Journal of Education and Health Promotion

Abstract CONTEXT: Shortage of physicians particularly in specialty levels is considered as an important issue
in Iran health system. Thus, in an uncertain environment, long‑term planning is required for health
professionals as a basic priority on a national scale.
AIMS: This study aimed to estimate the number of required neurosurgeons using system dynamic
modeling.
SETTING AND DESIGN: System dynamic modeling was applied to predict the gap between stock
and number of required neurosurgeons in Iran up to 2020.
SUBJECTS AND METHODS: A supply and demand simulation model was constructed for
neurosurgeons using system dynamic approach. The demand model included epidemiological,
demographic, and utilization variables along with supply model‑incorporated current stock of
neurosurgeons and flow variables such as attrition, migration, and retirement rate.
STATISTICAL ANALYSIS USED: Data were obtained from various governmental databases and
were analyzed by Vensim PLE Version 3.0 to address the flow of health professionals, clinical
infrastructure, population demographics, and disease prevalence during the time.
RESULTS: It was forecasted that shortage in number of neurosurgeons would disappear at 2020.
The most dominant determinants on predicted number of neurosurgeons were the prevalence of
neurosurgical diseases, the rate for service utilization, and medical capacity of the region.
CONCLUSIONS: Shortage of neurosurgeons in some areas of the country relates to maldistribution of
the specialists. Accordingly, there is a need to reconsider the allocation system for health professionals
within the country instead of increasing the overall number of acceptance quota in training positions.

Abstract OBJECTIVE: Exercise evaluation is one of the most important steps and sometimes neglected in
designing and taking exercises, in this stage of exercise, it systematically identifying, gathering, and
interpreting related information to indicate how an exercise has fulfilled its objectives. The present
study aimed to assess the most important evaluation techniques applied in evaluating health exercises
for emergencies and disasters.
METHODS: This was meta-evaluation study through a systematic review. In this research, we
searched papers based on specific and relevant keywords in research databases including ISI web
of science, PubMed, Scopus, Science Direct, Ovid, ProQuest, Wiley, Google Scholar, and Persian
database such as ISC and SID. The search keywords and strategies are followed; “simulation,”
“practice,” “drill,” “exercise,” “instrument,” “tool,” “questionnaire,” “ measurement,” “checklist,” “scale,”
“test,” “inventory,” “battery,” “evaluation,” “assessment,” “appraisal,” “emergency,” “disaster,” “cricise,”
“hazard,” “catastrophe,: “hospital”, “prehospital,” “health centers,” “treatment centers,” were used in
combination with Boolean operators OR and AND.
RESULTS: The research findings indicate that there are different techniques and methods for data
collection to evaluate performance exercises of health centers and affiliated organizations in disasters
and emergencies including debriefing inventories, self‑report, questionnaire, interview, observation,
shooting video, and photographing, electronic equipment which can be individually or collectively
used depending on exercise objectives or purposes.
CONCLUSION: Taking exercise in the health sector is one of the important steps in preparation and
implementation of disaster risk management programs. This study can be thus utilized to improve
preparedness of different sectors of health system according to the latest available evaluation
techniques and methods for better implementation of disaster exercise evaluation stages.

Abstract BACKGROUND: Childbirth self‑efficacy is one of the most important factors causing a shift in
mothers do vaginal delivery. If the mother feels that she can cope well with stress, will be protected
from the harmful effects of stress on your health. Self‑efficacy contained individual’s assessment of
her ability to deal with stressful situations. Strengthen the spiritual beliefs of the patient causes her
to be a good result every situation even incurable condition. This study aimed to determine the effect
of religious‑spiritual support on childbirth self‑efficacy in primiparous women.
METHODS: This is a quasi‑experimental study carried on seventy primiparous women; participants
were randomly divided into two intervention and control groups. The intervention group received the
e‑learning package based on religious‑spiritual content. Self‑efficacy questionnaire by both groups
before and 4 weeks after it was completed. Collected data were entered into SPSS version 11
descriptive statistics, independent t‑test, and paired t‑test which were used for analysis of data. The
significant level was considered <0.05.
RESULTS: The results showed that the mean self‑efficacy score before and after intervention in
case group was 105.2 (27.01) and 110.12 (21.2), respectively, and in control group; 111.2 (23.12)
and 116.9 (24.43).   Paired t‑test in two groups was significant (P = 0.042, P = 0.045) but independent
t‑test showed no significant difference in scores of childbirth self‑efficacy before and after intervention
in two groups (P = 0.061).
CONCLUSION: In prenatal periods, religious‑spiritual support through electronic package method can
increase childbirth self‑efficacy, so the planning and establishment of this training are recommended
as an effective training.

