Journal of Education and Health Promotion

Abstract AIM AND BACKGROUND: Mental health and empowerment are two of the women’s essential
needs. These two related concepts play an important role in women’s lives. Therefore, this study
aimed to investigate empowerment of women and its relation with mental health problem prevention
during difficult situations.
METHODS: This qualitative study was conducted through semi‑structured interviews with 33 experts
in the fields of psychology, social sciences, women studies, medicine and crisis management
specialists using snowball sampling in cities of Tehran, Isfahan, Tabriz, and Mashhad during the year
1395 (March 2016–March 2017). Samples were selected heterogeneously. The interview transcripts
and codes were presented to the participants, and structural analysis was used for data evaluation.
RESULTS: The factors related to empowerment of women with consideration to their mental health
were determined based on Longew theory and interviews and include: welfare (primary needs
(biological and security) and developmental needs (social needs and dignity), access (facilities and
values), knowledge (about inequalities and rights), participation (in politics, decision‑making and
society), and control (implementation and institutionalization of the above‑mentioned needs).
CONCLUSIONS: The indicators determined in this study show that empowerment has an important
role in determining women’s real position in society. Since women make up half of the population and
affect society as a whole, the advantages of empowerment of women will be felt in the entire society.

Abstract OBJECTIVES: The objective of this study was designed to investigate medical students’ perceptions
of small group teaching effectiveness in a hybrid curriculum.
MATERIALS AND METHODS: A cross‑sectional, descriptive survey was conducted at the School
of Medicine, The University of the West Indies, St. Augustine where we collected the data from
195 undergraduate students. A self‑administered questionnaire consisting of 25 items was used to
measure students’ perception on the effectiveness of problem‑based learning (PBL) with regard to
learning experience, teamwork, confidence, communication skills, and role of the tutor. Statistical
analyses included mean and standard deviation for the description of each item; t‑test to compare
the mean scores for gender and class year, and one‑way analysis of variance between groups for
age group comparisons.
RESULTS: The students overall perceptions of small group teaching effectiveness showed that the
PBL sessions were beneficial to their learning process (mean: 3.63 ± 0.46). Students have positive
perceptions toward small group effectiveness, particularly in learning experience (mean: 3.98 ± 0.63)
and teamwork (mean: 3.67 ± 0.58). The mean scores, measuring teamwork, for 2nd year students was
significantly higher than that for 1st year students (3.76 ± 0.55 and 3.55 ± 0.60 respectively, P = 013).
A similar significant trend was observed between 2nd year and 1st year students on communication
skills (3.48 ± 0.67 and 3.29 ± 0.55, respectively, P = 0.046).
CONCLUSIONS: PBL is an effective small group teaching method for medical students. Faculty
development and students’ training programs are required before implementing PBL.

Abstract INTRODUCTION: Recently, medical education has made significant progress, and medical teachers
are trying to find methods that have most impressive effects on learning. One of the useful learning
methods is student active participation. One of the helpful teaching aids in this method is mobile
technology. The present study aimed to determine the effect of sending educational questions through
short message service (SMS) on academic achievement and satisfaction of medical students and
compare that with lecture teaching.
SUBJECTS AND METHODS: In an semi‑experimental, two chapters of urology reference book,
Smiths General Urology 17th edition, were taught to 47 medical students of Isfahan University of
Medical Sciences in urology course in 2013 academic year. Kidney tumors chapter was educated
by sending questions through SMS, and bladder tumors part was taught in a lecture session. For
each method, pretest and posttest were held, each consisting of thirty multiple choice questions.
To examine the knowledge retention, a test session was held on the same terms for each chapter,
1 month later. At the end, survey forms were distributed to assess student’s satisfaction with SMS
learning method. Data were analyzed through using SPSS 20.
RESULTS: The findings demonstrated a statistically significant difference between the two learning
methods in the medication test scores. Evaluation of the satisfaction showed 78.72% of participants
were not satisfied.
CONCLUSIONS: The results of the study showed that distance learning through SMS in medical
students could lead to increase knowledge, however, it was not effective on their satisfaction.

