Journal of Education and Health Promotion

Abstract BACKGROUND: Drug abuse influences the quality of life significantly. Thus, the present study is
designed to compare the quality of life of adolescents and young adults who have voluntarily referred
to addiction treatment centers at different time slots of upon admission, and 1, 4, and 8 months after
maintenance therapy.
METHODS: The present paper is a longitudinal study on 141 of adolescents and young adults who
had referred to various addiction treatment centers throughout Isfahan voluntarily. The population
was selected through convenience sampling method and 137 of adolescents and young adults
continued the research until the end. The results were analyzed using descriptive and analytic
statistics (frequency, mean, standard deviation, repeated measure test, and post‑hoc test) in SPSS 17.
RESULTS: Results showed that the average of quality of life total score was sequential and not the
same in the 4 times slots under study. The total quality of life score upon admission was significantly
different from 1, 4, and 8 months after maintenance treatment. However, quality of life at 1‑month
was not significantly different to that at 4 and 8 months after the treatment; quality of life at 4 months
after the treatment was not significantly different to that at 8 months after.
DISCUSSION: According to the present study, it can be concluded that the quality of life of adolescents
and young adults referring to addiction treatment centers increases 1‑month after the treatment;
nevertheless, it is worth to note that the degree of quality of life increase in 4 and 8 months after the
treatment is not as much as that in 1‑month after the treatment.

Abstract CONTEXT: Fresh Bachelor of Medicine and Bachelor of Surgery graduates (FMGs) are responsible
for the majority of prescription errors and irrational use of medicines. Little research has explored
their knowledge on rational prescribing practices.
AIMS: The present study aimed to evaluate the awareness of rational use of medicines (RUMs)
among the FMGs.
SETTINGS AND DESIGN: A multicentric, cross‑sectional, and questionnaire‑based study was
conducted among 308 FMGs during the internship orientation program.
SUBJECTS AND METHODS: The structured and prevalidated questionnaire consisted of
35 statements on important aspects of RUM.
STATISTICAL ANALYSIS USED: Data were analyzed using SPSS version 24.0 at 95% level of
significance with Fisher’s exact test.
RESULTS: Nearly 31% of FMGs did not know that the generic drugs are equally efficacious as branded
drugs whereas 53% were in support of pregnant female should not consume any drug. Nearly 58% of
FMGs were confused about deciding the dose in children and 18% were in favor of using antibiotics
in common cold. Almost 55% of FMGs were disagree for adjusting the dose of antidiabetic drugs by
patient depending on the meal taken whereas 12% were not aware of the importance of compliance
of antihypertensive drugs and 40% were supporting the safety of fruits in chronic renal disease. The
FMG from government colleges answered more correctly than that of the private colleges.
CONCLUSIONS: The awareness of RUM among FMG is not satisfactory, and also there is a gap in
its implementation. Thus, they should be supervised during the initial phase of their medical practice.

Abstract INTRODUCTION: Pregnancy is one of the high‑risk periods for women’s health that the lack of
attention to healthy behaviors such as weight control behaviors can lead to adverse consequences
on the health of women and also the fetus. Therefore, the aim of this paper was to explore the
determinants of weight control self‑efficacy among pregnant women using Health Belief Model (HBM).
MATERIALS AND METHODS: In this cross‑sectional study were enrolled 202 pregnant women
referring to Health Care Center in Isfahan city, Iran. Sampling method was multistage random.
A researcher‑made instrument based on HBM structures was used after confirming the valid and
reliable. Data were analyzed by software SPSS 21 and descriptive statistics were represented
with (frequency, mean and standard deviation) and analytical (Pearson correlation, independent t
and liner regression) at the significant level of <0.05.
RESULTS: The average age of participants was 27.80 ± 5.08. HBM structures were able explained
31% of variance of weight control self‑efficacy. Also, of the studied structures, perceived benefits,
perceived barriers were statistically significant predictors of weight control self‑efficacy, within which
perceived barriers (β = 0.391) was the most significant predictor.
CONCLUSION: The findings of current study showed that the HBM model could be as a suitable
framework to identify effective factors for designing educational intervention to improve weight control
behaviors among pregnant women.

