Journal of Education and Health Promotion

Abstract BACKGROUND: Online teaching has been practiced after lockdown due to Coronavirus Disease 
2019 (COVID‑19) pandemic which has replaced conventional classroom teaching. The aim of the 
present study was to know the perceptions regarding online learning as perceived by both teachers 
and students during COVID‑19 pandemic.
MATERIALS AND METHODS: The present study was cross‑sectional and questionnaire‑based. 
Web‑based respondent‑driven sampling technique was used to recruit participants for the present 
study. Three hundred and thirty‑two students and 130 teachers of varying ages and gender participated 
in the study. The link of web‑based questionnaire was sent to respondents through WhatsApp/
Facebook. Responses from all the participants were tabulated and analyzed using univariate 
analysis (Chi‑square test).
RESULTS: Prerecorded lectures (38.9%) and Webinar apps (35/8%) were the most common 
modules of online teaching by students. One‑third (34.3%) had the convenience to attend lectures 
from home whereas 44.3% had difficulty in concentration. Commonly cited disadvantage by students 
was inability to do practical work (37.9%). Regarding teaching faculty, 43.8% had no prior knowledge 
of online teaching. Sixty percent of teachers had 4 h/week of online teaching. No face‑to‑face 
interaction (67.7%) and internet issues (26.9%) were commonly stated barriers by faculty.
CONCLUSION: The pandemic has pushed the teachers and students toward newer teaching avenues. 
However, more needs to be done to supplement the existent teaching pattern and preparedness of 
teaching faculty by incorporating online assignments and assessment methods, strengthening digital 
infrastructure in medical schools, and training support for teachers.

Abstract BACKGROUND: Financial literacy is a person’s capability to manage their own monetary matters. 
There was no information available on financial literacy status of healthcare professionals (HCPs) of 
India. So, the current research was formulated to assess the financial literacy status and its correlates 
among HCPs of India.
MATERIALS AND METHODS: It was an observational study, cross‑sectionally designed, conducted 
among 524 HCPs of India using a structured Google form during July 2020. For data analysis, 
SPSS (version 22) was used.
RESULTS: Among the study participants, 68.3% were found to be financially literate. Among the 
various subdomains of the total financial literacy, knowledge regarding general domain was observed 
to be the best (69.3%) followed by savings (63.7%) and investment (58.0%) domains, respectively. 
The total financial literacy score was found to be positively correlated with higher age [spearman 
rho correlation co‑efficient (ρ) = 0.25; P =< 0.01], qualification [(medical postgraduate) (ρ = 0.16;
P =< 0.01); (medical super speciality) (ρ = 0.14; P =< 0.01)], and annual family income (ρ = 0.29;
P =< 0.01). Moreover, males (ρ = 0.23; P =< 0.01)], currently married (ρ = 0.19; P =< 0.01), and 
surgeons (ρ = 0.12; P =< 0.01) were found to be more financially literate compared with others. 
Positive financial attitude (ρ = 0.26; P =< 0.01) and regular maintenance of financial record (ρ = 0.21;
P =< 0.01) were the other enabling factors of financial literacy observed in the study.
CONCLUSIONS: Financial literacy was found to be quite low in the surveyed HCPs as every third 
study participant were found to be deficient in knowledge regarding one or more financial attributes. 
Incorporation of finance management in curriculum of the healthcare allied courses and repeated 
sensitization of the graduated HCPs are warranted to enable them to take effective financial decisions 
to meet their personal and organizational financial goals.

Abstract BACKGROUND: Cardiovascular diseases (CVDs) are among the most important causes of premature 
death, disability, disease burden, and increasing the cost of healthcare worldwide. Having an overview 
of service utilization can help policymakers to plan more effective use of those services and to cut 
costs. Thus, this study aims to determine the amount of use as well as the cost of various outpatient 
diagnostic procedures for CVDs in Isfahan province of Iran from 2011 to 2017.
MATERIALS AND METHODS: This descriptive study used insurance claim data (time period: 
2011–2017) from Health Insurance Organization in Isfahan province to determine the amount of 
use and the cost of various outpatient diagnostic procedures for CVDs. Afterward, based on these 
data, the use and the cost of various outpatient diagnostic procedures for CVDs were estimated for 
the total population of Isfahan province. The list of outpatient diagnostic procedures for CVDs was 
carefully chosen according to experts’ opinions.
RESULTS: The use and the cost of outpatient diagnostic procedures for CVDs have drastically 
increased in the study period (2011–2017). Since 2011, the number of procedures and their related 
costs have increased 6.6 and 30.76 times (11.74 times, adjusted with PPP conversion factor), 
respectively. Per capita use (per thousand people) was 18.75 in 2011, reaching 116.51 in 2017. 
Per capita cost (per thousand people) was 1,887,660 IRR (355 PPP$) in 2011, reaching 54,660,365 
IRR (3920 PPP$) in 2017. The highest cost and use were related to echocardiography and 
electrocardiography, respectively. A notable increase has been observed in the share of radionuclide 
myocardial perfusion scan and analysis of pacemakers and ICDs of the total cost.
CONCLUSIONS: The use of outpatient diagnostic procedures for CVDs has drastically increased 
during the studied period. Consequently, the cost borne by the health system and the patients have 
notably increased. This may be because of the increase in the incidence and prevalence of CVDs 
during the study period. Greater access to related health services can be mentioned as another reason 
for this increase. Further research is needed to explain all potential reasons and their importance, 
which can provoke a suitable health policy reaction.

Abstract BACKGROUND AND AIM: Vaccination has been appraised to be one of the most significant public 
health achievements in human history. However, in countries like Nigeria, vaccine hesitancy is a 
public health challenge that has consistently forestalled concerted efforts made by health authorities 
to curb the spread of communicable diseases such as COVID‑19. To improve COVID‑19 vaccine 
acceptance via targeted interventions, it is imperative to examine the public’s perception. Thus, 
this study aims to evaluate vaccine hesitancy among university students in Southwestern Nigeria.
MATERIALS AND METHODS: The study utilized a descriptive cross‑sectional design. 
A self‑administered questionnaire was administered to a total of 366 respondents who were recruited 
using the convenience sampling technique and snowball approach. Data were entered and analyzed 
using SPSS.
RESULTS: The majority of the respondents were over 18 years (88%) and were between their first 
and third years (81%). Over a tenth of the respondents reported having at least a loved one that 
had tested positive for the virus, while only 88% believed the virus is real. Furthermore, only 17% 
of the students had a positive attitude toward the vaccine. Although 90% of the respondents were 
aware of the administration of COVID‑19 vaccine in Nigeria, only around a quarter were willing to take 
the vaccine, while 5.5% had been vaccinated. The major reasons for COVID‑19 vaccine hesitancy 
highlighted by the respondents were concerns about vaccine side effects (21.3%), lack of trust in the 
authorities (26.5%), vaccine efficacy (13.1%), and diverse mystical possibilities (39.1%).
CONCLUSION: The results indicate that a significant communication gap exists between the 
respondents and local health authorities. To enhance the acceptance of COVID‑19 vaccines, extensive 
and targeted health promotion campaigns are required to allay specific concerns raised by the public.