Abstract OBJECTIVE: This study aimed to explore factors influencing the results of faculty member evaluation
from the viewpoints of faculty members affiliated with Isfahan University of Medical Sciences, Isfahan,
Iran.
MATERIALS AND METHODS: This qualitative study was done using a conventional content analysis
method. Participants were faculty members of Isfahan University of Medical Sciences who, considering
maximum variation in sampling, were chosen with a purposive sampling method. Semi‑structured
interviews were held with 11 faculty members until data saturation was reached. The interviews were
transcribed verbatim and analyzed with conventional content analysis method for theme development.
Further, the MAXQDA software was used for data management.
RESULTS: The data analysis led to the development of two main themes, namely, “characteristics
of the educational system” and “characteristics of the faculty member evaluation system.” The first
main theme consists of three categories, i.e. “characteristics of influential people in evaluation,”
“features of the courses,” and “background characteristics.” The other theme has the following as
its categories: “evaluation methods,” “evaluation tools,” “evaluation process,” and “application of
evaluation results.” Each category will have its subcategories.
CONCLUSIONS: Many factors affect the evaluation of faculty members that should be taken into
account by educational policymakers for improving the quality of the educational process. In addition
to the factors that directly influence the educational system, methodological problems in the evaluation
system need special attention.

Abstract INTRODUCTION: Anesthesia has become one of the most advanced specialties in modern medicine
with tremendous growth in knowledge and substances available for use. However, public awareness
toward anesthesiologist and anesthesiology is limited. It is important for us to make people aware about
the role played by an anesthesiologist in medical setup. The present study was conducted among
patients and attendants to assess the knowledge regarding the anesthesiologist and anesthesiology.
MATERIALS AND METHODS: The study was carried out at a rural hospital of New Delhi, on 250
adult patients and attendants visiting outpatient departments to assess their knowledge regarding
anesthesiologists and anesthesiology. An interview in their local language with the help of a
prestructured questionnaire was carried out over a 3 month period. The participants on the basis of
their answers were classified as aware or unaware. The data were analyzed using SPSS version 17.
RESULTS: Most of the patients in our study were not aware of the role of anesthesiologists, their
role in OT and postoperative period, and about anesthesiology as a separate discipline. They were
aware of the general and regional anesthesia techniques. Only half of the participants had good
knowledge (55.6%), and it was significantly associated with age, sex, and education (P < 0.001).
CONCLUSION: There is ignorance among the general population regarding the role played by
anesthesiologists. We need newer initiatives for educating public and professionals for future progress.