Abstract BACKGROUND: Capacity constraints on implementation research among policymakers and
researchers are a major challenge to the evidence to policy link. This study was designed to bring
together senior policymakers and researchers in Nigeria to consider issues around research‑to‑policy
interface and enhance their capacity on implementation research.
METHODS: The design was a cross‑sectional study. A 3‑day joint implementation research workshop
was held for policymakers and researchers using World Health Organization/TDR Implementation
Research Toolkit. Assessment of participants’ capacity for evidence‑informed policymaking and
knowledge on implementation research was done using a 5‑point Likert scale questionnaire.
A postworkshop key informant interview was also conducted.
RESULTS: A total of 20 researchers and 15 policymakers participated in the study. The
interaction/partnership between policymakers and researchers was generally rare in terms of
priority‑setting process, involvement as coinvestigators, and executing strategies to support
policymakers’ use of research findings. The mean ratings (MNRs) recorded mostly ranged
from 1.80 to 1.89 on the 5‑point scale. Researchers were rarely involved in the generation of
policy‑relevant research that satisfies policymakers’ needs with MNR very low at 1.74. The
MNRs for capacity to acquire, assess, and adapt research were generally considerably higher
among researchers (3.16–3.82) than policymakers (2.27–3.20). There was a general consensus
that the training tremendously improved participants’ understanding and use of implementation
research.
CONCLUSION: Policymakers and researchers are increasingly recognizing their need to work with
each other in the interest of the health systems. There is a need to create more capacity enhancement
platforms that will facilitate the interface between them.

Abstract BACKGROUND: The content of the mass media is a suitable tool for making changes to the society.
One of the most read news in the mass media is nutritional information. The goal of this study is to
assess the scientific authenticity of such information published in Iranian popular magazines.
MATERIALS AND METHODS: This study is a qualitative study (content analysis) and uses
bibliographic approach. A researcher‑designed checklist is used as data gathering tool, and the
statistical population included the messages obtained from the printed material in 173 volumes
of 8 Iranian popular magazines. 10 most frequent messages were identified, and their scientific
authenticity was investigated using Pubmed and IranMedex databases. The SPSS Software
version 24 (IBM Corporation, Armonk, New York, USA) was applied in the analysis of this work.
RESULTS: The findings indicated that preventive trends had the highest (86.8%) and the treatments
had the lowest (4.2%) frequency. Concerning the type of cancer, more than half (51.2%) of the
conclusions were about cancer. Regarding authorship, 68% of articles were author signed, but the
profession of 66.4% of the authors was not clear. Regarding references, only 25.4% of the articles
had validated references.
CONCLUSION: It is revealed that 70% of the “nutrition information” related to cancer which was
published in the popular magazines during 2012, considered to be acceptable according to scientific
medical information sources. Although in some cases, the amount of evidence is not sufficient.
Finally, it could be deduced that the nutrition information published in the Iranian popular magazines
are still credible.

Abstract OBJECTIVE: The objective of the study was to obtain data on prevalence and severity of dental
erosion among acid industry workers in Baddi (Himachal Pradesh).
MATERIALS AND METHODS: A cross‑sectional study was conducted among 800 battery industry
workers. The demographic details were recorded on a prestructured pro forma. Type III examination
was done. Dental erosion was recorded based on the index given by Bardsley (simplified scoring
criteria for tooth wear index). Appropriate statistical tests were used to interpret the data.
RESULTS: The prevalence of dental erosion was found to be 48.6%. Prevalence increased with
the duration of employment. Dental erosion was most commonly found in the labial surfaces of
maxillary anterior teeth.
CONCLUSION: Erosion is a condition which is multifactorial and becomes more aggravating in the
presence of acidic environment. Therefore, the workers working in such conditions should be more
careful, and mandatory policies should also be followed by such industries to maintain the overall
health of the workers.

