Journal of Education and Health Promotion

Abstract Background: This study intended to clarify the determining factors of complementary feeding
practices among Tehran 6–24 months failure to thrive children in order to use the results for
planning the interventions to reduce the possible adverse effects. Materials and Methods: In
this study, 132 mothers of three medical and health centers were chosen by random sampling
among those centers operating under the supervision of south of Tehran District Health Center
and study data were collected from them. A valid and reliable questionnaire as a data collection
instrument developed based on behavioral analysis phase of PRECEDE model. Spearman and
Pearson’s correlation coefficient test were used to determine the statistical relationship between
factors associated with complementary feeding practices among mothers. Results: The
mothers’ knowledge was as follows: 0.8%, 20.4%, and 78.8% of them were good, medium,
and poor, respectively. Mean scores for the mothers’ performance in terms of supplementary
feeding was 66.8. Pearson correlation indicated a positive and significant correlation between
the mothers’ performance with enabling and reinforcing factors, but there wasn’t any significant
relationship between the mothers’ performance and knowledge about complementary feeding.
Conclusions: According to the obtained results, reinforcing factors, and enabling factors are
associated with the mothers’ performance in terms of complementary feeding. Hence, attention
to these issues is essential for better health interventions planning.

Abstract Background: Health‑care acquired infections are significant given the risks and costs
they impose. All previous studies indicate a poor level of knowledge and performance
among the nurses in hospital infections; as such, educating nurses can play an important
role in infection control. This study aimed at evaluating the effects of the health belief
model (HBM) in making nurses adopting health‑care behaviors needed to control nosocomial
infections (Nis). Materials and Methods: The participants of the study were 135 nurses from
two hospitals in Mashhad, Iran. A self‑administered questionnaire was used to collect data.
The questionnaire consisted of seven parts. The intervention group received four 45 min
educational programs, both in individual and collective forms. After a 2‑month interval, a
post‑test was conducted to see whether any difference has been resulted. Results: There
was a significant relationship between knowledge (P = 0.001), perceived threat (P = 0.004),
perceived benefits (P = 0.001), and practices (P = 0.001) in comparing to control and
experimental groups after intervention. For the experimental and control groups, the most
frequent cues to action at the preintervention stage were, respectively, related to the period
of studying at university and in‑service classes. Conclusion: According to this study,
HBM‑based education can increase knowledge, perceived threat, and perceived benefits
of nurses. Additionally, it can reduce perceived barriers and improve the control of NIs
among nurses.

Abstract Introduction: Delay in diagnosis of bleeding can be due to underestimation of the actual
amount of blood loss during delivery. Therefore, this research aimed to compare the efficacy
of web‑based, simulation‑based, and conventional training on the accuracy of visual estimation
of postpartum hemorrhage volume. Materials and Methods: This three‑group randomized
clinical trial study was performed on 105 midwifery students in Mashhad School of Nursing and
Midwifery in 2013. The samples were selected by the convenience method and were randomly
divided into three groups of web‑based, simulation‑based, and conventional training. The three
groups participated before and 1 week after the training course in eight station practical tests,
then, the students of the web‑based group were trained on‑line for 1 week, the students of the
simulation‑based group were trained in the Clinical Skills Centre for 4 h, and the students of
the conventional group were trained for 4 h presentation by researchers. The data gathering
tool was a demographic questionnaire designed by the researchers and objective structured
clinical examination. Data were analyzed by software version 11.5. Results: The accuracy of
visual estimation of postpartum hemorrhage volume after training increased significantly in
the three groups at all stations (1, 2, 4, 5, 6 and 7 (P = 0.001), 8 (P = 0.027)) except station
3 (blood loss of 20 cc, P = 0.095), but the mean score of blood loss estimation after training did
not significantly different between the three groups (P = 0.95). Conclusion: Training increased
the accuracy of estimation of postpartum hemorrhage, but no significant difference was found
among the three training groups. We can use web‑based training as a substitute or supplement
of training along with two other more common simulation and conventional methods.

