the occurrence of UTI and strategies used by female student to prevent UTI.
MATERIALS AND METHODS: A cross‑sectional descriptive study carried out in a tertiary care 
teaching institute. A total of 338 conveniently selected B. Sc. Nursing and MBBS Medical students 
were surveyed. The data were collected by using a pretested, a self‑structured questionnaire 
related to occurrence and practices to prevent UTI along with necessary demographic details. 
Descriptive (frequency, percentage, mean and standard deviation) and inferential (Chi‑square test) 
statistics was used to compute the data.
RESULTS: The result of this study shows that 10.05% female students reported of having UTI. The 
proportion was higher in nursing students (67.6%) than medical (32.4%) but did not show a significance 
difference (P = 0.61). Age, duration of hostel life, and marital status were significantly associated 
with the status of UTI (P = 0.001). To prevent UTI, students were using commercial product with 
Tea Tree Oil, soap, drinking 3–4 l water/day, increased frequency of peri‑wash during menstruation 
period, and use of Citrus Fruits. The use of western toilet was also significantly associated with 
status of UTI (P = 0.04).
CONCLUSION: The occurrence of UTI was more among nursing students. Most of the perineal 
hygienic practices by the female students were associated with occurrence of UTI; hence, it is 
necessary to emphasize on preventive practices to minimize re‑occurrence.

Abstract BACKGROUND: One of the most important clinical teaching keys is the use of new evaluation that 
plays an essential role in strengthening the quality level of clinical skills students. Hence, the aim 
of this study was to determine the effect of smartphone clinical skills recording in the labor ward on 
satisfaction of midwifery students.
MATERIALS AND METHODS: This is a quasi‑experimental study that was conducted on 60 midwifery 
students in the 8th semester was selected through the convenience sampling method. Clinical 
skills of labor ward recorded by two methods groups (smartphone and traditional). The satisfaction 
questionnaire was completed before and after by the two groups. Data were analyzed using the 
descriptive and inferential statistics through the SPSS version 22 software.
RESULTS: Independent t‑test showed that the satisfaction scores before intervention in both 
smartphone and traditional groups were not statistically significant (P = 0.126), whereas there was 
a significant difference between two groups after intervention (P = 0.002).
CONCLUSION: The use of smartphone techniques in the labor ward can be effect in clinical skills 
recording among midwifery students.

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

Abstract BACKGROUND: Childbearing is the most important determinant of population fluctuations and its 
studies are more important than other population phenomena. Many factors are associated with 
childbearing, but individual factors associated with it have been less studied in a specific framework. 
The present study aimed to explore and identify the factors related to childbearing based on extended 
theory of planned behavior (ETPB).
MATERIALS AND METHODS: This qualitative study was conducted among married women <35 years 
of age and married men whose spouses were under 35 years of age and lived in the City of Hamadan, 
Iran, in 2019. The data were collected by semistructured and face‑to‑face in‑depth interviews and 
continued until the data saturation was reached. Overall, 15 interviews were conducted with 17 
people. The data were analyzed, using a directed content analysis approach.
RESULTS: The data analysis resulted in the extraction of 28 main codes, 9 subcategories, and 4 
themes, which were correspond to constructs of the theory, consisting of attitudes, subjective norms, 
perceived behavioral control, and social support in the field of childbearing. The main predictors were 
attitude toward childbearing and perceived control.
CONCLUSION: The findings of this study showed that ETPB has a potential to explain the intention 
and behavior of childbearing. The ETPB makes it possible to understand many of the factors 
associated with childbearing. The results of this study could be the basis for designing appropriate 
data collection instrument in quantitative studies and vast surveys.

Abstract BACKGROUND: Many measures have been taken so far to minimize the outbreak of COVID‑19, but 
it is still unclear to what extent people have understood the risk. Public participation plays a vital role 
in better and effective control of the coronavirus, and the importance of risk perception is effective 
in their preventive behavior. The aim of this study was to investigate the pandemic risk perception 
of coronavirus disease after began of pandemic in Iranian society.
MATERIALS AND METHODS: This cross‑sectional study was conducted in Iran in spring 2020. The 
data collection tool was a researcher‑made questionnaire. The questions were extracted through 
interviews with experts and summarizing the opinions of public interviews, etc., The questionnaire 
was made available to the public through social media. The information was collected within 
3 months. Quantitative data were reported as mean ± standard deviation and the qualitative data 
were reported as number and percent. Multiple linear regression and cross were also used to examine 
the demographic factors associated with risk perception. Data Analysis was performed using the 
SPSS version 21 statistical software.
RESULTS: In this study, 402 individuals from 28 provinces (Azarbaijan Gharbi, Azarbaijan Sharghi, 
Alborz, Ardabil, Bushehr, Chaharmahal and Bakhtiari, Esfahan, Fars, Ghazvin, Gilan, Golestan, 
Hamedan, Hormozgan, Ilam, Kerman, Kermanshah, Khorasan Razavi, Khorasan Shomali, Khuzestan, 
Kohgiluyeh and Boyerahmad, Kurdistan, Lorestan, Mazandaran, Semnan, Sistan and Baluchestan, 
Tehran, Yazd, and Zanjan) of Iran participated. The risk perception score obtained from the sum 
of the scores of the questions was classified into quartiles. Accordingly, the risk perception score 
of (22.9) 92 people was very low, (26.6) 107 people low, (26.9) 108 people moderate, and (23.6) 95 
people high. The results of multiple linear regression showed that the variables of gender (P = 0.008) 
and occupation (P = 0.013) had a significant relationship with risk perception. There was no 
significant relationship between risk perception and variables of age, marital status, and level of 
education (P > 0.05).
CONCLUSION: The study showed that the risk perception of the people is more in categories 
of moderate to high. Assessing the risk perception of a pandemic can be helpful for preventive 
measurements and planning, and also, according to the results of the research, can be done 
appropriate educational interventions. Given that 47.5% of respondents were employees, of course, 
it should be noted that in sending a questionnaire virtually, there is usually a lot of loss and this is 
a limitation of the research. The results of this study can be useful in making prevention decisions 
and maintaining safety and health in the workplace.