Abstract OBJECTIVES: Worldwide, i.e. in Iran, coronary artery bypass grafting (CABG) is one of the most
common and expensive surgeries. This study was designed to explore the demographic and
psychological factors which predict the recovery process in CABG patients.
MATERIALS AND METHODS: During a prospective correlational study, 250 CABG patients, in two
public and private hospitals, investigated for indexes of recovery during hospital stay and 4 weeks
after discharge. Demographic and psychological variables were collected through checklist and Farsi
validated and reliable versions of type D personality, the multidimensional scale of perceived social
support, revised illness perception questionnaire (IPQ‑R). Data were analyzed through statistical
tests through SPSS version 20.
RESULTS: Considering the total recovery index, 91.2% of CABG patients have not been recovered
4 weeks after surgery. Furthermore, 99% of them reported high scores of depression and anxiety.
Marital and insurance status, and perceived personal control, showed significant difference between
recovered and unrecovered patients based on total recovery index (P < 0.05); however, in regression
analysis, they did not identify as predictor variables. Age, gender, insurance status, and perceived
personal control were the most frequent variables identified as predictors of recovery indexes,
separately.
CONCLUSION: The correlation between depression, anxiety, perceived personal control, and
recovery status among our patients reveals the importance of considering psychological and mood
assessment in developing guidelines for CABG patients. Our findings will assist clinicians for
designing of psychological interventions for promotion of perceived personal and illness control and
better recovery post‑CABG.

Abstract BACKGROUND: Caregiver burden threatens the psychological, emotional, functional and even
physical health of caregivers. The aims of this study were to determine caregiver burden and family
distress and the relationship between them, also to explore predictors of caregiver burden in a sample
of Iranian family caregivers of cancer patients.
MATERIALS AND METHODS: This is a cross‑sectional study with correlational design. A total of 104
family caregivers of cancer patients were asked to respond to the Caregiver Burden Inventory (CBI)
and the Family Distress Index (FDI) together with a sociodemographic questionnaire. For evaluating
the relationship between CBI and FDI scores, the Pearson’s product‑moment correlation was used.
In addition, multiple linear regression analysis was applied to explore the predictive factors of
caregiver burden.
RESULTS: A high burden was experienced by almost half of the caregivers (48.1%). The FDI
mean score was 9.76 ± 5.40 ranged from 0 to 24. A strong positive correlation was found between
the caregiver burden and family distress (r = 0.76). Multiple linear regression results showed the
predictive role of FDI score (β = 0.71, P = 0.001), patient’s gender (β = −0.25, P = 0.001), and early
cancer diagnosis (β =0.13, P = 0.027) in caregiver burden. They could explain 65% of variance in
the level of burden in family caregivers.
CONCLUSION: Family nurses should consider the caregivers burden and vulnerability of families
with cancer patient, especially if the patient is a male or has a new diagnosis. They should also
design special programs for the whole family as a system that family can adapt to the new situation.

Abstract BACKGROUND: Due to consumption of various forms of tobacco in large amounts by Indian
population, it has become a cause of concern for major oral diseases. In 2008, the WHO named
tobacco as the world’s single greatest cause of preventable death. It is also known that certain amount
of carbohydrates are incorporated in processed tobacco to make it acceptable for consumption. Thus,
its role in oral diseases becomes an important question at this point of time. Through this study, it is
attempted to find out the carbohydrate content of various forms of tobacco by phenol‑sulfuric acid
method.
MATERIALS AND METHODS: Tobacco products selected for the study were Nandi hookah
tambakhu (A), photo brand budhaa Punjabi snuff (B), Miraj (C), Gai‑chhap tambakhu (D),
Hanuman‑chhap Pandharpuri tambakhu (E), and Hathi‑chhap Bidi (F). The samples were decoded
and transported to laboratory and tested at various concentrations by phenol‑sulfuric acid method
followed by ultraviolet spectrophotometry to determine their absorbance.
RESULTS: The present study showed Hathi‑chhap bidi/sample F had a maximum absorbance (1.995)
at 10 µg/ml which is a smoking form of tobacco followed by rest all smokeless forms of tobacco,
i.e. sample C (0.452), sample B (0.253), sample D (0.077), sample E (−0.018), and sample A (−0.127),
respectively.
CONCLUSION: As the concentration of tobacco sample increases, their absorbance increases
which in turn is suggestive of increase in its carbohydrate concentration. Carbohydrates in the form
of sugars, either inherently present or added in it during manufacturing can serve as a risk factor for
higher incidence of dental caries.