Abstract BACKGROUND: Research self‑efficacy is one of the main factors influencing the successful
conduction of research and following it in students. This study was performed with the aim of
determining the research self‑efficacy and its relationship with academic performance in postgraduate
students of Tehran University of Medical Sciences (TUMS) in 2016.
MATERIALS AND METHODS: This cross‑sectional study was performed on 320 postgraduate
students of TUMS in 2016. Proportional stratified sampling was done with simple random sampling
from each school. The data were gathered with Phillips and Russell’s research self‑efficacy
questionnaire, demographic questions, and grade point average (GPA) and were analyzed with
independent t‑tests, ANOVA, Pearson’s correlation, and multiple linear regressions in SPSS 18.
RESULTS: Out of 320 students participating in this study, 152 patients (47.5%) were male and
168 (52.5%) were female with the mean age of 27.83 ± 4.3 years. The mean of research self‑efficacy
score was 186.18 ± 59.5 which was significant depended on college degrees and was significantly
higher in doctorate students (P = 0.0001). However, no significant difference was seen in research
self‑efficacy score of students due to gender (P = 0.754) and school (P = 0.364). There was a significant
direct relationship between students’ GPA and research self‑efficacy score (r = 0.393, P = 0.0001).
CONCLUSIONS: Results of this study showed that the research self‑efficacy score of TUMS
postgraduate students is at an acceptable level, except the quantitative and computer skills that
need appropriate educational interventions. As a direct and significant relationship existed between
research self‑efficacy score and student’s academic performance, improving the research self‑efficacy
will also increase students’ academic performance.

Abstract BACKGROUND: Mobile health has the potential to revolutionize the role of educators by empowering
nurses to take more responsibility for their own learning. Hence, this study was designed to examine
the effect of mobile health method to emergency nurses’ knowledge about Emergency Severity
Index triage.
MATERIALS AND METHODS: A two groups’ pool blind quasi‑experimental study was performed
on emergency department nurses working in hospitals affiliated with Isfahan University of Medical
Sciences. The study was conducted from September to November 2014. Sample size was calculated
as 35 participants in each group (a total of seventy participants). Participants were divided into two
groups of mobile health and workshop, randomly. Participants’ knowledge score was collected
according to researcher‑made questionnaire with twenty questions. SPSS version 11.5 was used
to conduct statistical tests such as independent t‑test and paired t‑test for analyzing the data with
the significant level <0.05.
RESULTS: The results show that there was not any significant difference between the knowledge
scores of mobile health and workshop group before intervention, but there was a significant difference
after 2‑week intervention (P = 0.012).
CONCLUSION: The electronic program was an attractive education method for emergency nurses
because in these method educators by empowering nurses to take more responsibility for their own
learning. Hence, it is suggested that mobile health is used by authorities along with routine training,
due to its less cost and spending less time.

Abstract BACKGROUND: Tobacco use is a disease of addiction and a behavior choice. It is valuable to
understand the psychosocial dimension of disease.
OBJECTIVES: The research aimed to assess the (I) behavioral determinants and pattern of tobacco
use (II) readiness to quit tobacco among patients with oral potentially malignant disorders (OPMDs)
using transtheoretical model (TTM) approach visiting the dental college in Goa, India.
MATERIALS AND METHODS: This cross‑sectional analytical study was conducted among
300 patients over 3 months. Information about sociodemographics, determinants including age
and reason of onset, behavioral stages, and the presence of OPMDs was collected using specially
designed pro forma. Descriptive and inferential statistics were performed using SPSS 18.0.
RESULTS: Smokeless form of tobacco 199 (66.34%) was most prevalent followed by smoking
79 (26.33%) and dual tobacco use 22 (07.33%) in males. Majority belonged to low socioeconomic
class. Peer influence was the most‑cited reason. Around 1/3rd of the participants had OPMDs
associated with tobacco use. Significant association was observed between the presence of OPMDs
and TTM behavioral stages. Patients with OPMDs are more motivated for tobacco cessation
(odd’s ratio = 2.30, P = 0.002), that is, they are more in preparation and action stages.
CONCLUSION: The findings reflect that smokeless tobacco use is more prevalent in males with low
level of education and socioeconomic class. Readiness to quit tobacco increases among patients
with OPMDs using TTM.

