Journal of Education and Health Promotion

Abstract BACKGROUND: Respiratory diseases are a major cause of mortality and morbidity worldwide.
A sound knowledge of management of respiratory diseases is thus very vital. The clinical exposure
of undergraduate medical students is limited to 2 weeks in pulmonary medicine. We hypothesized
that the short duration of posting can be best utilized by developing need‑based modules for bedside
teaching.
AIMS: This study aimed to determine gain in knowledge and skills of final‑year medical students
in diagnosis and management of common pulmonary diseases and assess students’ perception of
the module.
METHODS: A one‑group pretest‑posttest quasi‑experimental study design enrolled a convenience
sample of 48 final‑year medical students. Twenty‑four students were posted at a given time for the
bedside clinical posting in pulmonary medicine between August 2013 and November 2013. These
students were divided randomly into two groups of 12 students each. All students consented to be
part of the study. Two trained faculty taught in rotation. The bedside teaching module was prepared
by Delphi technique and curriculum was based on Kern’s six‑step approach. History taking, physical
examination, tuberculosis, chronic obstructive pulmonary disease, asthma, lung cancer, chest X‑rays,
and spirometry were taught. Students were administered pre‑ and post‑test questionnaires to assess
knowledge, while Objective Structured Clinical Examination assessed skills. Students’ feedback
questionnaire evaluated the teaching module. A two‑tailed paired sample t‑test assessed mean gain
in knowledge and skills. Effect size was calculated by Cohen’s d, while Cronbach’s alpha estimated
the reliability testing of perception questionnaire. Statistical analysis was performed using statistical
software package IBM SPSS version 23.
RESULTS: Mean pre‑ and posttest knowledge scores were 12.46 (8.09) and 43.17 (10.7),
respectively, P = 0.001. Mean pre‑ and posttest skills scores were 7.00 (4.76) and 24.79 (3.31),
respectively, P = 0.001, and Cohen’s d showed large effect size. Most students stated that the
module enhanced their clinical skills, helped to understand difficult material, and promoted inquiry
and thinking. Cronbach’s alpha for perception questionnaire was 0.854.
CONCLUSIONS: Structured bedside teaching module in pulmonary medicine improved the knowledge
and skills of undergraduate medical students. The contents and various teaching methodologies
were evaluated positively.

Abstract BACKGROUND: To provide quality care to the patient’s perspective and patient satisfaction are
two major multidimensional concepts. In India, patient satisfaction with dental services has received
only minor attention as the importance of the teeth is always neglected.
OBJECTIVE: To assess the satisfaction level among patients toward dental treatment rendered at
an academic institution.
MATERIALS AND METHODS: A cross‑sectional study was conducted among 474 voluntary camp
patients visiting Department of Public Health Dentistry, Swami Devi Dyal Hospital and Dental College,
Barwala, using a 14‑item closed ended questionnaire which included demographic details, attitude,
and practices of the participants and their satisfaction level to the treatment rendered to them was
graded as highly satisfied, satisfied, and not satisfied. The data were analyzed using SPSS version 18
which covered both descriptive and inferential statistics.
RESULTS: Curative and preventive treatment was mostly required in younger age groups whereas
extraction and prosthetic rehabilitation were found to be present in older age groups. Lack of
education and awareness was the most common reason behind not seeking treatment. Majority of the
participants were satisfied with the treatment rendered and were found to be statistically significant
with visiting and referrals (P < 0.01).
CONCLUSION: Imparting proper and appropriate information regarding the dental treatment will
definitely change the attitude of the patients, thus help in raising the satisfaction levels.

Abstract BACKGROUND: People with physical disability are vulnerable in disasters because of their mobility
limitations. They are unable to escape from hazards and their needs have been somewhat neglected
in planning and relief measures.
AIM: This study aimed to identify the mobility needs of people with physical disability during
earthquakes across different provinces of Iran.
MATERIALS AND METHODS: A qualitative study was conducted using 18 semi‑structured interviews
with participants who had a kind of mobility disability. The participants, across six provinces of Iran
who had experienced an earthquake, were selected by purposive sampling in two ways of snowballing
and maximum variation in 2017. Data were analyzed thematically assisted by MAXQDA 10 software.
RESULTS: The mobility needs included house and workplace adaptation, spare assistive devices,
easy access to vehicles, special facilities for emergency evacuation, adaptation and accessibility of
shelters, adapted bathroom and toilet, and transferring by others.
CONCLUSION: By considering needs and experiences of people with physical disability in disaster
planning, appropriate interventions can be arranged to promote the level of response in disasters.
Such measures can have a significant role in maintaining the lives and health of such people.