Abstract INTRODUCTION: Hospital care transformation plan (HCTP) was implemented, in 2014, with the aim
of ensuring all Iranians have fair access to hospital care, mainly in the public sector. It was assumed
that HCTP would lead to increased quality and effectiveness of health care in public hospitals. To
explore whether HCTP has achieved its aim, this study has investigated the impact of this plan on
performance indicators (PIs) of the public hospitals.
MATERIALS AND METHODS: This cross‑sectional descriptive study was conducted in 2016. The
study population included all hospitals in the Isfahan City. Data (10 selected PIs) were collected
through formal reports which were available at the Isfahan University of Medical Sciences and
analyzed using Statistical Package for Social Sciences (version 17). The statistical significant level
analysis was 0.05.
RESULTS: After HCTP, it was shown an increase of (1) Bed occupancy, bed turnover, occupied
bed‑days, inpatients visits, and number of surgeries in all types of hospitals, (2) Outpatients’ visits in
all hospitals except private ones, (3) Emergency visits in public and social security hospitals, and (4)
Natural deliveries in public and semi‑public hospitals. Furthermore, the average length of stay and
hospital mortality rate has decreased in all types of hospitals after HCTP implementation.
DISCUSSION AND CONCLUSION: Although, improving PIs of hospitals were not directly stated
and known objectives of HCTP implementation, it seems HCTP could improve the performance of
all hospitals, including involved and noninvolved ones.

Abstract BACKGROUND: Preconception care is a set of interventions that aim to identify and repair the factors
that can affect the outcome of pregnancy. The aim of this study was to determine the prevalence of
receiving preconception care, its relation with recipients’ individuality, fertility, and determining the
reason for lack of checkup.
MATERIALS AND METHODS: This was a descriptive cross‑sectional study that was conducted based
on simple stratified random quota sampling on 702 women who gave birth in hospitals of Isfahan (Iran)
from April to June in 2016. The tool of collecting data was researcher‑made questionnaire. The data
were analyzed by the SPSS software version 18 using the mean, standard deviation, relativity, and
independent Chi‑square tests.
RESULTS: The results showed that 47.7% of participants had received preconception care. There
was a significant relationship between educational levels, income, wanted pregnancy, number of
pregnancies, and previous individual delivery with preconception care (P <   0/05). The main reason
for the lack of preconception care was unplanned pregnancy.
CONCLUSIONS: Results of this study indicated that the quantity of preconception care is not
desirable. Therefore, notifying and sensitizing women of childbearing age is essential to refer to
service centers and receiving preconception care and planning to present it to all eligible women
before pregnancy care. The main causes of the lack of preconception care can be adjusted through
health programs.

Abstract BACKGROUND: Test anxiety is one of the most disabling disorders and annual school academic
performance will affect millions of students. Hence, it needs attention and treatment. Therefore,
this research aimed to examine the effectiveness of a mindfulness‑based stress reduction (MBSR)
therapy on emotion regulation and test anxiety of students and test the remaining effect of this
treatment after 3 month.
METHODS: Sample size of fifty participants randomly divided into experimental (MBSR) and control
groups. The MBSR training interventions were implemented to the experimental group, in eight
weekly sessions using MBSR manual by John Kabat‑Zinn (2013). Participants in both groups were
evaluated using the Test Anxiety Scale and the Cognitive Emotion Regulation Questionnaire. The
study findings were analyzed using analysis of variance with repeated measures.
RESULTS: The result shows that the MBSR program has had continuous significant effects on test
anxiety (P < 000) and emotion regulation (P < 000) but was not significant only for the self‑blame
subscale (P = 0.126).
CONCLUSIONS: The study results indicated that the effects of MBSR lasted through the follow‑up,
for both of these variables. Using the results of this study may be proposed school counselors use
mindfulness to reduce the anxiety of their pupils.

Abstract INTRODUCTION: Adolescence is a period of life that is a bridge between childhood and adulthood.
India has the world’s largest adolescent girl’s population, and adolescent girls are an important
vulnerable group of population. Perceived health is a predictor of morbidity and mortality in adults
and has been an important marker of the health status in population health studies for decades. The
aim of the study was to describe adolescent’s perception of health and association between some
factors such as nutrition status, socioeconomic status (SES), and health status. As their perception
of health discomfort affects their health behavior and self‑care, therefore, their health status is an
important matter to discuss.
MATERIALS AND METHODS: A cross‑sectional study was conducted in urban areas from a major
city in South India. Six hundred and fifty adolescent female students aged 10–19 years formed the
study population. Standardized self‑reporting questionnaires were used to obtain relevant data
regarding demographic features, SES, and health status. BMI calculated for each individual. The
data were analyzed using SPSS version 16.
RESULTS: About 83.3% of participants ranked their health status as good to excellent. A majority
of the girls had one or more problems related to their menstrual cycles. The most common occurring
problem was headache (45.3%). 47.8% of participants exhibited symptoms of mild insomnia.
Strong significant association between nutritional status and SES was found. Higher percentage of
undernourished adolescents belonged to low SES.
CONCLUSION: Adolescents are expected to enjoy good health, but this does not seem to be the case
in the developing countries like India, where poverty, malnutrition, and repeated infection are rampant.
Majority of the problems such as healthy nutrition and self‑care can be solved by community‑based
programs, health education, and food fortification.