Abstract BACKGROUND: Mothers play an important role in oral health of children. The present study was 
planned, implemented, and evaluated to determine the impact of mothers’ educational program based 
on PRECEDE–PROCEED model on oral health promotion of Rafsanjan 3–6‑year‑old children, in 2020.
MATERIALS AND METHODS: This quasi‑experimental study was conducted on 100 mothers with 
children aged 3–6 years divided into two groups. The research tool was developed and approved 
based on the model phases in the form of demographic information, predisposing, enabling, and 
reinforcing factors. At phase five, intervention planning was conducted and the program was 
implemented in four sessions (45 min each) in 30 days. Follow‑up was done 2 months after the last 
training session. The data were analyzed by SPSS18, using Chi‑square, paired t‑test, and independent 
t‑test at the significance level of 0.05.
RESULTS: After implementing the program, a significant difference was observed between 
predisposing, enabling, and reinforcing factors, as well as oral health‑related behaviors of the two 
groups (P < 0.05). Finally, 30.4% of the changes in oral health‑related behavior resulted from the 
implementation of the designed educational program.
CONCLUSION: Considering the importance of planning to promote children’s oral health and 
hygiene, it is recommended that the PRECEDE–PROCEED model be used to design, implement, 
and evaluate health evidence‑based interventions.

Abstract BACKGROUND: Visual impairment (VI) is one of the major public health problems that cause 
suffering, disability, loss of productivity, and reduced quality of life (QoL). This study aimed to evaluate 
the health‑related QoL (HRQoL) among adults with visual problems in 2021.
MATERIALS AND METHODS: This analytical cross‑sectional study was conducted on 300 patients with 
VIs referring to ophthalmology centers in Yazd, Iran. Data were collected through face‑to‑face interviews 
using EQ‑5D, visual analog scale (VAS), and demographic information questionnaires. The results were 
analyzed using independent sample t‑test, one-way analysis of variance, Pearson correlation coefficient, 
and adjusted limited dependent variable mixture model (ALDVMM) model by STATA, and SPSS.
RESULTS: The mean and standard deviation of EQ‑5D‑5 L index and EQ‑VAS score in the studied 
patients were 0.68 ± 0.25 and 72.46 ± 19.36, respectively. Most problems at unable/extreme level 
were related to the mobility dimension (12%) and the usual activities dimension (9%). Factors related 
to HRQoL scores using ALDVMM model showed that divorced or widow marital status, age over 50, 
having strabismus, and acuter visual problems had significant negative effects on EQ‑5D‑5 L index 
values (P < 0.05).
CONCLUSIONS: The results showed that HRQoL was moderate in patients with VIs and reduced in 
patients with high disease severity, old age, lack of a spouse, retirement, and nonuniversity education. 
As a result, socioeconomic and demographic characteristics were required to be considered in visual 
health policies.

Abstract BACKGROUND: Pregnant women experience falls, particularly in the third trimester. In this 
population, physiological changes, as well as ligament laxity, might influence joint proprioception and 
do not return to normal during the postpartum period. The prevalence of falls during pregnancy and 
postpartum periods imposes a need to study proprioception in pregnant women and the postpartum 
period. 
MATERIALS AND METHOD: An observational longitudinal study was conducted in June 2018 in 
outpatient clinic Chinchwad Pune. A total of 36 primiparous women were included in the study by using 
purposive sampling. The mean and standard deviation of the age was 25.92 (2.59). Proprioception 
was assessed for the knee joint and the ankle joint during the third trimester of pregnancy and 6th and 
12th week postpartum. Outcomes included were the Joint Reposition Test for both knee and ankle 
joints using UTHSCSA Image Tool Software 3.0. Repeated‑measure ANOVA was performed for the 
normally distributed data, and nonparametric test Friedman’s test was performed for data that were 
not distributed normally. The data was statistically analyzed using the SPSS software version 26. 
The level of significance was set at 0.05, confidence intervals of 95% were used. 
RESULT: The result revealed significant (P < 0.05) improvement in both knee and ankle proprioception 
during the third trimester of pregnancy and postpartum period 6th and 12th week. 
CONCLUSION: Knee proprioception and ankle proprioception were found to improve significantly 
during the postpartum period 6th and 12th weeks compared to the third trimester of pregnancy but do 
not return to the prepregnancy state.

Abstract BACKGROUND: Preconception reduces unplanned pregnancies and plays an important role in 
reducing maternal and infant mortality. Considering the importance of these care services, this study 
was conducted to determine the status of preconception care (PCC) model with Structural Equation 
Modeling (SEM).
MATERIALS AND METHODS: This cross-sectional descriptive study was conducted on 394 pregnant 
women referring to Gorgan’s health centers. Samples were selected by multi‑stage stratified sampling 
method. The instrument used in this research was a researcher-made questionnaire by Bayrami. Data 
were analyzed using R software version 4.1.4. Structural equation modeling (SEM) with weighted 
least square mean and variance method was used to fit the conceptual model and the significance 
level of the tests was considered 0.05.
RESULTS: The results showed that PCC model was deemed appropriate as optimum conditions 
indicators of goodness of fit; knowledge with a coefficient of 0.182 leads to self‑efficacy (SE), and 
SE affects the accessibility of facilities with a coefficient of 0.465 and the expected outcome with a 
coefficient of 0.500. After facility structure with a coefficient of 0.500, SE construct with a coefficient 
of 0.215 had the most effect on performing PCC behavior.
CONCLUSIONS: Facilities and SE as a key element of empowerment have an important role in 
promoting PCC. Identifying the factors associated with this care appears to help health policymakers 
to planning for these caregivers more precise and sensitive.