Abstract Background: Multi‑dimensional self‑compassion is one of the important factors predicting
fetal‑maternal attachment which vary among different cultures and countries. So the aim of
this study was to determine the relationship between multi‑dimensional, self‑compassion, and
fetal‑maternal attachment in the prenatal period. Subjects and Methods: This cross‑sectional
study was carried on 394 primigravida women to Mashhad Health Care Centers in with
two stage sampling method (cluster‑convenience) in the year 2014. Demographic/prenatal
characteristics, multi‑dimensional self‑compassion (26Q) with five dimension (including
self‑kindness, self‑judgment, common humanity, isolation items, mindfulness, over‑identified),
and fatal‑maternal attachment (21Q) were completed by the participants. The statistical analysis
was performed with various statistical tests such as Pearson correlation coefficient, t‑test, one‑way
ANOVA, and linear regression using SPSS statistical software (version 14). Results: Based
on the findings, the mean (standard deviation) value for multi‑dimensional self‑compassion
was 59.81 (6.4) and for fatal‑maternal attachment was 81.63 (9.5). There was a positive
correlation between fatal‑maternal attachment and total self‑compassion (P = 0.005, r = 0.30)
and its dimension including self‑kindness (P = 0.003, r = 0.24), self‑judgment (P = 0.001,
r = 0.18), common humanity (P = 0.004, r = 0.28), isolation items (P = 0.006, r = 0.17),
mindfulness (P = 0.002, r = 0.15), over‑identified (P = 0.001, r = 0.15). Conclusions: There
was a correlation between the multi‑dimensional self‑compassion and fetal‑maternal attachment
in pregnant women. Hence, educating people like caregivers by community health midwives
regarding psychological problems in during pregnancy can be effective in early diagnosing
and identifying such disorders.

Abstract Introduction: In the new approach, all health care providers have been obligated to maintain
and improve the quality and have been accountable for it. One of the ways is the implementation
of clinical governance (CG). More accurate understanding of its challenges can help to improve
its performance. Aims: In this study, barriers of CG implementation are investigated from
the perspective of the hospitals involved. Besides, some solutions are suggested based on
stakeholders’ opinions. Materials and Methods: This study used combined method (qualitative
content analysis and questionnaire) in hospitals affiliated to Isfahan University of Medical
Sciences in 2014. First, experts, and stakeholders talked about CG implementation obstacles
in a semi‑structured interview. Interviews were confirmed by the interviewee (double check).
After analyzing the interviews using reduction coding the questionnaire was drawn up. The
questionnaire “validity was confirmed by Cronbach’s alpha (0/891)” and its reliability was
obtained using experts confirmation. Data analyzing was performed using SPSS (18) software.
Results: According to results staffing and management factors were the main obstacles.
After them, were factors related to organizational culture, infrastructure elements, information,
sociocultural and then process factors. The learning barriers were in final rank. Thirty‑four
solutions was proposed by experts and divided into subset of eight major barriers. Most solutions
were offered on modifying processes and minimal solutions about modifying of organizational
culture, sociocultural, and educational factors. Conclusion: Removing the obstacles, especially
management and human resource factors can be effective by facilitating and accelerating CG.
Furthermore, use of experts and stakeholders opinions can help to remove CG barriers.

Abstract Background and Aims: Newborn death is an unexpected outcome for parents. Parents face
with several needs in infant end‑of‑life. The health care team is responsible for meet these
needs. This qualitative study aim was to explore of parental needs in infant end‑of‑life and
bereavement. Materials and Methods: For this qualitative study, 24 single semi‑structure
interviews were done. A qualitative content analysis method was used. Sampling conducted
on purposeful with maximum variation in five Neonatal Intensive Care Unit (NICU) environments
in Isfahan city. Inclusion criteria for nurses and doctors were having at least one experience of
caring for an infant and their family at end‑of‑life. Inclusion criteria for parents and their families
were having at least one infant at end‑of‑life or had lost their infant for 6 months before in
NICU. Results: Data analysis uncovered two main themes. Family’s support needs with two
subthemes (family’s support needs before infant’s death and family’s support needs after infant’s
death) and family’s preparatory needs upon infant’s death with two subthemes (management
of the bad news of infant’s death by treatment team and management of the bad news of
infant’s death by family). Discussion: Mourning mother’s need for her husband’s presence
by her side, getting hospitalized in a separate room, and management of infant’s death news
by father and family were among items rarely pointed out in other studies. Exploration of these
needs cab be helpful for the health care team for providing care.