Abstract INTRODUCTION: Studies about globalization and internationalization demonstrate different attitudes
in explaining these concepts. Since there is no consensus among Iranian specialists about these
concepts, the purpose of this study is to explain the concepts of internationalization and globalization
in Iran.
MATERIALS AND METHODS: This study is a systematic review done in the first half of 2016.
To explain the concept of globalization and internationalization, articles in  Scientific Information
D atabase, Magiran database, and Google Scholar were searched with the keywords such as
globalization, scientific exchange, international cooperation, curriculum exchange, student exchange,
faculty exchange, multinational cooperation, transnational cooperation, and collaborative research.
Articles, used in this study, were in Persian and were devoted to internationalization and globalization
between 2001 and 2016. The criterion of discarding the articles was duplicity.
RESULTS: As many as 180 Persian articles were found on this topic. After discarding repetitive
articles, 64 remained. Among those, 39 articles mentioned the differences between globalization
and internationalization. Definitions of globalization were categorized in four categories, including
globalization, globalizing, globalization of higher education, and globalizing of higher education.
Definitions about internationalization were categorized in five categories such as internationalization,
internationalization of higher education, internationalization of the curriculum, internationalization of
curriculum studies, and internationalization of curriculum profession.
CONCLUSION: The spectrum of the globalization of higher education moves from dissonance and
multipolarization to unification and single polarization of the world. One end of the spectrum, which
is unification and single polarization of the world, is interpreted as globalization. The other side of the
spectrum, which is dissonance and multipolarization, is interpreted as globalizing. The definition of
internalization is the same as that of globalizing. In other words, it is possible to say that internalization
is similar to globalizing but different from globalization.

Abstract BACKGROUND: Dental health‑care personnel are at an increased risk toward infections caused
by various microorganisms including hepatitis B and hepatitis C viruses (HCV). A dentist can play
an important role in the prevention of HCV by considering every patient as a potential carrier for
hepatitis. Therefore, the present study was conducted to assess the knowledge and awareness of
dental health‑care professionals regarding various aspects of HCV.
MATERIALS AND METHODS: A cross‑sectional study was conducted among 247 private dental
practitioners of tricity. A close‑ended self‑structured questionnaire was administered which contained
12 questions on knowledge and awareness regarding HCV infection keeping in view the time
constraints. Categorization of knowledge scores was done at three levels ‑ poor, moderate, and
good. Statistical analysis was done using ANOVA and Student’s t‑test.
RESULTS: Nearly 96% (102) of postgraduates and 84% (117) of graduates had heard about HCV.
45.5% (112) had poor knowledge scores, 33.6% (83) had moderate knowledge scores, and only
21% (52) of participants had good knowledge scores. On the opinion of treating an HCV‑infected
patient by a dentist, only 61% (65) of postgraduates and 46% (64) of graduates agreed. There was
statistically significant association of mean knowledge scores with gender, education level, and
experience (P < 0.05).
CONCLUSION: Majority of the dental professionals lacked knowledge regarding HCV infection and
were not fully aware regarding certain aspects. Therefore, there is an urgent need for modification
of the existing dental curriculum so that knowledge regarding these diseases can be imparted during
graduation.

Abstract BACKGROUND AND GOAL: Screening of fetal anomalies is assumed as a necessary
measurement in antenatal cares. The screening plans aim at empowerment of individuals to
make the informed choice. This study was conducted in order to compare the effect of group and
face‑to‑face education and decisional conflicts among the pregnant females regarding screening
of fetal abnormalities.
METHODS: This study of the clinical trial was carried out on 240 pregnant women at <10‑week
pregnancy age in health care medical centers in Mashhad city in 2014. The form of
individual‑midwifery information and informed choice questionnaire and decisional conflict scale
were used as tools for data collection. The face‑to‑face and group education course were held
in two weekly sessions for intervention groups during two consecutive weeks, and the usual
care was conducted for the control group. The rate of informed choice and decisional conflict
was measured in pregnant women before education and also at weeks 20–22 of pregnancy in
three groups. The data analysis was executed using SPSS statistical software (version 16), and
statistical tests were implemented including Chi‑square test, Kruskal–Wallis test, Wilcoxon test,
Mann–Whitney U‑test, one‑way analysis of variance test, and Tukey’s range test. The P < 0.05
was considered as a significant.
RESULTS: The results showed that there was statically significant difference between three groups
in terms of frequency of informed choice in screening of fetal abnormalities (P = 0.001) in such
a way that at next step of intervention, 62 participants (77.5%) in face‑to‑face education group,
64 members (80%) in group education class, and 20 persons (25%) in control group had the informed
choice regarding screening tests, but there was no statistically significant difference between two
individual and group education classes. Similarly, during the postintervention phase, there was a
statistically significant difference in mean score of decisional conflict scale among pregnant women
regarding screening tests in three groups (P = 0.001).
DISCUSSION AND CONCLUSION: With respect to effectiveness of group and face‑to‑face
education methods in increasing the informed choice and reduced decisional conflict in pregnant
women regarding screening tests, each of these education methods may be employed according
to the clinical environment conditions and requirement to encourage the women for conducting the
screening tests.

