Journal of Education and Health Promotion

Abstract Discourse analysis (DA) is an interdisciplinary field of inquiry and becoming an increasingly popular
research strategy for researchers in various disciplines which has been little employed by health‑care
researchers. The methodology involves a focus on the sociocultural and political context in which
text and talk occur. DA adds a linguistic approach to an understanding of the relationship between
language and ideology, exploring the way in which theories of reality and relations of power are
encoded in such aspects as the syntax, style, and rhetorical devices used in texts. DA is a useful and
productive qualitative methodology but has been underutilized within health‑care system research.
Without a clear understanding of discourse theory and DA it is difficult to comprehend important
research findings and impossible to use DA as a research strategy. To redress this deficiency, in
this article, represents an introduction to concepts of discourse and DA, DA history, Philosophical
background, DA types and analysis strategy. Finally, we discuss how affect to the ideological
dimension of such phenomena discourse in health‑care system, health beliefs and intra‑disciplinary
relationship in health‑care system.

Abstract INTRODUCTION: Some skin diseases are incurable and modern medicine can only control them. In
addition, alternative treatment remedies including balneotherapy can be effective in improving skin
conditions. However, there are only a limited number of studies on particular mineral or trace elements
of mineral sources that have been identified in Iran. In this respect, the amount of minerals and trace
elements in Mamasani thermal source, Fars Province, Iran, was measured using electrochemical,
titration, and spectrophotometric methods and evaluated.
MATERIALS AND METHODS: The amount of minerals and trace elements in Mamasani thermal
source, Fars Province, Iran, was measured using electrochemical, titration, and spectrophotometric
methods.
RESULTS: The concentrations of natural gases such as H2
S and NO3
 in Mamasani thermal source
were measured to be 22.10 mg/L and 42.79 mg/L, respectively. The source also contained major
ions such as chloride, sulfate, sodium, calcium, magnesium, potassium, and carbonate. Due to the
high concentration of chloride, sulfate, and sodium ions in comparison with other major ions, the
water source is also classified as sulfide water. The existing trace elements in this thermal water
source are iron, zinc, copper, selenium, cobalt, chromium, boron, silisium, aluminum, magnesium,
and molybdenum.
CONCLUSION: We concluded that bathing in this source could be beneficial. As nitrate concentration
is close to the highest standard concentration for drinking water, it can be used in chronic dermatitis,
psoriasis, burns, and allergy. Furthermore, the antibacterial and antifungal effects of sulfur‑containing
water in this source can be helpful in the treatment of leg ulcers, tinea versicolor, tinea corporis,
and tinea capitis.

Abstract BACKGROUND: Air pollution is an important environmental issue due to its proven serious impacts
on human health. The aim of this study was to estimate the attribution of particulate matter with an
aerodynamic diameters of ≤ 2.5 and 10 (PM2.5 and PM10) in the prevalence of cardiovascular and
respiratory diseases and premature deaths in Isfahan in 2013–2014.
MATERIALS AND METHODS: This descriptive, ecological study was conducted to assess health
impacts of PM2.5 and PM10 on the population using Air Q2.2.3 software, suggested by the World Health
Organization (WHO).
RESULTS: The results showed that the annual mean, winter mean, summer mean, and the
98 percentile of PM10 concentration in Isfahan were 108, 100, 116, and 264 µg/m3
, respectively. The
number of deaths per year related to PM2.5 was 670 and that for PM10 was 713 cases. The number
of annual deaths due to cardiovascular and respiratory diseases attributed to PM10 was 316 and
68 cases, respectively.
CONCLUSION: The results of this study revealed that about 44.3% of total annual death due to
cardiovascular diseases and 9.55% of that due to respiratory diseases were attributed to PM10
exposure. In the other word, residents were exposed to PM2.5 and PM10 concentrations higher than
the WHO guidelines which caused a notable increase in the rate of mortality.