Abstract Background: School‑based sex education has the potential to prevent unwanted
pregnancy and to promote positive sexual health at the individual, family and community
level. Objectives: To develop and validate a sexual health questionnaire to measure young
peoples’ sexual health knowledge and understanding (SHQ) in Nepalese secondary
school. Materials and Methods: Secondary school students (n = 259, male = 43.63%,
female = 56.37%) and local experts (n = 9, male = 90%, female = 10%) were participated
in this study. Evaluation processes were; content validity (>0.89), plausibility check (>95),
item‑total correlation (>0.3), factor loading (>0.4), principal component analysis (4 factors
Kaiser’s criterion), Chronbach’s alpha (>0.65), face validity and internal consistency using
test‑retest reliability (P > 0.05). Results: The principal component analysis revealed four factors
to be extracted; sexual health norms and beliefs, source of sexual health information, sexual
health knowledge and understanding, and level of sexual awareness. Kaiser‑Meyer‑Olkin (KMO)
measure of sampling adequacy demonstrated that the patterns of correlations are relatively
compact (>0.80). Chronbach’s alpha for each factors were above the cut‑off point (0.65). Face
validity indicated that the questions were clear to the majority of the respondent. Moreover, there
were no significant differences (P > 0.05) in the responses to the items at two time points at seven
weeks later. Conclusions: The finding suggests that SHQ is a valid and reliable instrument to
be used in schools to measure sexual health knowledge and understanding. Further analysis
such as structured equation modelling (SEM) and confirmatory factor analysis could make the
questionnaire more robust and applicable to the wider school population.

Abstract Context: Feedback is an integral part of formative assessment though underutilized in
medical education. The objective of this study was to review our feedback module through
students’ perceptions. Methodology: We have developed a feedback module which is
practiced by us for last 10 years for term ending examination that gives collective feedback
to the whole class, followed by individual student‑teacher interactions. Students were also
exposed to 6–7 multiple choice questions (MCQs) based assessment during the course of
pharmacology. Immediately after each MCQ test the answer keys is displayed along with
an explanation. Two classes of students were requested to give their perceptions about
the feedback by responding on Likert scale for the statements in the questionnaire. All
the 206 students who volunteered for the study were enrolled in the study. Mann–Whitney
test was used to calculate the difference in perceptions. Results: Of 278 students of two
classes, 206 responded (74%). Students’ agreement varied from 93% to 98% for 5 items in
the questionnaire for the feedback after term ending examinations. Perception of students
attending one or more than one feedback session did not differ significantly. For MCQs, tests
agreement was 91% to 98% for the 4 items. There was no significant difference between two
classes in their perceptions regarding feedback practices (P < 0.05). Conclusion: Students
gave a favorable opinion for our feedback module. In the medical colleges with a large
number of students, this module is feasible for feedback in formative assessment in the
form of written tests.

Abstract Objective: Snacks play an important role in child health and nutritional status. Schools are
considered as the preferred place to encourage healthy eating among children. The aim of this
study was to evaluate the effect of buffet school‑based intervention on acceptance and satisfaction
of parents and students in Iran. Materials and Methods: Primary school students (n = 1120,
68.83% girls) from first to third grade, with one of their parents, participated in this prospective field
trial study conducted in Isfahan, Iran. The study was consisted of three phases; schools selection,
kitchen selection, implementation including two different parts, getting order and distribution. We
provided hot snacks as traditional and healthy fast food according to taste and food preferences
of children. Acceptance and satisfaction of parents and students were evaluated via a researcher
made questionnaire before and after the intervention in one‑third of participants as a representative
sample of students who ordered the snacks. Results: Most of the students usually ate snack in
the break‑time at school, the eagerness of provided snacks was 98.8% and 63.6% in girls and
boys, respectively. The most interesting tastes were Ashe Reshteh and Tahchin, (45.1% girls vs.
36.8% boys), while bean (among girls) and Ashe Jo (among boys) were ranked as the lowest.
More than half of parents (66.7%) evaluated the price of snacks as “acceptable,” showing
their satisfaction. Conclusion: Results of this study indicate that school‑based interventions
accompanied with parental and principals’ support is considered as a practical approach to
promote healthful eating at an early age. Developing effective interventions for youth might,
therefore, help to prevent unhealthy dietary choices becoming habitual.