Abstract BACKGROUND: COVID‑19 pandemic pushed all educational institutions to rely exclusively on 
technology‑based learning. As this was done for the first time, it is ideal to evaluate the e‑learning 
program to refine and consolidate the learned experience. Hence, the current study was undertaken 
to evaluate the online learning and teaching experiences of students and teachers.
MATERIALS AND METHODS: This program evaluation on e‑learning was carried out in the 
department of Community Medicine (DCM) in a private medical college using context/input/process/
product framework among IV, VI, and VII semester undergraduate students and faculties in DCM 
who were exposed to e‑learning for the period of 2 months since April 2020. Google Forms was 
used to design a survey questionnaire that was conceptualized as per the needs of the evaluation 
framework. Ethics Committee approval was obtained. Descriptive analysis was done for quantitative 
variables and manual content analysis using Lewin’s force field framework was performed for the 
qualitative data.
RESULTS: Out of 301 undergraduates contacted, 196 (65.1%) responded to online survey. Their 
mean age was 19.9 years and 128 (65.3%) were females. Mobile phone was used by 93.4% to 
access e‑learning. Combined modality of learning was preferred by 58.2% of them in future. Six 
“for” and “against” factors on e‑learning emerged out of content analysis pertaining to three main 
stakeholders, namely administrator, faculty, and student.
CONCLUSION: Our evaluation conveys that for effective e‑learning in any subject, the students, 
educators, and institutional factors that were identified need to be considered throughout all phases 
of program development with careful assumptions about its acceptance by the millennial.

Abstract BACKGROUND: The Iran Package for Essential Noncommunicable Disease (Ira‑PEN) program 
has been established since 2018 with the aim of controlling and caring of noncommunicable 
diseases (NCDs) as well as their underlying causes in Iran. In this study protocol, a healthy lifestyle 
module will be used for the first time in Iran, which was recommended in 2018 by the World Health 
Organization to train health workers. This module relies on the 5As model, a training intervention 
design, then, implement, evaluate, and present the results to the managers and decision makers 
of the Ira‑PEN program.
MATERIALS AND METHODS: This study will be performed in 2 stages, including 2 steps per stage. 
The first stage involves designing the 2 steps and validation of the healthy lifestyle counseling skills 
tool. The tool will encompass a health counseling evaluation checklist and a counseling assessment 
questionnaire according to the counseling recipients. The second stage also entails 2 steps; 
designing a training program for health workers in the field of healthy lifestyle counseling based on 
the Oles‑Cement model followed by implementation and evaluation.
CONCLUSIONS: The training program and the results obtained in this study will be presented to 
the managers and decision makers of both the Ira‑PEN program and NCDs control in Iran, and it is 
suggested to enhance the training program, network, and educational curriculum of health workers 
in providing healthy lifestyle counseling to play a more effective role in changing the public behavior 
toward a healthy lifestyle and preventing the risk factors of NCDs.

Abstract BACKGROUND: Human papillomavirus (HPV) is the most common sexually transmitted infection 
and causes more than 90% of cervical cancers. The highest rate of infection occurs between the 
ages of 18 and 28. This study aimed to determine the effect of education based on the theory of 
planned behavior (TPB) on the intention of vaccination against HPV in female students.
MATERIALS AND METHODS: This controlled educational trial study was performed on 72 female 
students aged 18–26 years of Mashhad University of Medical Sciences by random assignment to 
intervention and control groups. For random assignment in the intervention and control groups, 
random blocking with four blocks was performed using a random number table with a ratio of 1:1. 
Data collection tools included demographic questionnaire, awareness about HPV vaccination, 
and TPB theory constructs. The control group was received the university routine training. The 
intervention group was received the virtual group training in four sessions, 60–90 min at weekly 
intervals and with educational content including TPB constructs on HPV vaccination with the 
method of lecture training, group discussion, questions and answers, and presentation of training 
package. Questionnaires were completed before, instantly, and 1 month after the educational 
intervention. Data were analyzed using the Chi‑square test, Fisher’s exact, t‑test, Mann–Whitney 
test, and Friedman test.
RESULTS: The mean age of students was 18.9 ± 1.1 years. The intervention and control groups 
were homogeneous in terms of demographic characteristics (P > 0.05). Before the intervention, 
the mean score of model constructs did not show a statistically significant difference between the 
two groups (P > 0.05), but after the intervention, in the intervention group, mean scores of attitude, 
subjective norms, perceived behavioral control, and behavioral intention in the intervention group 
was significantly higher than the control group (P < 0.001). In the intervention group, the difference 
in the mean score of HPV vaccination intention instantly (P < 0.001) and 1 month (P < 0.001) after 
the intervention significantly increased.
CONCLUSION: TPB‑based education was effective in increasing attitudes, subjective norms, and 
perceived behavioral control and the intention to vaccinate against HPV in the female students of 
Mashhad University of Medical Sciences. Therefore, it is suggested that the present educational 
intervention be widely used to educate female students.

Abstract BACKGROUND: Severe acute respiratory syndrome coronavirus‑2 (SARS‑CoV‑2) causes COVID‑19. 
On March 11, 2020, the WHO declared it a pandemic. SARS‑CoV‑2 indicates that it poses a 
significant threat to public health and global economy. The aim of the study was to determine (a) 
patient characteristics, (b) demographic characteristics, (c) comorbidities, diagnostic methods used, 
treatment, and outcomes, and (d) mortality rates of patients.
MATERIALS AND METHODS: This retrospective cohort study included 352 hospitalized adult 
patients from Baskent University Hospital in Ankara who were confirmed cases of COVID‑19 between 
March 2020 and March 2021. SPSS v. 14.0 was used for statistical analysis.
RESULTS: Out of 352 patients, 55 died (males: 37, females: 18), while 297 survived (males: 162, females: 
135). The most common comorbidities were hypertension (HT), diabetes mellitus (DM), coronary artery 
disease (CAD), cancer, Vitamin D deficiency, and chronic obstructive pulmonary disease. Comorbidities 
associated with mortality rate were obesity (33%) (P = 0.118), Vitamin D deficiency (28%) (P = 0.009), 
DM (25%) (P = 0.004), CAD (21.2%) (P = 0.142), cancer (20.9%) (P = 0.084), and HT (16.6%) (P = 0.90). 
Normal ward admission resulted in death in 67.3% and survival in 93.9% (P = 0.001), intensive care 
unit (ICU) admission resulted in death in 69.1% and survival in 18.5% (P = 0.001), and oxygen therapy 
was used in 80% death and survival in 39.4% (P = 0.001).
CONCLUSIONS: Our study shows that male gender, advanced age, and presence of comorbidities 
in COVID 19 patients are at higher risk for severe disease, ICU admission, and death. We emphasize 
that morbidity and mortality can be reduced by early and comprehensive identification of risk factors 
and the warning systems that will meet the ICU needs of these patients.