Abstract BACKGROUND: Consuming fish plays a key role in human health and prevention of diseases. The
aim of this study was using transtheoretical model to analyze the trend of fish consumption among
women.
MATERIALS AND METHODS: In this descriptive‑analytic research, 383 housewives who referred
to health centers in Bandar Abbas were selected through a stratified sampling method. Data were
collected by a questionnaire to determine fish consumption based on transtheoretical model and
analyzed by using SPSS software version 19.0. with the significance level of P < 0.05.
RESULTS: Nearly 11.7% of the patients were found to be at the precontemplation stage; 3.9% were
at the contemplation stage; 13.6% were at the preparation stage; 7.3% showed to be at the action
stage, and 63.4% were at the maintenance stage. The results showed a significant relation of the
constructs of the model with the stages of change of consuming one or two meals of fish a week.
Moving through the stages of change from the precontemplation stage to maintenance stage was
accompanied by an increase in decisional balance, self‑efficacy, and processes of change (P < 0.05).
CONCLUSION: It is suggested that in designing educational interventions in the light of this model,
more emphasis is placed on perceived benefits and self‑efficacy. The processes of change are
advised to be used more often, and perceived barriers to fish consumption need to be reduced as
far as possible.

Abstract INTRODUCTION: Barriers to medication adherence in patients with hypertension can have significant
differences that made researchers confute to conclude that medication adherence is required to
be more explored, and then, beneficial interventions develop to decrease these barriers. Thus, the
current study was aimed to identify barriers to adherence in Iranian society.
MATERIALS AND METHODS: A qualitative content analysis was carried out. Participants were as
follow: Patients with hypertension who had clinic records in the health centers of Isfahan University of
Medical Science. Purposive sampling method was conducted and continued until data saturation, as
well. Semi‑structured interview was selected as the best‑qualified technique to select data. Data were
analyzed using qualitative content, constant comparative analysis, and MAXQDA (Ver 10) software.
RESULTS: After study and separation of basic concepts, 1620 basic codes were extracted from
interviews. Classes were made based on codes and after multiple reviews, summarizing as well
as similarity. Primary themes were identified using more explorations and comparison of classes.
Based on the nature, the conceptual themes were named. These themes include (1) environmental
challenges of life, (2) incompatibility of patients; (3) forget to take medicine, and (4) inefficient
recommendations of family.
CONCLUSION: Findings revealed that barriers to patient adherence to the treatment had four
dimensions that may be likely useful for managers and planners in the health field to plan and intervene
regarding medication adherence as the most critical preventing factor for patients with hypertension.

Abstract CONTEXT: Scientific research not only promotes health and combats diseases of an individual,
but also it can strengthen the effectiveness of health systems. Hence, understanding of scientific
methods becomes a crucial component in the medical profession.
AIMS: This study was conducted to assess the knowledge, attitudes, and barriers toward research
among undergraduate medical and dental students.
SETTINGS AND DESIGN: This cross‑sectional study was conducted among 295 undergraduate
Bachelor of Medicine and Bachelor of Surgery (MBBS) and Bachelor of Dental Surgery (BDS)
students from a private medical college in Malaysia.
MATERIALS AND METHODS: We purposively selected 360 students attending the 3rd, 4th, and
5th year in MBBS course and BDS course in September 2015. A total of 295 students who were
willing to provide written informed consent were included in this study. We collected data using a
validated, self‑administered, structured questionnaire which included 20 questions about knowledge
toward scientific research, 21 attitude items in regard to scientific research, a list of 10 barriers toward
conducting medical research, and 5 questions of confidence to conduct the medical research.
STATISTICAL ANALYSIS USED: Data were analyzed using descriptive statistics, independent
t‑test, ANOVA, and multiple linear regression.
RESULTS: Among the students, 56.9% had moderate knowledge while the majority (83.3%) had
moderate attitude toward scientific research. The majorly cited barriers were the lack of time (79.9%),
lack of knowledge and skills (72.1%), lack of funding (72.0%) and facilities (63.6%), and lack of
rewards (55.8%). There was a significant association between age, academic year, and knowledge
of research as the older age group, and 4th‑ and 5th‑year students had higher knowledge score. The
students of higher attitude score had better‑perceived barriers score toward research with regression
coefficient 0.095 (95% confidence interval 0.032–0.159).
CONCLUSIONS: Even though the students had the positive attitudes toward scientific research, a
supportive and positive environment is needed to improve skills and knowledge of research and to
overcome the barriers toward the conduct of scientific research.