Abstract INTRODUCTION: Simultaneously along with information technology progress, knowledge
has considered as a fundamental base for economic growth for the time being. In today’s
knowledge‑based economy, production and exploitation of knowledge play the main roles in the
process of wealth creation. The current revolution in information technology has given new light to
the importance of knowledge such that it has now become the base of economy in today’s world.
In today’s knowledge‑based economy, production and exploitation of knowledge play the main
roles in the process of wealth creation. Considering key contributions of knowledge management in
competitiveness of organizations and their entry into global arenas, this study sought to evaluate the
impact of different aspects of intellectual property on innovations in computer and health information
system (HIS) units at selected medical center in the city of Isfahan during 2015.
OBJECTIVES: The present study seeks to evaluate the impact of different aspects of intellectual
property on innovations in computer and HIS units at selected medical centers in the city of Isfahan
during 2015 (2015).
SETTINGS AND DESIGN: Population of this research includes staff working in computer and HIS units
of 10 medical centers. Data were collected using a questionnaire made by the researcher. A written
questionnaire (also referred to as self‑administered questionnaire) is a data collection tool in which
written questions are presented that are to be answered by study individuals, where for the case of
the present study include staff members working at computer and HIS units of 10 medical centers.
MATERIALS AND METHODS: In the first stage, medical factors were determined by experts of
Isfahan University of Medical Sciences as intellectual property. Factors were then distributed randomly
among 100 employees during a survey, after considering their validity and reliability.
STATISTICAL ANALYSIS: Descriptive and inferential statistics were used for data analysis.
RESULTS: Data analysis showed that innovation is one of the most important indicators of intellectual
capital in computer and HIS units of medical centers and has a higher than average importance.
CONCLUSIONS: The results of this study, in addition to providing guidelines in the management of
intellectual capital in Isfahan province hospitals, can be used as a model for improving innovation in
hospitals and understanding various factors affecting organizational innovation.

Abstract

Abstract INTRODUCTION: Beta‑thalassemia is the most severe form of thalassemia major in which where
the person needs regular blood transfusions and medical cares. The genetic experiment of prenatal
diagnosis (PND) has been effective in the diagnosis of fetus with thalassemia major. This study
was aimed to evaluate educational interventions on perceived susceptibility, perceived severity,
perceived benefits, perceived barriers, cues to action and self‑efficacy in beta‑thalassemia carriers
and suspected couples on doing a PND genetic test in Andimeshk.
MATERIALS AND METHODS: In this quasi‑experimental study, 224 beta‑thalassemia carriers
and suspected couples were randomly assigned to intervention and control groups. The data were
collected using a researcher‑made validated questionnaire using the self‑administrated method.
Before the intervention, questionnaires for both groups were completed, and then, an educational
intervention was done for the intervention group during a month in four sessions for 30 min. After
2 months, the questionnaire was completed again by both groups. Data were analyzed using SPSS
software version 20.
RESULTS: There was no significant difference in the mean score of health belief model (HBM)
variables and behavior between intervention and control groups before intervention (P < 0.05).
However, after the educational intervention, the significant statistical difference in the mean score
of perceived sensitivity, perceived severity, perceived benefits, perceived barriers, guidance for
action, self‑efficacy, and behavior of PND β‑thalassemia genetic tests was observed between the
intervention and control groups. (P < 0.001).
CONCLUSION: Educational programs based on HBM can increase HBM constructs, behavior, and
self‑efficacy of beta‑thalassemia carrier couples for doing beta‑thalassemia PND.

Abstract BACKGROUND/AIM: Today, the problem of obesity is a chronic condition that affects all age groups
in developed and developing countries. Since adolescence is a transitional period and behavioral
patterns formed in this period affect people in their adult years, attention to obesity and extra weight
in this age group is more important than other groups. Therefore, this study aims to investigate the
effects of nutrition education course on awareness of female 1st‑year high school students of Isfahan
based on transtheoretical model ( TTM) of behavioral change.
MATERIALS AND METHODS: In this semi‑empirical study, 64 female 1st‑year high school students
with weight problem were selected using nonpercent stratified sampling and divided into two control
and test groups. Data gathering was carried out using researcher‑made nutrition awareness and
stages of change questionnaire whose validity and reliability was confirmed. Participants in the
test group participated in a 2‑month education with sessions every 2 weeks and received one
brochure and 3 educational massages each week. Data were analyzed using independent t‑test
and Mann–Whitney test.
RESULTS: The results showed that the average nutrition awareness score of students in test group
was significantly higher than control group after intervention. Students in test group were also in
higher stages of change compared to control group after intervention.
CONCLUSION: The results show that TTM was effective in changing nutritional behavior in students.