Abstract This systematic review protocol is developed with the objective to identify the strategies, facilitators, 
and barriers to interaction between researchers and policy makers to use research evidence in health 
policy making. It seems that review of interactive methods between researchers and policy makers can 
help to understand the role of researchers on evidence‑informed policy making. Moreover, identifying 
barriers and facilitators of these interactions can help universities and institutions associated to 
health policy making in planning to improve the interaction between researchers and policy makers 
to facilitate evidence‑informed policy making.

Abstract BACKGROUND: The therapeutic environment is commonly acknowledged as a significant influence 
on mental inpatient treatment experiences and outcomes. Therapeutic milieu interventions provide a 
distinct, secure hospital ward/unit atmosphere where patients with mental illness receive therapeutic 
interactions and collaborative attentiveness. The review aimed to explore the studies related to the 
role of a nurse using therapeutic milieu/milieu therapy in a psychiatric setting.
MATERIALS AND METHODS: A systematic literature search was conducted between 1976 and 2021 
using PsycINFO, Medline, Embase, and Scopus. A total of 13 papers were identified for a full review.
RESULTS: A total of 70 studies were found, out of which 13 of them were analyzed. These studies 
looked at several therapeutic milieu concepts, such as therapeutic communication, patient satisfaction, 
nurse involvement, ward design and structure, and a mixture of therapeutic milieu concepts. Most 
of the studies explored the concepts of milieu therapy in community settings.
CONCLUSION: In the mental health nursing literature, the milieu, as well as milieu therapy, is a 
well‑debated subject. Though the importance of therapeutic milieu in psychiatric settings is recognized, 
empirical studies on milieu implementation are scarce. Therefore, research is needed to explore the 
effectiveness of milieu therapy in inpatient psychiatric care, which facilitates patient recovery, safety, 
and good interpersonal relationships.

Abstract BACKGROUND AND PURPOSE: Most patients experience anxiety before heart surgery. On the 
other hand, spiritual health can improve the candidate patient’s adaptation to surgery. Therefore, 
this study aimed to investigate the effect of group logotherapy on spirituality and anxiety of patients 
undergoing cardiac surgery.
MATERIALS AND METHODS: In this quasi‑experimental study, 60 hospitalized candidates for 
cardiac surgery were randomly assigned to two groups (30 in the experimental group, 30 in the 
control group). To measure anxiety and relationship with God, Beck Anxiety Questionnaire and the 
researcher‑made scale about relationship with God (reconstruction of Lawrence’s scale of perception 
of God) were used, respectively. In the intervention group, in addition to drug therapy, individuals 
received two sessions of group discussion and spiritual skills training using the behavioral‑cognitive 
method with emphasis on spiritual thoughts and problem‑solving methods, but the control group 
received only drug therapy. Data were analyzed using SPSS software.
RESULTS: In the experimental group, the anxiety scores mean in the posttest and follow‑up were 
significantly lower than the pretest (P < 0.05), while the mean anxiety in the control group in the 
posttest stage was not significantly different, but at the follow‑up stage, it was significantly lower 
than the pretest, but the decrease in mean anxiety in the experimental group was greater (P < 0.05). 
The mean subscales of relationship with god (influence, divine providence, acceptance, presence, 
challenge, benevolence) were significantly higher in the experimental and control groups in the 
follow‑up stage than the pretest, but the increase in the mean of these variables was more in the 
experimental group in the follow‑up stage (P < 0.05).
CONCLUSION: Findings showed that the components of relationship with God are a good predictor 
of pre‑surgery anxiety, so by focusing on spiritual training of patients who are candidates for surgery, 
the incidence or severity of anxiety can be reduced.

Abstract BACKGROUND: Sleep disturbances as a major health problem are common in patients hospitalized 
in critical care units. This study examined the effects of a team‑based care plan on the quality of sleep 
in patients hospitalized in a cardiac surgery intensive care unit (CSICU) of a multidisciplinary hospital.
MATERIALS AND METHODS: In this clinical trial, 100 patients with cardiac surgery were selKMected 
through convenience sampling and then nonrandomly allocated to the intervention and or the control 
group. A plan of care with the recommendation of all intensive care unit care teams was designed 
and then applied. In this study, the Richards‑Campbell Sleep Questionnaire was used to evaluate 
sleep quality. Patients in the intervention group received the care plan for two consecutive nights. 
The study’s national approval code is IRCT2017091915512N2. Collected data were analyzed using 
SPSS software (v. 21), and by paired, independent t, Chi‑square, and Fisher’s exact tests.
RESULTS: Quality of sleep in patients admitted to the CSICU is significantly improved by noise 
reduction both in the first and second nights. Moreover, the team‑based care plan requires good 
coordination between all team members taking care of cardiac surgery patients admitted to the 
CSICU (P < 0.001).
CONCLUSIONS: The team‑based care plan significantly improves the quality of sleep. It may be 
due to the close coordination between all team members to avoid sleep disturbances.

Abstract BACKGROUND: Academic stress is a predominant phenomenon among grade 11 and 12 students. 
The performance in Grade 12 is important for entry to higher education programs in India. The 
purpose of the study was to assess the magnitude of the perceived academic stress and identify the 
main stressors and the sociodemographic variables associated with the perceived academic stress 
among adolescents enrolled in the science stream in coastal Karnataka.
MATERIALS AND METHODS: Upon Institutional Ethical Committee approval, a 
cross‑sectional survey was carried out among pre‑university students (science stream) of 
coastal Karnataka during February–April 2021. The study used Manipal Inventory of Academic 
Stress (MIAS) scale to collect data on perceived academic stress from 1859 students (response 
rate 68.3%). Stratified cluster sampling method was used to collect data from the study participants. 
IBM Statistical Package for the Social Sciences (SPSS) 26.0 was used to analyze the data. 
Descriptive statistics, unpaired t‑test, one‑way analysis of variance (ANOVA), and multiple linear 
regression analyses were used to study the association between academic stress and various 
demographic variables.
RESULTS: The study revealed that 28% of the Grade 11 students and 26% of the Grade 12 students 
experienced high or extreme stress. The significant stressors were lack of time for revision, queries 
from neighbors or relatives, and parental expectations on academic performance. Gender, residence, 
and the medium of instruction until Grade 10 were associated with academic stress.
CONCLUSION: Measures at the institutional and national levels are necessary to reduce the 
academic stress in higher secondary education. The integrated curriculum proposed in the National 
Educational Policy 2020 addresses a few stressors identified in this study.