Abstract Background: Heat stress is a threat to those who work in high temperatures. The purpose in
this study was an examination of the cooling ability of Iranian phase change material (PCM)
cold vest in hot and dry conditions in a climatic chamber. Materials and Methods: This
experimental study was implemented on 12 male students (age 23.7 ± 2.8 years, weight
66.1 ± 11.4 kg, and VO2
 max 2.53 L/min) in 2013. The heat strain score index (HSSI), skin
temperature and oral temperature, and heartbeat in two phases with and without cooling vest
was measured during 30 min in a climatic chamber (temperature 38.8 ± 1.3°C humidity
ratio 32.9 ± 2.3%) and in two activity intensity of 2.4 and 4.8 km/h speed on the treadmill,
and the data differences between groups “with” and “without” vest were tested by t‑test and
repeated measurement. The level of significance was considered as 0.05. Results: The change
in heartbeat at two activities, the oral temperature and heat strain score at 4.8 km/h, did not
differ significantly between groups (with and without vest), as expected (P > 0.05). However,
the change in skin temperature at two activities, oral temperature and heat strain score at
2.4 km/h, was significant between groups, as expected (P < 0.05). The average of skin
temperature at 15th and 30th min during the experiment at two activities of 2.4 and 4.8 km/h
was significant. Conclusion: The findings of the study indicated that using the Iranian PCM
cold vest in hot and dry climate can affect the reduction of skin temperature, oral temperature,
and HSSI in light activities.

Abstract Background: The application of the nursing research findings is one of the most important
indicators of development in the nursing profession, which leads to providing efficient and
effective patient care and improving the quality of nursing care. According the result of some
studies, transferring the evidence‑based findings to the nurses’ practice and education in
the world has been slow and sometimes unsuccessful. This study aimed to investigate the
most important barriers to the application of research findings from the nurses’ perspective.
Materials and Methods: This cross‑sectional study conducted on a sample of 210 nurses
in a teaching hospital in Tehran in 2013. The data were collected using a researcher‑made
questionnaire consisted of two parts, including items about nurses’ demographic characteristics
and 30 items to identify the most important barriers to the application of research findings from
the studied nurses’ perspective. Results: “The lack of sufficient time for reading the studies,”
“the lack of sufficient time to implement the new ideas,” “the lack of adequate facilities to
implement the ideas,” “nurses’ little interest in conducting studies,” and “the lack of authority
to change the methods and patterns of care” with, respectively, 85%, 84.6%, 83.8%, 83.4%,
and 80.5% agreement with the existence of barriers were the most barriers to application of
research findings from the studied nurses’ perspective. Conclusion: The lack of time was the
most important barrier to the use of research findings from the perspective of studied nurses.
Therefore, some effective strategies should be used by hospital managers and health policy
makers to overcome this barrier. Some of these strategies can be employing new personnel
and hiring skilled and efficient human resources in order to decrease the workload of nurses,
organizing the nurses’ work shifts, providing right balance between patients and nurses in the
wards, etc.

Abstract Objective: To determine the tea consumption pattern in an urban society in Isfahan. Methods: A descriptive, cross‑sectional survey was carried out using questioner among 664 households who were selected by two steps cluster sampling. A questionnaire was developed including demographic questions, information on the quantity of tea intake by every member of the family, tea type, and tea brand preference. Results: The individuals who prioritized black tea as their 1st choice were 90.1% of the total surveyed community. The average amount of tea consumed was calculated as 1243 ± 530 ml/day. The individuals who were between 36 and 45 and <15 years old were shown as the highest and the lowest tea consumers, respectively. Men significantly consumed more amount of tea than women did and married participants significantly used more amount of tea than singles (P < 0.05). The number of the family members, though, had no impact on tea consumption (P > 0.05). Brand preference of tea showed that the individuals who prioritized Ahmed brand as their 1st choice constituted 44% of the total participants. Conclusion: Tea consumption pattern in an Iranian sample is specific. Despite of the huge evidence on the green tea benefits, this type of tea has very low popularity and among the available black tea brands, the imported ones are the most preferred. 