Abstract BACKGROUND: Breast periodic pain is the most common disorder of the breast which leads to
consultation with knowledgeable people like a midwife. The aim of this study was to compare the
therapeutic effect of flaxseed, evening primrose oil, and Vitamin E on the duration of the period of
breast pain.
MATERIALS AND METHODS: This study is a quasi‑randomized clinical trial conducted in 2015 on
ninety patients complaining of breast periodic pain referring to Gynecologic Clinics of Ghaem Hospital
or residents living in dormitories of Mashhad University of Medical Sciences. Randomization was
conducted based on the study environment. The first group received 30 g of powdered flaxseed, the
second group received two 1000 mg capsules of evening primrose, and the third group received 1
capsule of 400 IU Vitamin E, daily and for two menstrual cycles. Cyclical breast pain was measured
at the beginning and end of both intervention periods by daily subscription form of pain duration. Data
analysis was performed by SPSS 16 software and Kolmogorov–Smirnov, Chi‑square, Friedman,
Fisher’s, and one‑sided ANOVA tests. The level of significance was set at P < 0.05.
RESULTS: The mean duration of breast pain in flaxseed group within 2 months of intervention
decreased significantly (confidence interval [CI] =95%, P = 0.006), but despite reducing the
duration of pain in evening primrose oil group (CI = 95%, P = 0.058) and Vitamin E (CI = 95%,
P = 0.306), this reduction was not significant. In overall, the average duration of breast pain in all
three flaxseed, evening primrose oil, and Vitamin E groups was not significantly different before
the intervention (CI = 95%, P = 0.286), 1 month after the intervention (CI = 95%, P = 0.195), and
2 months after the intervention (CI = 95%, P = 0.667).
CONCLUSION: The use of flaxseed, evening primrose oil, or Vitamin E may reduce breast pain,
and this is a significant reduction in flaxseed.

Abstract OBJECTIVES: Teaching of clinical pathology to medical students has been ignored in many countries
such as Iran. We aim to introduce a practical brief course and its proper timing.
MATERIALS AND METHODS: Three groups of medical students from consecutive years of entrance
passed a 1.5 working day practical course on the field. Their level of knowledge was assessed by
pre‑ and post‑tests. Their idea and satisfaction were gathered by questionnaires.
RESULTS: Knowledge of students became significantly higher after the course. Their satisfaction
was high. Students in later year of education got significantly higher marks. Most of the students
wished such a course should be away from basic sciences period and as near as possible to
internship.
DISCUSSION: Due to overloaded curriculum of general medicine in Iran, we decided to run a brief
practical course of laboratory medicine education for medical students. Although the course was
practical, the knowledge of students became higher. Students with more clinical experience and
knowledge absorbed more. Being actively involved in the classes lit the enthusiasm of students and
made them satisfied with the course. It seemed that the course should be placed in later years of
clinical training to get the best uptake and results.

Abstract BACKGROUND: This study was aimed at developing and studying the scale of self‑efficacy in
adherence to treatment in Iranian patients with hypertension.
METHODS: A mix‑method study was conducted on the two stages: in the first phase, a qualitative
study was done using content analysis through deep and semi‑structured interviews. After data
analysis, the draft of tool was prepared. Items in the draft were selected based on the extracted
concepts. In the second phase, validity and reliability of the instrument were implemented using a
quantitative study. The prepared instrument in the first phase was studied among 612 participants. To
test the construct validity and internal consistency, exploratory factor analysis and Cronbach’s alpha
were used, respectively. To study the validity of the final scale, the average score of self‑efficacy in
patients with controlled hypertension were compared with patients with uncontrolled hypertension.
RESULTS: In overall, 16 patients were interviewed. Twenty‑six items were developed to assess
different concepts of self‑efficacy. Concept‑related items were extracted from interviews to study
the face validity of the tool from patient’s point of view. Four items were deleted because scored
0.79 in content validity. The mean of questionnaire content validity was 0.85. Items were collected
in two factors with an eigenvalue >1. Four items were deleted with load factor <0.4. Reliability was
0.84 for the entire instrument.
CONCLUSION: Self‑efficacy scale in patients with hypertension is a valid and reliable instrument that
can effectively evaluate the self‑efficacy in medication adherence in the management of hypertension.