Abstract BACKGROUND: Substance abuse and mental disorder often coexist and may cause several
consequences in sociooccupational functioning and health care and management. Indian data are
sparse in this area.
OBJECTIVES: The aim of the study was to examine the sociodemographic profile, pattern, and
prevalence of alcohol and substance use among person suffering with mental illness and to compare
with those without mental illness.
METHODS: A total of 80 treatment‑seeking patients with mental illness and 80 nontreatment seeking
healthy accompanying persons were assessed for current substance use. Mental illness was screened
using Structured Clinical Interview for DSM‑IV Axis I Disorders and the diagnosis was made as per
DSM IV, semi‑structured sociodemographic pro forma was also applied. The data collected were
analyzed using the Chi‑square and Student’s t‑test.
RESULTS: Substance use was found 2.5 times higher among cases (56.2%) than controls (22.5%).
Substance‑using participants comprised mainly males belonging to rural residence. The substance
using cases were more unmarried, less educated, poorer economically, and more nuclear family
structures that substance‑using controls. When compared with non‑substance using cases, cases
with substance use had more males than females and lower education. Although both groups were
almost similar in term of marital status, family structure, residence, and socioeconomic status.
Among both groups, most common substance use was tobacco, followed by alcohol and cannabis.
Although all the substances were more prevalent among cases than controls. The prevalence of
any substance use was highest among cases with psychotic disorder (77.3%), followed by unipolar
depression (62.5%), bipolar affective disorder (41.7%), and anxiety disorders (21.4%). Tobacco and
cannabis use was most prevalent among cases suffering with psychotic disorders, whereas alcohol
use was most prevalent among cases suffering with unipolar depression.
CONCLUSIONS: Mentally ill individuals are vulnerable to develop substance use, thus they are doubly
jeopardized. The susceptibility of these individuals stem from lesser insight, need for stimulation, to
decrease the anhedonia induced by psychoactive medicines and poor awareness hence this group
of individuals has several health and social consequences; therefore, they require due attention.
A better care, support, and education are needed for substance using patients with mental illness
to improve their prognosis and also help in their appropriate rehabilitation.

Abstract INTRODUCTION: Patients undergoing hemodialysis have a low level of health and mindfulness
technique in mind‑body medicine is used to help patients with chronic illness. Therefore, this clinical
trial was conducted to determine the effect of the mindfulness program on the general health of
patients undergoing treatment with hemodialysis.
METHODS: Sixty hemodialysis patients were selected through the convenient method and randomly
divided into experimental and control groups. Both groups completed demographic information
questionnaire and general health questionnaire. Then, the experimental group received 8 sessions of
mindfulness training and the control group received 8 sessions of education in relation to end‑stage renal
disease and hemodialysis. Educational sessions were performed for both groups in the second 30 min
after hemodialysis for 1 h in six individual sessions and two 1.5 h group sessions. Immediately after
and 1 month after the intervention, the General Health Questionnaire was completed by both groups.
RESULTS: Analysis of the findings showed no significant differences between the mean score
of general health disorder and its subscales before the intervention in to two groups (P > 0.05).
Nevertheless, after intervention in the experimental group, the mean of general health disorder score
decreased from 44.17 ± 12.32 to 21.9 ± 6.4 and 1 month after the intervention, the mean score
of this score was 23.6 ± 6.2. The mean score of physical symptoms, anxiety and sleep disorder,
social functioning deficiency, and depression were also significantly lower in the experimental group
immediately after intervention and 1 month after the intervention; however, there were no significant
differences between the mean of this score immediately and 1 month after the intervention. In addition,
the mean score of general health disorder changes immediately and 1 month after the intervention
in the experimental group was significantly more than the control group. In the control group, there
was no significant difference between the mean score of general health disorder and its subscales
before, immediately, and 1 month after the intervention (P > 0.05).
CONCLUSIONS: The results of this research showed that mindfulness has been effective in reducing
physical and anxiety symptoms, sleep disorder, social dysfunction, and depression symptoms.
Therefore, the use of mindfulness as a complementary treatment can improve the general health
level in these patients.