Abstract BACKGROUND: Although education is one of the most substantial needs of patients that should be
taught by nurses and midwives, it is not clearly defined through the hidden curriculum in students’
teaching programs. The aim of this study was to explore the patient education through the hidden
curriculum in the perspectives of nursing and midwifery students.
MATERIALS AND METHODS: A qualitative, content analysis study was performed and twenty nursing
and midwifery students were interviewed. Data were collected using face‑to‑face semi‑structured
interviews and analyzed using conventional content analysis approach.
RESULTS: Students’ perception of the hidden curriculum in patient education emerged in three
main themes concerning: (1) interactions, (2) teaching and learning opportunities, and (3) reflective
evaluation.
CONCLUSIONS: The hidden curriculum in patient education can be transferred as interactions
between professors, students, nurses, doctors, and also patients who are rooted from paying attention
to the human dimension of the patient, avoiding the materialistic treatment of the patient and treating
the patient with dignity. Educational policies and students’ assignments should be designed based on
the patient’s educational goals and the goal of evaluation has to be presented to the students clearly.

Abstract INTRODUCTION: Using fertility treatment will cause high levels of anxiety and depression. The study
was carried out with the objective of determining the effect of problem‑solving skills (PSS) training on
mental health and the success of treatment of infertile women under intrauterine insemination (IUI)
treatment.
MATERIALS AND METHODS: this randomized clinical trial was carried out on 72 women
referring to Milad Infertility Center in Mashhad. Individuals were randomly assigned into control and
intervention groups. PSS were taught in three sessions in the intervention group, and the control
group received usual care. The success rate of therapy and the mean of anxiety and depression
on the day of IUI operation were compared using the Beck Depression Inventory and Spielberger
Anxiety Inventory in both groups. t‑test, Mann–Whitney, paired t‑test, Wilcoxon, and Chi‑square
tests were used to analyze the data.
RESULTS: on the day of IUI operation, the mean score of state anxiety in the control
group (5 0 . 11 ± 8.51) and PSS (68.12 ± 11.49) was significant (P < 0.001), trait anxiety in the
control group (46.41 ± 8.70) and PSS (44.00 ± 9.92) was significant (P < 0.001), and depression in the
control group (17.44 ± 11.70) and PSS (12.99 ± 8.99) was significant (P < 0.001); however, the success
of treatment in both groups (14.7% and PSS (26.5%) was not significantly different (P = 0.230).
CONCLUSION: Considering the effect of problem‑solving on reducing anxiety and depression, it is
suggested that infertility center of this intervention should be used.

Abstract BACKGROUND AND AIM: Increasing incidence of medically compromised patients seeking dental
treatment and implant rehabilitation, necessitates greater knowledge toward managing such patients.
The objective of the present study was to evaluate the perceptions of dental interns in Riyadh,
Saudi Arabia, toward dental implant therapy for medically compromised patients.
MATERIALS AND METHODS: Using a convenience random sampling technique, a cross‑sectional
questionnaire‑based study was conducted to evaluate the perceptions of the interns from dental
schools in Riyadh, Saudi Arabia. Data pertaining to demographic details of the participants, academic
grade point average (GPA), clinical implant training and experience and perceptions about dental
implant therapy for medically compromised patients were collected.
RESULTS: The survey response rate was 82.9% (n = 174/210; Males‑129/Females‑45). Less than
half of the interns (n = 82/174; 47.1%) had performed dental implants, out of which 41.5% (n = 34/82)
had placed implants in medically compromised patients. Most medical illnesses except controlled
diabetes mellitus and hypertension were perceived by the interns as contraindications for dental
implant placement.
CONCLUSION: Based on the results of the present study, it could be concluded that courses with a
greater emphasis toward management of dental patients with medical problems and undergraduate
implant training for such patients would result in better knowledge and perception among dental
interns regarding dental implant placement in medically compromised patients.

Abstract BACKGROUND: Family participation is an important element on nutritional education especially
for students. Parents have a key role in instilling and understanding healthy eating habits, but yet
the use of family participation strategies in the nutrition education was low. The aim of this study
is determining the effect of parental educational intervention program for parents on adolescents’
nutritional behaviors in Isfahan, Iran in 2016.
MATERIALS AND METHODS: This study was a kind of field trial that conducted on 63 girl teenagers
from junior high schools of Isfahan in 2016 that were randomly divided into two groups of intervention
and control. The data collection tool which was a researcher made questionnaire was completed
in both groups before and 1 month after the intervention. The intervention included three training
sessions for parents and giving educational compact disc and forwarding SMS. To analysis of data
independent t‑test and paired t‑test were used.
RESULTS: Paired t‑test showed that in intervention group the average score of fruit (P = 0.03) and
in control group the average score of vegetables (P < 0.05) were significant statistical difference, but
in other aspects of nutritional behaviors was not a significant difference. Independent t‑test showed
that after intervention, mean scores nutritional behavior of adolescent girls in both groups had no
significant differences.
CONCLUSIONS: No significant difference was in the nutritional behaviors before and after the
intervention. Hence, just educating the parents is not enough for achieving appropriate nutritional
behaviors in the adolescents.