Abstract ntroduction: COVID‑19 has affected the quality of life of all age groups. Medical education during 
the pandemic shifted to online mode due to lockdown restrictions. The stress felt by medical students 
during the pandemic has been studied less. The current study aimed to assessed the stressors and 
de‑stressors for undergraduate medical students during the COVID‑19 pandemic.
Materials and methods: A cross‑sectional online survey was conducted for the undergraduate 
medical students of a tertiary care institute of eastern India. A total of 307 medical students were 
included in the study by convenient and snowball sampling. A self‑designed semi‑structural 
questionnaire was created as a Google form and circulated among the students between September 
and October 2020. A combination of purposive and snowball sampling was adopted. Responses 
regarding stressors and de‑stressors were recorded on a Likert scale. Data analysis was performed 
using Statistical Package for Social Sciences (SPSS) version 22. Categorical variables were presented 
as percentages and descriptive statistics were performed.
Results: A total of 307 students responded and 64.5% of them were men and 35.5% were women. 
47.6% of the students experienced stress due to changes brought about by COVID‑19. Risk of parents 
getting infection (63.2%), fear of not easily returning home (53.1%), lack of clinical exposure (52.7%), 
and financial impact (47.9%) were the major stressors perceived by the students. Connecting with 
family and friends through social media (47.5%), gaming (45.0%), online streaming platform (51.2%), 
spending time with family members (54.4%) were the coping strategies adopted by these students.
Conclusion: Higher level of psychological stress perceived by the undergraduate students needs 
psychological intervention. Academic revamp and adaptation of coping strategies are required for 
the medical under‑graduates.

Abstract BACKGROUND: Informal and formal caregivers of older adults with noncommunicable 
diseases (NCDs) are important in every aspect of current caregiving for older adults by understanding 
reality specific to direct experiences perceived by each person in caring for older adults in order to 
develop nursing knowledge and using knowledge to plan care for older adults with NCDs to have a 
good quality of life. The current study aimed to investigate the points of view on factors concerning 
the care provided by informal and formal caregivers providing care for older adults with chronic 
diseases in the community.
MATERIALS AND METHODS: This study was conducted with a qualitative design. The sample 
was 5 informal and 20 formal caregivers providing care for patients with chronic diseases, namely 
hypertension and diabetes mellitus. Furthermore, a qualitative approach was used with four focus 
groups (FGs) with 25 informants. Data were collected during March–August 2021 in rural communities 
of Nakhon Phanom Province, Thailand. Finally, the qualitative analysis used content analysis; FG 
data were analyzed using content analysis in which a preliminary set of codes was determined 
according to other documented experiences of patients.
RESULTS: The findings revealed three main themes emerging in the data obtained on the perceived 
factors contributing to the care provided by informal and formal caregivers: “caregivers’ knowledge,” 
“factors related to caregivers” and “community factors.”
CONCLUSION: Points of view on the factors correlated with the care provided by informal and formal 
caregivers of older adults with chronic diseases that explain and confirm the findings can be used to 
plan care with effects on quality of life among older adults with chronic diseases.

Abstract BACKGROUND: Identifying and addressing the needs of Colorectal cancer (CRC) patients/survivors’ 
is important to improve patients/survivors’ quality of life (QoL) and health. The present study aimed 
to review studies that have investigated CRC patients/survivors’ needs. 
MATERIALS AND METHODS: In this narrative review, databases including PubMed, Scopus, Web 
of Science, Iranmedex, ISC, SID, and Magiran were searched during 2011–2021 using keywords 
included need, CRC, colon cancer, rectal cancer.
RESULTS: The findings of the studies showed that the needs of the CRC patients/survivors’ can 
be categorized into the 6 domains including informational, psychological, social, physical, financial, 
and spiritual needs.
CONCLUSIONS: By identifying CRC patients/survivors’ needs, healthcare providers particularly 
nurses can develop and design comprehensive care programs tailored to the needs and priorities 
of these patients/survivors to improve their QoL and health.

Abstract BACKGROUND: A structured physical activity program has many health benefits. Physical activity 
improves the functional ability of a patient with mental illness as an adjunctive treatment. This study 
aimed to evaluate the efficacy of a physical activity program on the level of functional ability of 
patients with mental illness.
MATERIALS AND METHODS: A pre‑experimental research design and one group pre‑post design 
were adopted. Thirty‑one in‑patients with mental illness who met the inclusion criteria were recruited 
for the study using convenient sampling. Baseline data were collected using sociodemographic and 
illness profiles developed by the researcher and validated by the experts. Functional ability and illness 
severity were assessed using the standardized World Health Organization Disability Assessment 
Schedule (WHODAS) (36‑item version) and the Clinical Global Improvement Scale. Pretest, i.e., 
intervention with structured physical activity, was administered for 40 consecutive days. A posttest 
was given 30 days after the intervention ended to assess the impact of the structured physical activity 
program on the level of functional ability among the study participants.
RESULTS: The impact of structured physical activity on functional ability was measured using the 
WHODAS 2.0, a 36‑item version. The paired Sample t‑test and the Wilcoxon Rank test analyzed the data. 
There was a significant improvement in the overall functional ability of study participants at P = 0. 001.
CONCLUSION: The study findings support that structured physical activity substantially impacts 
functional ability among patients with mental illnesses.

Abstract BACKGROUND: With the outbreak of the COVID‑19 virus crisis worldwide, including Iran, the 
need for corona prevention and treatment has become a national priority. With many businesses 
closed in the wake of COVID‑19 and job losses and declining incomes, vulnerable individuals’ and 
families’ access to the minimum wage and healthcare facilities is falling, and their health is exposed 
to a great risk. In Iran, a significant number of vulnerable groups are supported by nongovernmental 
organizations (NGOs). This study is designed to understand the performance of NGOs after the 
onset of the COVID‑19 crisis.
MATERIALS AND METHODS: This study was carried out based on qualitative research between 
June and September 2020 in Tehran. This study was conducted using individual interviews with 33 
managers and experts of 24 active NGOs providing services to vulnerable groups and a member of 
an NGO network. Data were analyzed using content analysis.
RESULTS: Two main themes of service initiatives were extracted: (a) service initiatives to protect 
the target population against COVID‑19 infection and its aftermath and (b) management initiatives 
to retain staff, finance, and adapt the organization to crisis situations. Service initiatives included five 
categories of health service initiatives, livelihood, employment, education, and leisure initiatives, while 
organizational management initiatives include human resource management, financial management, 
and communication with organizations.
CONCLUSION: The COVID‑19 breadth and its special features have set it apart from other crises 
and have led NGOs to work hard on several fronts to care for the most vulnerable people against 
the epidemic and its consequences and maintain the performance of their organizations. The unique 
role of cyberspace has made it one of the definitive pillars of the activities of NGOs, not only during 
the epidemic but also after its end.