Abstract BACKGROUND: Social media has become a most inseparable part of young adults’ lives with the 
rapid development of information and communication technology. The study aimed to assess the 
use of social media and its association with academic performance, well‑being, and interpersonal 
relation of the health sciences undergraduates.
MATERIALS AND METHODS: A descriptive cross‑sectional study was conducted among 
undergraduates in Faculty of Allied Health Sciences (n = 220), University of Sri Jayewardenepura, 
Sri Lanka. Data were collected using a pretested, self‑administered questionnaire and analyzed 
using descriptive and inferential statistics.
RESULTS: The response rate was 79.5%. All undergraduates (n = 175) had social media accounts, 
and WhatsApp was the most frequently used social media site (96.0%), followed by Facebook (70.9%), 
mainly for communicating (85.1%), entertainment (83.4%), and online learning (65.7%). Most 
undergraduates (72.0%) spent 2–5 h daily on social media sites and followed social media 1–10 times 
per day (54.9%). The majority of them wished to use social media for academic purposes (94.9%), and 
the most preferred site for academic work was WhatsApp (65.1%). Most undergraduates’ self‑reported 
Grade  Point Average  (GPA)  (46.3%) was  <2.9. There was a statistically significant association
between the mean GPA and frequencies of using social media (P = 0.02) (not daily [3.3 ± 0.3], 
1–10 times a day [2.9 ± 0.4], and more than 10 times a day [3 ± 0.4]). Perceived social media addiction 
and duration of sleep (P = 0.02), activities of daily living (P = 0.004), and study time (P = 0.02) were 
found to be significantly associated.
CONCLUSIONS: Despite the undergraduates’ willingness to use social media for academic purposes, 
the frequency of using social media had a significant influence on their academic performance. This
highlights the importance of guidance on effective use of social media and social media addiction 
to improve undergraduates’ academic performance, well‑being, and interpersonal relationships.

Abstract BACKGROUND: The traditional model of teaching surgical skills on “real” patients using graded 
responsibility is being seriously questioned, and there is a paradigm shift toward exploiting simulators. 
There is a lack of clarity on the impact of using simulation as a teaching strategy in novice learners. 
The purpose of our study was to determine if the number and duration of training sessions influence 
the acquisition and retention of laparoscopic skills in naïve learners. There are some data to suggest 
that distributed training programs might have better outcomes, but the results are inconclusive. We 
designed a controlled trial at Aga Khan University, Karachi, with the hypothesis that students trained 
using the distributed method may have enhanced learning outcomes.
MATERIALS AND METHODS: 100 medical students were assigned in a 1:1 ratio to one of two groups. 
Group A underwent a single orientation and supervised practice session of 3 h duration. Group B 
underwent distributed teaching with three learning sessions of 1 h each spread over 3 consecutive 
weeks. Participant scores were analyzed before and after the intervention and at 3‑ and 6‑month 
intervals using repeat measures of ANOVA.
RESULTS: Pretest and immediate posttest scores were comparable between the two groups. The 
3‑month interval test showed significantly higher scores in Group B (difference = −2.90, P < 0.001). 
The 6‑month interval test showed no differences in scores between the two groups (P = 0.178).
CONCLUSIONS: Distributed teaching resulted in significantly enhanced scores at 3‑month 
assessment. However, similar scores at 6 months suggest the need for repeated intervention.