Abstract BACKGROUND: The oral health of pregnant females needs attention, especially in developing countries
like India where oral checkup and care is not considered to be a part of mandatory antenatal protocols.
OBJECTIVE: This study aimed to evaluate the oral health status of pregnant females in Central India
including the assessment of their knowledge, attitude, and awareness about oral health.
MATERIALS AND METHODS: The study population comprised of 320 pregnant females, and a
control group consisted of 103 age‑matched nonpregnant females. A cross‑sectional self‑reported
questionnaire‑based survey and clinical examination was conducted.
RESULTS: Out of 320, 192 (60%) pregnant females had some dental problem during pregnancy.
Community periodontal index (CPI) score for total pregnant females (2.16) was significantly higher
in comparison to control group (1.29). Nearly 72.81% of pregnant females had never attended the
dentist. Trimester‑wise comparison showed time‑dependent increase in CPI score. Low educational
status, older age, earlier issues, poor hygiene habits, and tobacco use showed a direct effect on
compromised oral health.
CONCLUSION: The study highlights the need of interaction between dental practitioners and
gynecologists including routine dental checkup during antenatal visits of pregnant females as essential.

Abstract BACKGROUND AND AIM: One of the methods that help students in learning critical thinking and
decision‑making skills is storytelling. Story helps the students to place themselves in the same
situation as the main protagonist and try different ways and finally select and implement the best
possible method. The goal of this study is to investigate the effect of storytelling on hopefulness of
students, age 8–11 in Isfahan’s 2nd ed.ucational district.
METHODS: This is an applied, quasi-experimental study. The study population comprised of
34 randomly selected students attending one of the schools in Isfahan’s 2nd ed.ucational district. The
data gathering tool was the standard Kazdin hopefulness scale (α = 0.72) and data were gathered before
and after 8 storytelling sessions for the intervention group. The gathered data were analyzed using
descriptive and analytical (paired and independent t‑test) with the help of SPSS Version 18 software.
RESULTS: The study’s findings showed a significant difference in the average hopefulness score
of students in study group in pre‑ and posttest (P = 0.04). Furthermore, independent t‑test results
showed a significant difference in hopefulness score of intervention and control (P = 0.001). The
average hopefulness score of the control group after storytelling sessions was higher than that of
the intervention and control.
CONCLUSION: The results show the effectiveness of storytelling as a method for improving
hopefulness in students.

Abstract OBJECTIVE: The objective of this study is to explore the student’s perspectives toward the interactive
lectures as a teaching and learning method in an integrated curriculum.
MATERIALS AND METHODS: This cross‑sectional study was conducted among 1st, 2nd and
3rd year male medical students (n = 121). A self‑administered questionnaire based on the Visual,
Auditory, Reader, Kinesthetic learning styles, learning theories, and role of feedback in teaching
and learning on five‑point Likert rating scale was used. The questionnaire was constructed after
extensive literature review.
RESULTS: There was an 80% response rate in this study. The total number of undergraduate medical
students responded in the study were n = 97, 34 students of 1st year, n = 30 students of 2nd year and
n = 33 student were in 3rd year, the mean scores of the student responses were calculated using
Independent samples Kruskal–Wallis. There was no significant difference in the responses of the
students of different years except for the question “The Interactive lectures facilitate effective use of
learning resources.” Which showed significant difference in the responses of the 3 years students by
Independent samples Kruskal–Wallis test. No significant association was found between the year of
study and items of the questionnaire except for the same item, “ The Interactive lectures facilitates
effective use of learning resources” by Spearman rank correlation test.
CONCLUSION: The students perceive interactive lecture as an effective tool for facilitating visual and
auditory learning modes, and for achieving curricular strategies. The student find the feedback given
during the interactive lectures is effective in modifying learning attitude and enhancing motivation
toward learning.