Abstract BACKGROUND: The development of public transportation (PT) is a crucial issue in the modern
societies. The aim of this study was to assess the status of PT usage among the population residing
in Mashhad.
MATERIALS and METHODS: In a cross‑sectional design, 464 citizens of Mashhad filled a checklist
about PT‑use (i.e., bus, taxi, and metro) to find their supporting and opposing factors in 2014.
Chi‑square, Mann–Whitney, Student’s t‑test, and logistic regressions were used for inferential
analysis in SPSS 11.5.
RESULTS: Mean age was 30.02 ± 11.24 years and 57% (263) were female. Bus (169, 50%) was the
most popular PT means, followed by metro (98, 29%) and taxi (74, 21%). Most transportations were
happened at morning (248, 35%) and evening (221, 31%). Increasing age (odds ratio [OR] =1.04,
confidence interval [CI] 95% = 1.008–1.07), higher education (OR = 2.91, CI 95% = 1.14–7.38),
being homemaker (OR = 2.97, CI 95% = 1.19–7.36), or student (OR = 2.91, CI 95% = 1.14–7.38)
were predictors of PT‑use.
CONCLUSION: Individual preference between PT and driving is associated with social, economic,
and cultural aspects of a population. Recognizing the influencing factors can help to design
population‑oriented services.

Abstract AIM: To translate OHIP‑14 into Hindi and test its psychometric properties among school teacher
community.
METHODS: The OHIP‑14 was translated to OHIP‑14‑H using WHO recommended translation
protocol. During pre‑testing, an expert panel assessed content validity of the questionnaire. Face
validity was assessed on a sample of 10 individuals. The OHIP‑14‑H was administered on a random
sample of 170 primary school teachers. Internal consistency and test‑retest reliability were assessed
using Cronbach’s alpha and Intra‑class correlation coefficient (ICC) respectively, with 2 weeks
interval. Predictive validity was tested by comparing OHIP‑14‑H scores with clinical parameters.
The concurrent validity was assessed using self‑reported oral health and discriminant validity was
ascertained through negative association with sociodemographic variables.
RESULTS: The mean OHIP‑14‑H score was 9.57 (S.D = 4.58). ICC and Cronbach’s alpha
for OHIP‑14‑H was 0.96 and 0.92 respectively. Concurrent validity using binomial regression
model indicated that good (OR = 0.56, 95% CI = 0.55 – 4.47) and moderate (OR = 0.25, 95%
CI = 0.17 – 1.87) OHIP‑14‑H scores were negative but significant risk indicators of poor self reported
oral health (P < 0.009). Significant predictive validity was observed between OHIP‑14‑H scores and
clinical parameters (P < 0.000).
CONCLUSION: Translated and culturally adapted OHIP‑14‑H indicates good reliability and validity
among primary school teachers.