Abstract Aim: Evidence‑based dentistry (EBD) is an approach to oral health that requires the
application and examination of relevant scientific data related to the patient’s oral health
and his priorities. The aim of this study was to assess knowledge, attitude, and practice of
dental students of Isfahan about EBD. Materials and Methods: In this descriptive study,
168 dental students in 3 final years of their education who engaged in clinical practice by
consensus sampling were recruited. For data collection, a validated questionnaire was used.
The questionnaire was consisted of demographic questions and some questions about
four issues: Knowledge of self‑assess (KSA), evidence‑based practice, actual knowledge
and attitude about EBD. Data were analyzed with t‑test, one‑way ANOVA, Chi‑square, and
linear regression with SPSS 16. Results: One hundred and thirty‑six students from 168
students were filled the questionnaire. The mean of KSA was 13 ± 4.3, mean of usage
of useful references in EBD was 16.9 ± 7.6. One‑third of students were studied their last
article in last 6 months before. The mean of actual knowledge and attitude was 7.4 ± 2.3
and 24 ± 3.8, respectively. The relation between 4 main issues was significant (P < 0.05).
Conclusion: By considering overall interest and positive attitude toward learning EBD in
dental students, it is highly recommended that practical educational courses about EBD
be planned by dental faculties.

Abstract Background: Women and mothers are the most important educational audience to convey
health teachings. This study was aimed to evaluate the knowledge level of different types
of health violations of food production, distribution, sale centers and public places; and
authorities investigating the violations among women referring to health care centers in Bushehr.
Materials and Methods: In this descriptive‑analytical study, which was done cross‑sectionally,
600 women who were referred to health care centers affiliated to the Bushehr University of
Medical Sciences was selected by convenience sampling. Two‑part questionnaire was used
to collect data: demographic information and a researcher‑designed knowledge survey
questionnaire consisted of 25 questions with Cronbach’s alpha = 0.7. Data were analyzed
with the software SPSS version 13; using Chi‑square test and Phi and Cramer test. P ≤ 0.05
was considered to be statistically significant. Results: The findings showed that 56.9% and
26.5% of women had good and moderate knowledge levels regarding health violations,
while the general knowledge level of authorities investigating health violations were at the
moderate level among 57.3% and at the good level among 15.3% of women. Overall, there
was a significant relationship between education level and the women’s knowledge level of
health violations (P < 0.0001). The relationship between the women’s education level and
authorities investigating health violations was not significant (P = 0.073). Conclusion: Applying
interventional methods of education in health violations to the women by health centers can
elevate the level of health knowledge among them.

Abstract Context: Exact measurement of quality of life (QOL) in schizophrenia patients for evaluation
of the patient’s deterioration and also to assess the efficacy of therapeutic Interventions has
become a daily task, which requires accurate assessment tools. Aims: This study was aimed to
assess the psychometric properties of a Persian version of schizophrenia QOL scale (SQLS) as
a common transcultural instrument. Settings and Design: One hundred and fifty schizophrenia
patients who referred to Psychiatric Clinic in Noor Hospital (Isfahan, Iran) have been selected
using simple sampling method. Subjects and Methods: Aside with SQLS, short form‑36
general health (SF‑36) and World Health Organization QOL‑brief‑26 (WHOQOL‑BREF‑26).
Questionnaires were completed by the cases for determination of correlation coefficients.
Statistical Analysis Used: The data were analyzed using descriptive statistics, factor
analysis, Cronbach’s coefficient alpha, Pearson correlation coefficient by Statistical
Package for Social Sciences software, version 18 (SPSS‑18). Results: Total reliability of
the questionnaire was reported by using Cronbach’s coefficient alpha 0.84, reliability of
individual relationships subscales was 0.91, signs 0/87, symptoms 0/72 and motivation/
energy 0/61. Correlation coefficients of SF‑36 with a total scale of SQLS and correlation
coefficient of WHOQOL‑BREF‑26 with a total scale of SQLS were acceptable. Exploratory
factor analysis using varimax rotation identified four principle components (interpersonal
relationship, symptoms, signs, motivation, and energy), which will determine QOL at 52.7%
variance. Conclusions: Persian version of the SQLS can be used as a simple, reliable and
valid tool in Iranian population.