Abstract BACKGROUND: The first step toward organizing research activities is to obtain a correct perception
of available capabilities. This study was conducted to investigate the researchers’ views about barriers
affecting research activities.
METHODS: This descriptive, cross‑sectional study was conducted using the census method. The
population consisted of the faculty members of Birjand University of Medical Sciences in 2014. The
research tool was a questionnaire in six areas of financial, facility, professional, scientific, personal,
and organizational– managerial barriers. The results were analyzed using descriptive statistics and
Friedman test.
RESULTS: Faculty members confirmed that although all barriers affected research activities,
organizational–managerial barriers (3.73 ± 0.63) had the greatest and scientific barriers (3.15 ± 0.93)
had the lowest effect, respectively. The results of Friedman test showed that there is a significant
difference between the mean values of factors related to various barriers affecting research activities
from the viewpoint of the participants’ answers.
CONCLUSIONS: Research activities are affected by numerous barriers. Strategies, such as
empowering researchers, employing new technologies in the creation of research teams, and
benefiting from research experts in various stages of research, may have a positive effect on the
removal of the barriers.

Abstract BACKGROUND: Although there is advancement in the health‑care system, the rates of
hospital‑acquired infections (HAIs) are still high. Poor hand hygiene (HH) among healthcare workers
(HCWs) is identified as one of the major causes of HAIs.
AIMS: The aim and objective of this study is to assess the awareness and attitude regarding hand
hygiene (HH) among HCWs in a superspecialty hospital in Ghaziabad, Uttar Pradesh, India.
SETTINGS AND DESIGN: A cross‑sectional, semi‑structured, questionnaire‑based study was carried
out in a superspecialty hospital, Uttar Pradesh, India. Questionnaires were distributed on the training
session of HH organized in the eve of World HH Day on May 5th, 2016.
SUBJECTS AND METHODS: A total 104 questionnaires were distributed among various HCWs.
Each questionnaire was composed of 14 questions to test the awareness and attitude regarding
HH. Awareness regarding HH among HCWs was graded as excellent (>80% correct response),
satisfactory (80%–50%), and unsatisfactory (<50%). Attitude was graded on the basis of their
response: excellent (strongly agree), satisfactory (agree), and unsatisfactory (other response).
RESULTS: Awareness was found to be unsatisfactory regarding the most frequent source of germs
in hospital setting (39.42%) and effective time of proper hand rub (42.30%). Lack of awareness
regarding adequate time of hand wash among doctors (85.71%) was an important issue.