Abstract BACKGROUND: The current study measured the executive tasks and cognitive flexibility and their 
relationship to the academic achievement of female students of the College of Education at Imam 
Abdulrahman Bin Faisal University in the Kingdom of Saudi Arabia.
MATERIALS AND METHODS: This research is a descriptive quantitative design. The study sample 
included 200 female students using purposive sampling. The study applied a test of executive 
tasks, cognitive flexibility, and a scale of attention deficit hyperactivity disorder for adults prepared 
by the researchers. Data were analyzed using several tests, namely descriptive statistics, Pearson 
correlation at the level of <0.05.
RESULTS: The results showed a statistically significant relationship between the scores of students 
with attention deficit and hyperactivity on the executive tasks scale and its dimensions (planning, 
organization, purposeful action, self‑monitoring, and total score), cognitive flexibility, and academic 
achievement, which necessitates the need to design empirical research to reduce the severity of 
attention deficit hyperactivity disorder among undergraduate students because it will have a positive 
impact on their academic achievement.
CONCLUSION: The researchers highlight the necessity for conducting empirical research to improve 
the executive tasks of students as it will have a positive impact on their lives.

Abstract BACKGROUND: Medication adherence means compliance with patient adherence to medication 
orders, including timely and correct consumption of medication prescribed by a physician. The present 
study aimed to determine the extent of adherence to hypertension drug medication in patients covered 
by comprehensive health service centers of Shahrekord, Iran.
MATERIALS AND METHODS: A cross‑sectional study examined 401 hypertensive patients 
registered in the Integrated Health Record System (SIB). SIB is a Persian term related to Health 
Record System. To collect data, Morisky Medication Adherence Scale was used. The questionnaire 
was completed by the patients and analyzed using SPSS (SPSS Inc., Chicago, Illinois, USA, 
version 26), Chi‑square test, independent t‑test, and analysis of variance.
RESULTS: The results indicated that adherence to antihypertensive medication was low in 5.7% of 
patients, while 63.3% of patients had sufficient compliance. Forgetting to take medications (52.9%) 
was the most common reason for nonadherence to medication in hypertensive patients.
CONCLUSION: Given that forgetting to take medications was the main reason for nonadherence 
to medication in hypertensive patients, designing and implementing necessary trainings by 
comprehensive health centers to realize the importance of daily use of medication by hypertensive 
patients and their families are recommended.

Abstract BACKGROUND: Nurse managers are the frontline leaders in the ward that directly impact the quality 
of care services. Many nurse managers in Indonesia were inadequately prepared to fulfill this role, 
especially during this crisis. The objective was to develop blended learning an Integrated Nursing 
Leadership Training (INLeT) using web based and test the effectiveness.
MATERIALS AND METHODS: This research is a research development using modified Borg and 
Gall by researcher, namely, Planning, Redesign, Intervention, Modify, and Evaluation. The INLET 
model was validated by nine experts in health and media technology design. Data were tested using 
quasi‑experiment research in Sanglah General Hospital and Wangaya Public Hospital in Bali.
RESULTS: The results of analysis of the content validity of all items valued V index 0.96 (high category) 
from design experts and V Index 0.92 (high category from health experts. The experiment group 
obtained N Gain scored 0.5603 at medium level, and the control group result of N Gain Score was 
0.2845 in the low‑level category. Using t‑test, both the experiment and control group showed significant 
improvement of score test with P = 0.000 (P < 0.005). Bivariate analysis using independent t‑test 
result P = 0.000 (P < 0.005) means significant difference score test compared between experiment 
and control group.
CONCLUSIONS: Using the web, this blended learning INLeT Model is effectively applied for nurse 
manager professional development; therefore, this study can prepare nurse managers into a 
leadership role by integrating moodle web‑based into nursing training.

Abstract BACKGROUND: Due to the rapid advancement of medical knowledge, promotion in research 
is necessary to have the best clinical practice. Research Self‑efficacy (RSE) is the researcher’s 
confidence in their ability to conduct a specific study. The Evidence‑Based Practice (EBP) represents 
how to improve the quality of care and treatment of patients. RSE and EBP are the cornerstones 
of successful research and then efficacious medical practice.This study aims to evaluate RSE and 
acceptance of EBP and their correlation among medical students.
MATERIALS AND MEHODS: This is a cross‑sectional study designed on 600 clinical students at 
the medical school of Shiraz, using a census method in 2020. Students were invited to fill out the 
standardized Phillips and Russell’s questionnaires about RSE (4 domains, 33 questions) and Rubin 
and Parrish’s questionnaire of EBP (10 questions). The gathered data were analyzed through the 
SPSS at α = 0.05 using descriptive statistics, t‑test, Chi‑square, and multiple linear regressions.
RESULTS: There was a positive correlation between EBP and RSE score (P < 0.05). The results of 
linear regression test showed that all variables had a significant effect on our response variables and 
their effect were significant (P < 0.05). The highest mean score in RSE was shown in the subscale 
of writing skills (52.54). The lowest score was observed in the subscale of quantitative (student’s 
subjective assessment of their ability to work with statistically related data and formulas) as well as 
computer skills (35.61).
CONCLUSIONS: Students who participated in a research project, workshop, or Master of Public 
Health program got a higher RSE and EBP. Due to the positive correlation between RSE and EBP, 
we conclude that trained physicians who can research independently and use research evidence 
can find the best treatment approach for patients. These finding support the importance of integrating 
research education in medical curriculum to increase RSE and finally improvement of EBP among 
medical students.