Abstract BACKGROUND AND OBJECTIVE: Maintaining and improving the health situation of children
requires them to become more aware about personal hygiene through proper education. Based on
several studies, teachings provided through informal methods are fully understandable for children.
Therefore, the goal of this study is to compare the effects of creative drama and storytelling education
methods on increasing the awareness of children regarding personal hygiene.
METHODS: This is an applied study conducted using semiempirical method in two groups. The
study population consisted of 85 children participating in 4th center for Institute for the Intellectual
Development of Children and Young Adults in Isfahan, 40 of which were randomly selected and
placed in storytelling and creative drama groups with 20 members each. The data gathering tool
was a questionnaire created by the researchers whose content validity was confirmed by health
education experts. The gathered information were analyzed using both descriptive (average and
standard deviation) and analytical (independent t‑test and paired t‑test) statistical methods.
RESULTS: The findings showed that there was a meaningful difference between the awareness score
of both groups before and after intervention. The average awareness score of storytelling group was
increased from 50.69 to 86.83 while the average score of creative drama group was increased from
57.37 to 85.09. Furthermore, according to paired t‑test results, there was no significant difference
between average scores of storytelling and creative drama groups.
CONCLUSIONS: The results of the current study showed that although both storytelling and creative
drama methods are effective in increasing the awareness of children regarding personal hygiene,
there is no significant difference between the two methods.

Abstract BACKGROUND: Cancer and its treatments have been shown to have a negative psychological
effect on many cancer patients. One of these effects is often described as body image disturbance.
Due to the limited number of studies in this area, this study was performed to assess body image in
cancer patients and its association with clinical variables.
MATERIALS AND METHODS: This was a descriptive and correlational research that was designed
in Sayyed‑Al‑Shohda Hospital affiliated to Isfahan University of Medical Sciences, Iran in 2013. Two
hundred and ten adult patients who had been suffering from cancer were selected and completed
the personal/demographic/illness questionnaire and the multi‑dimensional body‑self relations
questionnaire that contained 64‑items with appearance orientation, appearance evaluation, fitness
evaluation, fitness orientation, health evaluation, health orientation, illness orientation, body areas
satisfaction, self‑classified weight and overweight preoccupation sub‑scales. Data were analyzed
by ANOVA and Pearson correlation with a significance level of P < 0.05.
RESULTS: The mean (standard deviation (scores of body image in cancer patients was 184.40 (43.68)
indicating that 58.3% of them had negative body image. In addition, most of patients had negative health
evaluation (60.2%), negative appearance evaluation(63%), negative illness orientation(61%), and negative
fitness orientation(56%). Furthermore, there were no significant correlations between type of cancer (P=0.5,
f = 0.3), kind of treatment (P = 0.8, f = 5.2) and duration of illness with body image (P = 0.6, r = −0.2).
CONCLUSION: In this study most of the cancer patients had body image disturbances. Also, body image in
this group wasn’t associated with the type of cancer, kind of treatment and duration of illness. Totally, these
results underscore the importance of assessing and treating body image disturbance in cancer patients.

Abstract BACKGROUND: Previous studies showed that family caregivers of hemodialysis patients have low
level of quality of life. However, these caregivers are mostly neglected, and no studies are available
on improving their quality of lives. Therefore, this study aimed to examine the effects of supportive
educative program on the quality of life in family caregivers of hemodialysis patients. Materials and
METHODS: A randomized controlled clinical trial was conducted on 76 family caregivers of
hemodialysis patients referred to Shahid Hasheminejad Hemodialysis Center in Tehran, Iran in 2015.
The subjects were equally allocated into two groups of 38. Caregivers of patients were randomly
assigned into the intervention group and the control group. The intervention group received six training
sessions on supportive educative program. Both groups answered demographic information and short
form‑36 questionnaires before and 6 weeks after the intervention. Descriptive statistics, Chi‑square
and Fisher exact tests, independent samples t‑test, and t‑couple, was used to analyze the data.
RESULTS: No significant difference was found between the baseline mean scores of “quality of life”
of the intervention and the control groups (P = 0.775). However, the mean scores of quality of life
of the intervention group increased at the end of the study, and the two groups were significantly
different in this regard (P < 0.001).
CONCLUSIONS: Supportive educative program improved the quality of life in caregivers of
hemodialysis patients. Therefore, it is suggested that health system managers encourage their staff
to implement such programs for improving the health status of the caregivers.