Abstract CONTEXT: Individuals with social well‑being can cope more successfully with major problems of
social roles. Due to the social nature of human life, it cannot be ignored to pay attention the social
aspect of health.
AIMS: The purpose of this study was to identify variables that predict the social well‑being of medical
students.
SETTINGS AND DESIGN: A descriptive‑analytical study was conducted on 489 medical science
students of Gilan Province, the North of Iran, during May to September 2016.
SUBJECTS AND METHODS: The samples were selected using quota sampling method. Research
instrument was a questionnaire consisting of two parts: demographic section and Keyes social
well‑being questionnaire.
STATISTICAL ANALYSIS USED: Data analysis was done using SPSS software version 19 and
with descriptive and inferential statistics (t‑test, ANOVA, and linear regression).
RESULTS: The results showed that majority of the students had average social well‑being.
Furthermore, a significant relationship between the academic degree (P = 0.009),
major (P = 0.0001), the interest and field’s satisfaction (P = 0.0001), and social well‑being was
seen. The results of linear regression model showed that four variables (academic degree, major,
group membership, and the interest and field’s satisfaction) were significantly associated with
the social well‑being (P < 0.05).
CONCLUSIONS: The findings demonstrate that the different effects of the demographic factors on
social well‑being and the need for further consideration of these factors are obvious. Thus, health
and education authorities are advised to pay attention students’ academic degree, major, group
membership, and the interest and field’s satisfaction to upgrade and maintain the level of their social
well‑being.

Abstract AIM: This study aims to assess the association of sugary foods and drinks consumption with behavioral
risk and oral health status of 12‑ and 15‑year‑old government school children in Udaipur.
MATERIALS AND METHODS: A descriptive cross‑sectional study was conducted among of
12‑ and 15‑year‑old government schoolchildren of Udaipur. A survey pro forma designed based on
HBSC (Health behaviour in School‑aged Children) study protocol and WHO Oral Health Assessment
Form for Children (2013) was used. Chi‑Square test, Independent Sample t‑test, and Multinomial
Logistic Regression analysis were used with 95% confidence interval and 5% significance level.
RESULTS: Out of 710 participants, 455 (64.1%) were males and 255 females (35.9%). Majority of
15 years age (57.3%) consumed more soft drinks than 12‑year‑old. Males showed a comparatively
greater tendency to have sugar sweetened products than females. The decayed, missing, and filled
teeth (dmft) and DMFT scores were relatively higher for subjects who consumed sugary substances
more than once/day than who had less than once/day. Gingivitis was associated with high sugar diet.
CONCLUSION: Sugary foods and drinks consumption is significantly associated with behavioral
habits of children and is a clear behavioral risk for oral health.

Abstract BACKGROUND AND AIMS: The advent of social networking sites has facilitated the dissemination
of scientific research. This article aims to investigate the presence of Iranian highly cited clinicians
in social networking sites.
MATERIALS AND METHODS: This is a scientometrics study. Essential Science Indicator (ESI)
was searched for Iranian highly cited papers in clinical medicine during November–December 2015.
Then, the authors of the papers were checked and a list of authors was obtained. In the second
phase, the authors’ names were searched in the selected social networking sites (ResearchGate
[RG], Academia, Mendeley, LinkedIn). The total citations and h‑index in Scopus were also gathered.
RESULTS: Fifty‑five highly cited papers were retrieved. A total of 107 authors participated in writing
these papers. RG was the most popular (64.5%) and LinkedIn and Academia were in 2nd and
3rd places. None of the authors of highly cited papers were subscribed to Mendeley. A positive direct
relationship was observed between visibility at social networking sites with citation and h‑index rate.
A significant relationship was observed between the RG score, citations, reads indicators in RG, and
citation numbers and there was a significant relationship between the number of document indicator
in Academia and the citation numbers.
CONCLUSION: It seems putting the papers in social networking sites can influence the citation
rate. We recommend all scientists to be present at social networking sites to have better chance of
visibility and also citation.

Abstract Recent interest in the social determinants of health (SDOH) and the effects of neighborhood
contexts on individual health and well‑being has grown exponentially. In this brief communication,
we describe recent developments in both analytical perspectives and methods that have opened up
new opportunities for researchers interested in exploring neighborhoods and health research within
a SDOH framework. We focus specifically on recent advances in geographic information science,
statistical methods, and spatial analytical tools. We close with a discussion of how these recent
developments have the potential to enhance SDOH research in Iran.