Abstract BACKGROUND: Studies have found that nearly 90% of the first use of tobacco takes place before
high school graduation (teenagers) and training discussion due to prevention can be useful, therefore,
here, we aimed to determine the effects of training on awareness of cigarette outcomes (physical
and psychological) in male teenagers.
MATERIALS AND METHODS: We conducted an interventional study using Solomon’s four‑group
plan, which used a two‑stage cluster sampling in four groups (two experimental groups and two
control groups). The three sessions of at least 2 h of education intervention including visual displaying
using photo, film, and short scientific texts were held for the interventional group. After 1 month, all
four groups took posttest, and research groups were followed up after 8 months of intervention. All
data were analyzed using one‑way analysis of variance and covariance in SPSS.
RESULTS: According to the results, the mean of posttest scores had increased rather than pretest
scores, and generally, a significant difference was observed (P ≤ 0.001). These results were
significant in the aspect of both physical and psychological outcomes awareness. The difference
between the mean of scores in follow‑up period and posttest was not statistically significant, and it
shows training retention after 8 months (P < 0.666).
CONCLUSIONS: It can be concluded that through the training, it is possible to increase the awareness
of teenagers about physical and psychological outcomes of cigarette smoking that this can have an
important role in smoking prevention.

Abstract BACKGROUND: Although numerous studies have documented malocclusion in various age groups
in India, the literature on the prevalence of malocclusion in mixed dentition is scanty. Dental caries
is another most common condition affecting the general health. However, its association with
malocclusion in mixed dentition is not well known.
AIM: The purpose of this study was to establish the prevalence of malocclusion and its association
with caries experience in 8–9‑year‑old children of Davangere city, South Indian region.
SETTING AND DESIGN: The study design was a cross‑sectional survey.
MATERIALS AND METHODS: A total of 800 children from 350 schools (both males and females)
were randomly selected for the study. t‑test and Chi‑square test were used for statistical analysis.
RESULTS: The overall prevalence of malocclusion among 8–9‑year‑old children was 40.9%. The
most prevalent malocclusion was crowding (11.5%), followed by excessive overjet (9.4%), deep
bite (6.8%), spacing (6.5%), crossbite (4.5%), and open bite (3.2%). Class I molar relationship
prevailed in 95.5% of children.
CONCLUSION: The prevalence of malocclusion in our study was in accordance with the other studies
reported in India, which ranged from 19.6% to 90%. Furthermore, correlation of malocclusion and
dental caries in the primary dentition, although nonsignificant, presented children with malocclusion
to have a higher caries experience than children without malocclusion.

Abstract INTRODUCTION: Fear of childbirth is a common problem in pregnant women, which in many cases
leads to maternal requested cesarean. A midwife, as a responsible person, plays an important role in
providing advice and giving care to mothers during pregnancy, delivery, and the postpartum period.
The present study was conducted with the aim of determining the effect of individual counseling
program by a midwife on fear of childbirth in primiparous women.
MATERIALS AND METHODS: This clinical trial was conducted in 2015–16, on ninety primiparous
women with gestational ages of 28–30 weeks, who presented themselves at health‑care centers
in Mashhad. The individuals were randomly divided into two groups: intervention and control. The
intervention group received the counseling program individually during three sessions, and the routine
care was given to the control group. Data collection tools the Wijma Delivery Expectancy/Experience
Questionnaire. The data were collected at recruitment during 34–36 weeks of pregnancy and were
analyzed using SPSS 16 software and the statistical tests: Chi‑square and t‑test, and P < 0.05 was
considered to be significant.
RESULTS: During weeks 34–36 of pregnancy, the mean scores for fear of childbirth in the intervention
group and control group were 39.733 ± 17.085 and 65.666 ± 15.019, respectively, and there was a
significant difference between the two groups (P < 0.001).
CONCLUSION: The individual counseling program provided by the midwife to the primiparous women
during pregnancy resulted in reduced fear of childbirth.