Abstract Introduction: The process of assisted reproductive treatment is a stressful situation in the
treatment of infertile couples and it would harm the mental health of women. Fertile women
who started infertility treatment due to male factor infertility have reported to experience
less stress and depression than other women before the assisted reproductive process but
considering the cultural and social factors and also the etiology of the assisted reproductive
process, it could affect the metal health of these women. Therefore, this study was conducted
to evaluate the mental health of fertile women who undergo assisted reproductive treatment
due to male factor infertility. Materials and Methods: This study was a prospective study on
70 fertile women who underwent assisted reproductive treatment due to male factor infertility.
The exclusion criterion was to stop super ovulation induction. To assess mental health,
anxiety and depression dimensions of the general health questionnaire were used. Before
starting ovulation induction and after oocyte harvesting, the general health questionnaire
was filled by women who were under treatment. Data were analyzed using multi‑variable
linear regression, paired t‑test, and Chi‑square. Results: The results showed that the mean
score of depression and anxiety before ovulation induction and after oocyte harvesting were
not significantly different; but the rate of mental health disorder in the depression dimension
was significantly decreased after oocytes harvesting (31.7% vs. 39.7%). Also, there was a
significant relation between the level of anxiety and depression before ovulation induction and
after oocyte harvesting (P < 0.05). The anxiety level after oocyte harvesting had a positive
and significant correlation with the economic situation (P < 0.05). Conclusion: This study
revealed that the process of assisted reproductive treatment does not affect the mental health
in fertile women independently, but these women start assisted reproductive process with
high levels of depression and anxiety. Therefore, prior to the assisted reproductive treatment
mental health consultation is needed.

Abstract Introduction: Handicrafts seems to be one of the high‑risk jobs regarding work‑related
musculoskeletal disorders (WMSDs) which necessitate the implementation of different
corrective intervention like regular physical activities. This study aimed to investigate the
impact of physical activity on WMSDs among craftsmen. Methods: This cross‑sectional study
was an analytical – descriptive study carried out on 100 craftsmen working in Isfahan, Iran,
in 2013. The sampling method was census, and all workshops involved with this job were
included. Information on demographic parameters and physical activity was collected by
demographic forms. The data related to worker’s musculoskeletal discomforts were conducted
using Cornell Musculoskeletal Discomfort Questionnaire. The data were analyzed using
statistical tests including independent t‑test, Chi‑square, and ANOVA. The statistical analysis
was performed using SPSS 18. Results: The highest percentages of complaints related to
severe musculoskeletal discomfort were reported in right shoulder (%36), right wrist (%26),
neck (%25), and upper right arm (%24), respectively. A significant relationship was observed
between physical activity and musculoskeletal discomforts of left wrist (P = 0.012), lower
back (P = 0.016), and neck (P = 0.006). Discussion and Conclusion: Based on the study
results, it can be inferred that regular but not too heavy physical activity can have a positive
impact on decreasing the musculoskeletal discomforts.

Abstract Background: Primary healthcare (PHC) providers play a major role in provision of public health
in rural areas in Iran. They are considered as the key elements of health development in rural
population. There is limited research on clarification of their experiences from provision of health
services in their working conditions. This study aimed to clarify the experience of PHC providers
from working conditions in giving primary health services in health houses (district branches of
rural health care centers). Materials and Methods: This is a content analysis qualitative study,
conducted through personal and group interviews with 12 health workers working in health
care centers in rural areas in Isfahan province, 2010. Sampling continued until data saturation.
Data were analyzed through conventional content analysis and constant comparative method.
Results: Data analysis led to extraction of 11 categories, and finally, four themes of “ignoring
the rights,” “causing tension in working climate,” “pressure or overload of expectations beyond
the power,” and “occupational worn out” were yielded from the categories. These themes reveal
the concepts and nature of PHC providers’ experiences from giving health care at health houses
as the first level of PHC centers. Conclusion: The results of the present study showed that the
PHC providers work in a tense condition in health houses. Although they devote themselves
to the health of society members, their own health is neglected. Policy makers and authorities
should amend working conditions of PHC providers through modification of resources and
making supportive and collaborative strategies to improve the quality of services and promote
the health level of the service receivers.