Abstract INTRODUCTION: Primary dysmenorrhea without pelvic pathology is one of the most common
complaints in women’s medicine. Primary dysmenorrhea can affect the quality of life of women. Aerobic
exercise is one of the ways to reduce the severity of primary dysmenorrhea. The present study aimed
to determine the effect of 8 weeks of aerobic exercise on the severity of primary dysmenorrhea.
METHODS: This is a clinical trial study performed on 70 students with primary dysmenorrhea in
dormitories of Mashhad University of Medical Sciences in 2015. Participants were randomly assigned
to intervention and control groups. The instrument was a visual pain questionnaire completed by the
two groups in the first 3 days of the menstrual cycle. The exercise protocol included aerobic exercise,
which performed the intervention group for 8 weeks, three times a week, and each time for 30 min.
Data were analyzed by Fisher and Chi‑square tests.
RESULTS: The control and intervention groups were homogeneous in terms of demographic
characteristics. Results showed that the severity of primary dysmenorrhea at the beginning of the study
was not significantly correlated with the two groups. At the end of the 4 weeks after the intervention,
the intervention group did not show any significant changes in the control group (P = 0.423) but At
the end of 8 weeks after the study, the intervention group showed significant changes compared to
the control group (P = 0.041).
CONCLUSION: The results of this study showed that performing aerobic exercise can improve
primary dysmenorrhea. Therefore, aerobic exercise can be used to treat primary dysmenorrhea.

Abstract BACKGROUND: Humanism is a central tenant of professionalism, a required competency for all
residency programs. Yet, few residencies have formal curriculum for teaching this critical aspect of
medicine. Instead, professionalism and humanism are often taught informally through role‑modeling.
With increased burnout, faculty professionalism may suffer and may compromise resident
role‑modeling. The objective of this study was to design a pilot curriculum to foster humanism in
among residents and assess its ability to do so.
MATERIALS AND METHODS: Two‑phase exploratory sequential mixed methods study. Phase
1: a qualitative analysis of residents’ narratives regarding challenges to humanistic behavior, and
identified themes of compassion, fatigue, communication challenges, and work‑life balance. Themes
used as needs assessment to build curriculum. Phase 2: three sessions with themes taken from
faculty development course. Participants and controls completed baseline and 60‑day follow‑up
questionnaires assessing burnout, compassion, satisfaction, and ability to practice psychological
medicine. Phase one included Obstetrics/Gynecology and internal medicine residents. Phase two
included residents from the above programs, who attended at least 2/3 interactive sessions designed
to address the themes identified above.
RESULTS: Twelve participants began and ten completed curriculum (83%). The curriculum met
course objectives and was well‑received (4.8/5). Burnout decreased (−3.1 vs. 2.5, P = 0.048). A trend
toward improved compassion (4.4 vs.−0.6, P = 0.096) for participants compared to controls was noted.
CONCLUSION: A pilot humanism curriculum for residents was well‑received. Participants showed
decreased burnout and trended to improved compassion scores. Development and evaluation of an
expanded curriculum would further explore feasibility and effectiveness of the intervention.

Abstract Abstract:
BACKGROUND: Identifying nursing students’ plan after graduation is necessary to maintain the
profession in line with their nursing education. This study was conducted to explore the career plans
of diploma nursing students after graduation and factors influencing their plans.
MATERIALS AND METHODS: This was a qualitative descriptive study using focus group discussion,
conducted in Academy of Nursing of Belitung, Indonesia. Twenty diploma nursing students at the
beginning of their 1st year of study were recruited. Data were analyzed using content analysis model.
RESULTS: The plan of diploma nursing students after graduation: becoming a civil servant and its
influencing factors (fixed and higher salary, fair remuneration and incentives, and retirement fund);
becoming a bedside nurse and its influencing factors (helping others and gaining experiences); and
continuing higher education in nursing and its influencing factors (recognition as professional nurse,
financial support, family responsibilities, and location of nursing schools).
CONCLUSION: It is suggested that nurse educators should change the mindset of the students not
to focus only becoming a civil servant, and the government should open bachelor program in nursing
in Belitung and provide educational support for those who would like to continue studying nursing.