Abstract CONTEXT: The Maui Worksite Wellness Policy Initiative was evaluated utilizing a baseline and
follow‑up study to improve the prevalence and awareness of worksite wellness for Maui employers
following the Maui Worksite Wellness Summit intervention.
AIMS: To evaluate a worksite wellness intervention.
SETTINGS AND DESIGN: Worksites that attended the Maui Worksite Wellness Summit with a
pre‑ and post‑test design.
PARTICIPANTS AND METHODS: Worksite characteristics and worksite wellness
components (infrastructure, physical activity, and nutrition) were measured using a Likert‑scale survey.
STATISTICAL ANALYSIS USED: Repeated measures analysis of variance was used to compare
the pre‑ and post‑tests.
RESULTS: The baseline sample was comprised of 9 businesses, and the number of full‑time
employees ranged from 3 to 715; the follow‑up sample was comprised of 7 businesses, and the
number of full‑time employees ranged from 3 to 750. Results indicated that majority (71.43%) of
worksites improved their worksite wellness policies, 85.71% improved their infrastructure, 71.43%
increased their support for physical activity policies, and 57.14% improved their support for nutrition
policies after the Maui worksite wellness summit.
CONCLUSIONS: Based on this study, future efforts should comprise of a larger sample, more
rigorous methodology, and longer duration.

Abstract BACKGROUND: To increase the utilization of preventive dental care, it is essential to improve
the knowledge and attitude of parents about such cares. The aim of this study was to evaluate
the knowledge, attitude, and practice of school children’s parents toward fissure sealant (FS) and
professional fluoride therapy in Isfahan.
MATERIALS AND METHODS: In this cross‑sectional study, school children’s parents (n = 637) were
selected based on proportional cluster sampling. A valid and reliable questionnaire was designed,
including demographic section, questions about parents’ experience and their knowledge and attitude
about professional fluoride and FS therapy. Data were analyzed by ANOVA, regression, Chi‑square,
and correlation coefficient tests.
RESULTS: The means of total knowledge and knowledge about fluoride therapy and FS were 5.9 ± 4.1
out of 19, 3.3 ± 2.0 out of 9 and 2.6 ± 2.7 out of 10, respectively. The mean of attitude was 33.7 ± 5.8.
The mean of knowledge toward FS therapy was significantly higher in academically educated
parents (P = 0.023). The mean of total knowledge among those who received their knowledge by their
dentist was also significantly higher than that of other resources such as mass media (P = 0.003).
Total knowledge was positively correlated with attitude (P < 0.001, coefficient = 0.5). Of participants,
10.4% (54) and 23.2% (124) had the experience of FS and fluoride therapy, respectively.
CONCLUSION: Based on the low level of knowledge regarding professional preventive care in this
study and the effectiveness of knowledge acquired through dentists and mass media consultations,
it might be effective to require them to consider such training more seriously.

Abstract INTRODUCTION: Health literacy is a set of different skills, including reading, listening, analyzing,
deciding, and applying these skills related to health status. Epidermolysis bullosa (EB) is a rare
hereditary genetic disease which affects several aspects of the life of patients and their families. The
aim of this study was to assess the health literacy of patients with EB in Iran.
MATERIALS AND METHODS: Thirty‑three patients from Iran with EB, aged above 15 years-old,
were enrolled in the study. Iranian Health Literacy Questionnaire, which measures health literacy in
five domains including reading, access, perception, assessment, and decision-making skills, was
used for collecting the data. SPSS analytical software, version 22, was used for statistical analysis.
RESULTS: In total, 19 (57.6%) patients were male and 14 (42.4%) female with an age range of
15-41 years. Nineteen (57.6%) patients had inadequate health literacy in reading skills. One‑third of
patients had enough health literacy in the realm of access, and two‑thirds were excellent in perception.
Overall, there was no significant correlation between the level of health literacy with age (P = 0.92),
sex (P = 0.55), race (P = 0.58), and educational level (P = 0.51) of the patients.
CONCLUSION: The majority of the patients had inadequate health literacy in reading skills while
these patients had acceptable health literacy in perception, assessment, and decision‑making skills.
Improvement of health literacy of these patients should be a priority for health policy makers with the
aim of increasing their quality of life and decreasing their personal and social problems.