Abstract Background and Objectives: Congestive heart failure is one of the most common
cardiovascular diseases that have a progressive and chronic trend and influences individuals’
and their families’ various dimensions. Social support is one of the psychosocial factors that
can have a positive effect on individuals’ physical, mental and social status. Despite the
existence of evidences, revealing the importance of family’s support on patients’ condition,
family centered supportive interventions with goal of clinical outcomes improvement have
been less conducted among these patients. Therefore, the present study aimed to investigate
the effect of family supportive intervention on the level of the support, received among heart
failure patients. Materials and Methods: This is a two‑group two‑stage clinical trial, conducted
on 64 patients with cardiac failure, referring to selected educational centers and meeting the
inclusion criteria, who were selected through convenient sampling. They were assigned to
study (n = 32) and control (n = 32) groups through random allocation. Data were collected
by questioning through a two‑section medical records questionnaire and were analyzed by
SPSS. Results: Results of the study showed that mean scores of received support score were
13.7 (3.8) in the study and 0.8 (2.4) in the control group. Independent t‑test showed a significant
difference in mean changes of perceived support scores after the intervention between study
and control groups (P < 0.001). Conclusions: Based on familial dimension in social support
have a positive effect on patients’ perceived support. Nurses, as professional members of
health care team, and with an important role in education and care of cardiac failure patients,
can support, educate and guide these patients through designing appropriate care plans and
educating their family members.

Abstract Background and Purpose: “Uncontrolled anger” threats the compatible and health of people
as serious risk. The effects of weaknesses and shortcomings in the management of anger,
from personal distress and destruction interpersonal relationships beyond and linked to the
public health problems, lack of compromises, and aggressive behavior adverse outcomes.
This study investigates the effects of anger management education on mental health and
aggression of prisoner women in Isfahan. Materials and Methods: The single‑group
quasi‑experimental (pretest, posttest) by prisoner women in the central prison of Isfahan was
done. Multi‑stage random sampling method was used. Initially, 165 women were selected
randomly and completed the Buss and Perry Aggression Questionnaire and the General Health
Questionnaire‑28, and among these, those with scores >78 (the cut point) in aggression scale
was selected and among them 70 were randomly selected. In the next step, interventions in
four 90 min training sessions were conducted. Posttest was performed within 1‑month after
the intervention. Data were analyzed using SPSS‑20 software. Results: Data analysis showed
that anger management training was effective in reducing aggression (P < 0.001) and also
had a positive effect on mental health (P < 0.001). Conclusion: According to the importance
of aggression in consistency and individual and collective health and according to findings,
presented educational programs on anger management is essential for female prisoners.

Abstract Background: The knowledge about Ebola virus disease (EVD) is very crucial in the response
to the recent outbreak and in order to control its spread. This study was conducted to assess
the effectiveness of self‑instructional module (SIM) in enhancing knowledge of EVD among
Nigerian students in Bengaluru, India. Materials and Methods: A pre‑experimental study design
was employed, and a simple random sampling technique was used to select 60 participants.
A pretest was conducted with the tool to assess the baseline knowledge of participants after
which SIM was administered to all the participants in two episodes. The posttest was conducted
after 7 days using the same tool to assess any gain in knowledge among the participants.
Data were analyzed using SPSS at an alpha level of 0.001 and Descriptive analysis (such as
percentage, frequency, mean and standard deviation [SD]) as well as independent t‑test was
conducted. Results: Findings showed that the majority of the participants (53%) were males,
studying for the undergraduate degree (85%), 36 participants (60%) were in arts/social courses.
More than average of the participants (67%) had spent only 1‑year in India. Majority (53.3%)
had average knowledge but after the administration of the SIM, majority had very good
knowledge about EVD. The mean pretest knowledge score was 16.03 with an SD of 2.951
while the mean posttest knowledge score was 28.22 with SD of 3.273. The calculated t value
was 21.432 (P < 0.001). Conclusion: SIM was observed to be very effective in this study and
therefore should be adopted by health personnel in order to convey health‑related information
to the public.