Abstract INTRODUCTION: Addiction refers to the irresistible urge to engage in certain actions or dependence 
on a particular substance despite knowing negative consequences. The current study evaluated the 
severity of Smartphone addiction and the factors associated with cell phone‑like activity.
MATERIALS AND METHODS: This cross‑sectional study was conducted from July to August 
2019 among medical and dental students in Karachi, Pakistan. A pretested self‑administered 
questionnaire was used among 400 students. The mobile phone addiction was assessed using a 
20-item, Mobile Phone Addiction Scale. A two‑stage cluster analysis was used to assess mobile 
phone addiction‑like behaviours. Chi‑square test was used to find associations between categorical 
variables. Kolmogorov–Smirnov to test normality of data were also used. A P < 0.05 was considered 
to be statistically significant for all tests.
RESULTS: Out of the total 400 students, the majority 316 (79%) comprise female students. The 
mean age was 20.54 ± 1.59 years. In 184 (48%) students, there was evidence of mobile phone 
addiction‑like behavior. The prevalence was higher in female than male students and among older 
compared to adolescent students; the differences were statistically nonsignificant. A higher median 
score ≥ of 4 is found in questions related to components reflected intense desire, impaired control, 
and tolerance and harmful mobile use.
CONCLUSION: This study highlights that a large number of students are addicted to their 
smartphones. Smartphone addiction continues to be the most problematic addiction aided by the 
presence of intense desire, impaired control tolerance, and harmful mobile use. The phenomenon 
must be fully understood to draw deeper and richer inferences about the origins of this addictive 
behavior, which is becoming more prevalent in our Pakistani society on a daily basis.

Abstract BACKGROUND: Sufficient interaction between the trainers and the trainees in medical education 
is always one of the biggest challenges for an educational system. This study was designed to 
evaluate the effect of virtual interactions within the educational content of stroke on the effectiveness 
of teaching for general medicine students during COVID‑19 crisis.
MATERIALS AND METHODS: Eight medical students applying for stroke education were divided into 
two groups by simple random sampling (Rafsanjan Medical School, 2020). The first group participated 
in an online classroom via the Adobe Connect platform without virtual interaction. The second group 
used a video presentation containing interaction scenarios. The effectiveness evaluation of each 
type of educational content was done by comparison of the final exam scores and the results of an 
electronic satisfaction questionnaire in each group. Finally, using SPSS software version 18, the 
data were analyzed with independent samples t‑test.
RESULTS: This study showed that the mean of the examination scores of the interactive virtual content 
group (6.14 ± 1.46) was significantly higher than the online class group (4.50 ± 1.50) (P < 0.001), 
and also the results of satisfaction assessment showed that this group was more satisfied with their 
educational content (P = 0.005).
CONCLUSION: Evaluation of the virtual stroke training effectiveness for general medical students 
shows that the educational approach of video with virtual interactions is an effective learning method 
in medical topics and can be considered as an efficacious educational model in online teaching.

Abstract BACKGROUND: Vaccine hesitancy leads to an increase in morbidity, mortality, and health‑care 
burden. Reasons for vaccine hesitancy include anti‑vax group statements, misinformation about 
vaccine side effects, speed of vaccine development, and general disbelief in the existence of viruses 
like COVID‑19. Medical students are future physicians and are key influencers in the uptake of 
vaccines. Hence, investigating vaccine hesitancy in this population can help to overcome any barrier 
in vaccine acceptance.
METHODS: In this paper, we review five articles on COVID‑19 vaccine hesitancy in medical students 
and consider potential future research. All published papers relevant to the topic were obtained 
through extensive search using major databases. Inclusion criteria included studies that specifically 
investigated COVID‑19 vaccine hesitancy in medical students published between 2020 and 2021. 
Exclusion criteria included studies that investigated vaccine hesitancy in health‑care professionals, 
allied health, and viruses apart from COVID‑19. A total of 10 studies were found from our search.
RESULTS: Based on our exclusion criteria, only five studies were included in our review. The sample 
size ranged from 168 to 2133 medical students. The percentage of vaccine hesitancy in medical 
students ranged from 10.6 to 65.1%. Reasons for vaccine hesitancy included concern about serious 
side effects, vaccine efficacy, misinformation and insufficient information, disbelief in public health 
experts, financial costs, and belief that they had acquired immunity.
CONCLUSION: These results suggest that vaccine hesitancy is an important cause of the incidence 
and prevalence of COVID‑19 cases. Identifying the barriers of vaccine hesitancy in prospective 
physicians can help increase vaccination uptake in the general public. Further research is necessary 
to identify the root cause of these barriers.

Abstract BACKGROUND: Continuous evaluation is necessary to achieve appropriate quality in educational 
programs. The aim of this study was to evaluate the doctoral program of medical education at Isfahan 
University of Medical Sciences based on the CIPP model.
MATERIALS AND METHODS: This descriptive and educational evaluation study was conducted 
in 2020 at Isfahan University of Medical Sciences. The study population consisted of all heads of 
department, faculty members, students, and PhD graduates of medical education from 2010 to 2020 
who were enrolled in the study by census method. The data collection tool was a researcher‑made 
questionnaire of CIPP evaluation model which was used when validity and reliability of them were 
confirmed. The data obtained from the questionnaires were analyzed in two levels of descriptive 
statistics of mean and standard deviation and inferential statistics one‑sample t‑test.
RESULTS: Based on the CIPP model, the mean evaluation scores from the perspective of the heads of 
department, faculty members, and graduates were 4.1 ± 0.1, 3.64 ± 0.42, and 3.33 ± 0.66, respectively, 
which were significantly higher than the average (P ≤ 0.05). However, the mean evaluation score 
was not significantly higher than the average from the viewpoint of the students (3.24 ± 1.17).
CONCLUSION: Based on the results of the study, the status of the doctoral course in medical 
education at Isfahan University of Medical Sciences was assessed as appropriate by the subjects of 
the study including the heads of department, faculty members, and graduates. It was not, however, 
acceptable according to the students. Based on the results, it is suggested that evaluation be done 
continuously and measures are taken to correct the weaknesses and enhance the strengths.

Abstract BACKGROUND: Coronavirus disease 2019 (COVID‑19) is a global pandemic that has modified all 
social and, especially, learning instances. The purpose of this study was to determine the perception 
of final‑year nursing students at a university in southern Chile regarding the impact of the pandemic 
on their learning, and consequently on their quality of life, in the context of the COVID‑19 pandemic.
MATERIALS AND METHODS: This is a qualitative study. The research was conducted on 14 nursing 
students who were selected from a university located in the province of Talca, Maule Region, Chile. 
Data collection was done through semi‑structured interviews conducted during July and September 
2021. The data were analyzed using the inductive logic of theoretical categorization; this process 
was assisted by the Nvivo 10 program.
RESULTS: Two mega categories were generated that accounted for the nursing students’ experience 
during the COVID‑19 pandemic: objective factors category and subjective factors category. Six 
subcategories were derived from these two categories: free time, social relationships, learning from 
practice, physical exercise, eating habits, and emotional state.
CONCLUSION: The research findings indicate that the students, in addition to feeling upset about 
not being able to do the internship, also feel that they have not been able to acquire all the knowledge 
necessary for their training and professional development, since the virtual classes fail to deliver 
adequate learning as they lack the practical component that is so important in their careers. This has 
repercussions in the physical, social, and psychological areas, affecting their quality of life.