Abstract BACKGROUND: The prevalence of self‑medication is high in Bangladesh due to easy access 
and poor regulatory controls over these drugs. Our study aimed to assess the attitude of university 
students in Bangladesh toward antibiotic usage, especially their knowledge and awareness about 
antibiotics and their resistance. We also evaluated the determinants behind their attempts at drug 
intake without prescription.
MATERIALS AND METHODS: A cross‑sectional study was conducted in Mawlana Bhashani Science 
and Technology University that included information from randomly selected 200 students from 15 
departments using a structured questionnaire. The statistical analyses were performed by using 
SPSS software (version 21) and R programming.
RESULTS: The study revealed that 61.0% of the students use self‑medication at different times 
or always; 32.5% of the respondents keep antibiotics for future use, and 38% of the students think 
it is right to stop antibiotics when symptoms are improving. Half of the participants (47.5%) use 
antibiotics based on their previous experience. The criteria of antibiotic selection have a significant 
relationship with knowledge about antibiotic resistance (P = 0.017) and altered prescribed medicine 
without doctor’s advice (P < 0.001). The multivariate analysis indicates that respondents who know 
about antibiotic resistance select antibiotics from the community pharmacists with respect to their 
own experience 5.102 times higher than those who do not know about antibiotic resistance.
CONCLUSIONS: The study mainly explored the knowledge gaps of the students on the options that 
are responsible for antibiotic resistance in the community and found that students have mid‑level 
knowledge (66%) about antibiotic resistance.

Abstract BACKGROUND: Health‑care workers are exposed to complex types of health and safety hazards. 
A high percentage of hospital staff in Iran are women, who in addition to heavy and stressful hospital 
work, also carry the burden of the family roles. It is in these circumstances that creating a supportive 
environment for women is of particular importance. Accordingly, this study is designed to determine 
the characteristics of a mental supporting work environment in the workplace from the perspective 
of female hospital staff.
MATERIALS AND METHODS: This study was performed by a qualitative method and content 
analysis approach. Sampling was purposive and 26 women working in different wards of this 
hospital were included in the study. In this study, women with maximum diversity in terms of age, 
work experience, and employment ward were selected. The main method of data collection in this 
study was a semi‑structured interview. Interview texts were extracted and divided into meaningful 
units. To validate and confirm the results plus accuracy of the research, the criterion of data validity 
or data credibility, admissibility, data accuracy, verifiability, reliability, and transferability were used.
RESULTS: Through the data analysis, 58 primary concepts with the same features were classified 
into 10 subcategories. Then, based on common features at a more abstract level, they were converted 
into four main categories including job stressors, women’s stress management, providing women’s 
psychological‑job satisfaction, and women’s work‑life balance.
CONCLUSION: Creating supportive work environments for women, especially those operating in 
workplaces such as hospitals, which brings a lot of work pressure and workload for them, can be an 
important policy for organizations and hospital work environments.

Abstract BACKGROUND: Online learning self‑efficacy is considered a major contributor to academic success. 
The present study was conducted to assess the psychometric properties of the Persian version of 
the Online Learning Self‑Efficacy Scale.
MATERIALS AND METHODS: A cross‑sectional study was conducted on 211 medical students at 
Kerman University of Medical Sciences in 2021 who were selected through the convenience method. 
Data were collected using a two‑part self‑administered online questionnaire containing demographic 
information and the Persian version of the Online Learning Self‑Efficacy Scale (OLSES). Forward and 
back‑translation methods were used to provide the Persian version of OLSES. Internal consistency 
of the Persian version was determined by the Cronbach alpha coefficient in a pilot study. Exploratory 
and confirmatory factor analyses were conducted using SPSS version 20.0 and LISREL version 8.80.
RESULTS: The mean of the participants’ age was 21.40 ± 2.52 years, and most of them (56.4%) 
were female. The Cronbach alpha coefficient was determined as 0.74, 0.90, 0.75, and 0.89 for 
learning, time management, technology use subscales, and the whole scale, respectively. Exploratory 
factors analysis revealed the justifiability of factor analysis. In confirmatory factor analysis, most of 
the goodness of fit indices had an acceptable level.
CONCLUSIONS: Our study found that the Persian version of OLSES had good psychometric 
properties and can be used as a simple, valid, and reliable tool to assess students’ self‑efficacy 
related to the e‑learning environment.

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

Abstract Breastfeeding is the single intervention with the largest impact on the health of a new‑born baby. 
Evidence has to be generated to convince the mother as well as policy‑makers for the promotion 
of exclusive breastfeeding (EBF) for 6 months. This study aimed to assess the evidence for the 
effectiveness of breastfeeding education compared with standard hospital information among mothers 
on the rate of EBF. The study design is systematic review. Trials which are randomized or cluster 
randomized which studied the effect of educational interventions for mothers on EBF were searched 
for. Two databases were searched, namely PubMed and Cochrane. Manual search of reference 
lists of all included studies in Google scholar and Clinical Trial Registry was done. Two reviewers 
independently assessed the quality of the included studies. Data were extracted using a table format 
set by the reviewers referring the previously reported high‑quality systematic reviews. Out of the 12 
comparisons of nine studies included for review, eight studies report that breastfeeding education 
has added advantage on increasing the rate of EBF. We conclude that there is evidence to support 
breastfeeding education versus standard hospital information across diverse settings.