Abstract Background: Newspapers have immense potential for generating health awareness on diverse
issues such as hygiene, immunization, environmental pollution, and communicable disease. The
present study was conducted to determine the frequency of coverage and types of health‑related
articles published in local newspapers of Manipur. Materials and Methods: This was a
cross‑sectional study conducted among the most regularly published 10 local newspapers
(4 English and 6 Manipuri) of Manipur from February 2011 to January 2012. Health‑related
articles published in everyday local newspapers were collected after careful search and finally
entered into a design Proforma under different categories. Data were analyzed using SPSS
version 16. Results: Total health‑related articles published were 10,874 and maximum articles
were published during February (12.8%). Maximum health‑related articles were published on
Wednesday (16.1%). Among all the health‑related articles, almost half were related with injury
followed by public health articles. Maximum public health and injury‑related articles were
published on Monday, but medical topics were published more on Wednesday. Newspapers
of both the languages were publishing public health articles more compared to medical
topics. Public health (72.9%) and injury‑related articles (95.9%) were published maximum in
the news items section, but medical topics (45.8%) were published maximum in the health
section of the newspaper. Newspapers of both the languages published maximum small size
articles. Conclusions: There is a room for improvement for newspapers of both the languages
regarding number of health‑related articles’ publication, section of publication, and size of the
health articles.

Abstract Context: Successful aging is a pattern of aging that has gained much attention during recent
years. One factor that has a negative impact on successful aging variables is hypertension. The
phenomenon of aging when accompanied with hypertension promotes spiritual needs. The aim
of this study was to examine the effect of the Islamic spiritual program on successful aging in
elderly patients with hypertension who were referred to health centers of Isfahan, Iran, in 2014.
Settings and Design: This study was a randomized clinical trial. Materials and Methods: The
participants (52 elderly patients with hypertension) were randomly divided into experimental
and control groups. While the control group received training related to health promotion, the
Islamic spiritual program was implemented in the experimental group for eight sessions in two
health centers of Isfahan. The data collection tools consisted of the 12‑item General Health
Questionnaire developed by Goldberg and the satisfaction with life scale developed by Diener.
The questionnaires were completed in three steps; pretest, posttest, and follow‑up (1‑month).
Statistical Analysis Used: Data were analyzed using SPSS statistical software version 20
and Chi‑square, independent t‑test, and repeated measures ANOVA. Results: Statistical tests
showed that the mean score of general health and life satisfaction of the experiment group had
a meaningful difference from that of the control group in the posttest stage (P < 0.001). This
difference was also meaningful in the follow‑up stage (P < 0.001). Conclusion: The results of the
study indicated the effectiveness of an Islamic spiritual program on successful aging variables.

Abstract Introduction: Although cesarean section has saved many mothers’ and infants’ lives,
the problem is in its increasing prevalence. According to recent statistics, the current rate
of cesarean in Iran is in fact 3–4 times as more than the standard rate defined by WHO.
Therefore, the present study is aimed to estimate the effect of an instructional program based
on health belief model on reducing cesarean rate among primiparous pregnant women.
Materials and Methods: In this semi‑experimental research, 60 primiparous women who
had visited Bandar Abbas Healthcare Centers were selected as the subjects. They were in
their 26–30th week of pregnancy. They were selected in a multi‑stage cluster sampling method
(a combination of clustering and simple randomization), and were divided into two groups,
subjects and control group. The data were gathered using a valid and reliable questionnaire.
The instructional intervention was done after the completion of the pretest questionnaire based
on the sub‑constructs of the health belief model in six instructional sessions. 1 month after the
intervention, posttest questionnaires were completed by the subjects in both groups. The data
were analyzed using descriptive statistics, standard deviation, independent t‑test, and paired
t‑test. The significance level was set at <0.05. Results: Two groups had a significant difference
between awareness score, perceived sensitivity, intensity, benefits, barriers, self‑efficacy, and
the performance (P < 0.001). In the experimental group, nine subjects (30%) had a natural
delivery. Conclusion: According to the findings of the current research, an instructional program
illuminated (designed) by the health belief model can significantly influence pregnant women’s
awareness, intention, and choice of delivery type.