Abstract BACKGROUND: The small group teaching (SGT) is gaining popularity in medical education since 
it improves the student’s thinking capacity and aids knowledge retention. Several studies have been 
conducted to analyze students’ attitudes regarding SGT. Faculty, on the other hand, have mixed 
perception about SGT methodology. Therefore, the main objective of this study was to explore medical 
faculties’ perceptions of SGT effectiveness in the medical curriculum.
MATERIALS AND METHODS: Across‑sectional, descriptive survey was conducted among 50 medical 
college teachers. We have developed set of 12 questionnaires to assess the perception of teachers 
on SGT methods. Content validation of the survey questionnaire was done by Lawshe method, 
and Cronbach’s alpha was calculated for estimating the internal consistency. Teacher’s perception 
responses were presented as proportion and percentage. We performed principal component analysis, 
structural equation modelling, Chi‑squared test (χ2
/df), goodness‑of‑fit index (GFI), adjusted GFI, 
comparative fit index, and root mean square error of approximation.
RESULTS: The validation resulted in the 12 items model indicated superior goodness of fit for 
sample data. All the extracted factors had good internal consistency of >0.9. Majority of the 
teachers strongly agreed that the SGT method enhances the student intrinsic motivation (n = 42, 
84%), self‑confidence (n = 40, 80%) self‑directed learning (n = 35, 70%), and student teacher 
interaction (n = 38, 76%).
CONCLUSION: Teaching faculties’ perception reflected that SGT is an effective method to impart 
knowledge to the students and also helps in improving their understanding of their subject. It helps 
in developing intrinsic motivation to do self‑learning in the students. It also helps in developing good 
peer interaction and improves the communication skills.

Abstract BACKGROUND: Medical students who are prone to psychological stress due to their overburdened 
curriculum, are at an increased risk of getting adversely affected by the pandemic. The present study 
was planned to assess the anxiety level among undergraduate medical students across the country 
using generalized anxiety disorder scale (GAD‑7).
MATERIALS AND METHODS: In this online survey, anonymous data was collected through Google 
forms from undergraduate students from all the phases of MBBS course across the country from 
August 15, 2020, to October 15, 2020. Section I collected various demographic information, section 
II included GAD‑7 questionnaire for assessing anxiety and section III had open‑ ended questions 
about their impending fear, uncertainties, and apprehensions. The data was expressed in percentage 
and association among the variables was determined using Chi‑square test. Thematic analysis of 
the open‑ended responses was done.
RESULTS: Among the sample of 1208 students, 81% were from urban areas. During the pandemic, 
77% were residing with their parents and 71% parents having stable jobs. Eighty percent students had 
no relative diagnosed with COVID‑19, whereas 52% students had family members with comorbidity. 
The GAP score showed mild, moderate, and severe anxiety in 27, 24, and 16% students, respectively. 
Anxiety was significantly associated with rural setting and with COVID‑19 positive or comorbid family 
member (P < 0.05). Open ended responses revealed that majority of the students were finding it 
difficult to cope with the academic stress at home but still did not want to join back.
CONCLUSION: With such a high incidence of anxiety among medical students, it is pertinent to 
safeguard the mental health and implement efficient approaches to upkeep the scholastic, physical, 
emotional, and professional well‑being of medical students during such vulnerable times.

Abstract BACKGROUND: Vaginal childbirth is the most stressful physical and mental event for most women, 
which necessitates the use of coping styles. Furthermore, childbirth self‑efficacy will be one of the 
effective factors to cope with this stressful situation and doing compatible behaviors with childbirth 
pain. Therefore, the aim of this study was to determine the relationship between childbirth self‑efficacy 
and coping styles of problem based and emotive based in nulliparous pregnant women.
MATERIALS AND METHODS: This study is a descriptive‑correlational study that is done over 323 
nulliparous pregnant women attending the health centers in the city of Zahedan in 2020–2021. Data 
were collected by participants’ demographic questionnaire, childbirth self‑efficacy questionnaire 
of Lowe, and coping styles questionnaire of Folkman and Lazarus. The data were analyzed using 
Spearman’s correlation coefficient test, linear regressions model, and multiple regression in SPSS 
software version 22. P < 0.05 was considered statistically significant.
RESULTS: Results of Spearman’s correlation coefficient test showed a significant direct correlation 
between problem‑based coping style and childbirth self‑efficacy (P = 0/017, r = 0.13); but, there was 
no significant direct correlation with emotive‑based coping style (P = 0/782, r = 0.01). According 
to the linear regressions model, just the problem‑based coping style is predicted childbirth 
self‑efficacy (P = 0/006).
CONCLUSIONS: According to the findings, nulliparous pregnant women should be responsible, 
have a positive reassessment of vaginal childbirth, plan to solve their problems, and look for social 
support (all of these are part of a problem‑based coping style) to increase and improve their childbirth 
self‑efficacy. Furthermore, designing appropriate educational interventions based on problem‑based 
coping style is necessary.

Abstract BACKGROUND: Training of health profession students in telehealth is important to ensure proper 
implementation for healthcare delivery. This prospective study aimed to analyze the effects of 
didactic and experiential learning on knowledge, confidence, and attitudes of telehealth among 
health profession students (Survey 1). The perceptions of a mixed model telehealth platform were 
also considered among these students and community clients (Survey 2).
MATERIALS AND METHODS: A quasi‑experimental repeated‑measure study was conducted on 153 
university health profession students in physician assistant, physical therapy, occupational therapy, 
and nursing (NR) across the 2020–2021 academic year. Survey 1 was administered to students 
pre/postdidactic telehealth training and at two sequential points within two semesters of telehealth 
experiential learning. Survey 2 was distributed among students and a pool of 19 community clients 
at 4 time points across the experience. Survey data were analyzed using R software.
RESULTS: There was a significant improvement in telehealth knowledge, confidence, and attitudes 
among all student disciplines after the didactic module with marginal means ranging 3.313/5–4.318/5 
for pretest to posttest 1. Improvement continued through experiential learning with marginal means 
ranging 4.170/5–4.369/5 in posttest 3. There was also a significant student and client approval 
of the telehealth platform with a student mean high of 3.962/5 ± 0.527 and client mean high of 
4.727/5 ± 0.238.
CONCLUSION: A didactic training module combined with experiential learning is effective for health 
profession students’ improvement in perception, knowledge, and attitudes toward telehealth. Health 
profession students and community clients approve a mixed model telehealth platform.