Abstract INTRODUCTION: Posttraumatic stress disorder is an anxiety disorder that occurs after exposure
to an event that causes injury or threat. The prevalence of preeclampsia was reported to be 28%.
Considering the significant role of spiritual care in physical and psychological outcomes of patients,
this study was conducted to determine “the effect of spiritual care education on postpartum stress
disorder in women with preeclampsia”.
MATERIALS AND METHODS: In this randomized clinical trial, 72 pregnant women (36 in each group)
were selected in a convenient way between the ages of 34 and 38 weeks who had preeclampsia and
admitted to two public hospitals in Mashhad. The questionnaires such as Duke University Religion
Index, DASS 21, the Posttraumatic Stress Disorder Checklist (PCL), and  Prenatal Posttraumatic
Stress Questionnaire (PPQ) were used at the beginning in two groups. In the intervention group, first,
women were educated each day based on Richards and Bergin’s pattern, in three sessions, which
lasted 45–60 min. The control group also received routine cares. All units completed questionnaires
such as Prenatal Posttraumatic Stress Questionnaire (PPQ) at the 4th–6th postpartum period. Results
were analyzed by independent t‑test, Mann–Whitney test, Chi‑square test, and SPSS version 16.
RESULTS: The mean change score of postpartum stress disorder in the intervention and control
groups was different after intervention (P = 0.001).
CONCLUSION: Providing spiritual care to pregnant mothers with preeclampsia reduces their risk
of postpartum stress disorder. Therefore, this kind of care as an effective intervention is included in
the routine care of this group with high‑risk pregnancies.

Abstract CONTEXT: The World Health Organization (WHO) has emphasized the need for reorientation of
hospitals toward health promotion (HP).
AIMS: This study explores health‑care professionals’ perception of barriers and strategies to
implementing HP in educational hospitals of Isfahan Province in Iran.
SETTINGS AND DESIGN: The study settings included four selective educational hospitals and the
Treatment Administration affiliation to the Isfahan University of Medical Sciences.
SUBJECTS AND METHODS: A qualitative content analysis approach was employed in this study,
with semi‑structured in‑depth interviews. Eighteen participants from hospital and accreditation
managers, nurses, community medicine specialist, and directors of health‑care quality improvement
and accreditation participated in the study by purposeful sampling method. The data were analyzed
using content analysis method.
RESULTS: The barriers can be categorized into the following areas: (1) barriers associated with
patient and community, (2) barriers associated with health‑care professionals, (3) barriers associated
with the organization, and (4) external environment barriers. The results were summarized into four
categories as strategies, including: (1) marketing the plan, (2) identifying key people and training, (3)
phasing activities and development of feasible goals, and (4) development of strategic goals of health
promoting hospitals and supportive policies.
CONCLUSIONS: The interactions of individual, organizational, and external environmental factors
were identified as barriers to implementation of HP in hospitals. To hospital reorientation toward HP,
prioritizing the barriers, and using the proposed strategies may be helpful.

Abstract BACKGROUND: Infection control has become a major concern in the health‑care system and
health‑care workers, particularly nurses are at high risk of infection. This study, therefore, examined
the effect of a training program on attitude and practice of infection control among nurses in two
tertiary hospitals in Ogun State, Nigeria.
MATERIALS AND METHODS: This study adopted a pretest–posttest quasi‑experimental design.
The sample consisted of 87 participants. The experimental group consisted of 42 registered
nurses from Babcock University Teaching Hospital, Ogun state, Nigeria, while the control group
consisted of 45 registered nurses from Olabisi Onabanjo University Teaching Hospital, Sagamu,
Nigeria. The instrument for data collection was attitude toward components of infection control
questionnaire (r = 72) and practice of infection control questionnaire (r = 76). Data were analyzed
using SPSS version 21.0 (SPSS Inc. Chicago IL, USA).
RESULTS: Findings showed that the mean age in the experimental group was 34.92 ± 8.9 while the
control group was 47.43 ± 6.6. The average years of experience for the experimental group were
10.42 ± 9.9 while that of the control group were 21.89 ± 8.7. Responses on attitude showed that 30
participants (69%) had positive attitude in the experimental group compared to 21 participants (46.7%)
in the control group. The mean difference was 4.02. Significant difference was observed between
mean attitude score of participants in the experimental group and control group (P = 0.03), between
mean practice score (P = 0.001), and between self‑reported and observed practices (P = 0.000).
CONCLUSION: The training was effective in improving attitude and practice of infection control.
Adequate provision of structured training programs on infection control measures is recommended.

Abstract Experiential learning is an innovative learning method that knowledge is gained through experience.
The aim of this paper was to review the application of experiential learning in health education and
suggest an oral health education program using experiential learning. Experiential learning has
been used in the past successfully in health education mostly in university curricula. In oral health
education, its use is limited and without following a comprehensive structure. An experiential learning
oral health education program, implemented in the classroom by a trained teacher, is proposed to
be integrated in the school’s curriculum. Initially, using brainstorming students express their opinions
and feelings toward oral health. Then, students are allocated to working groups to develop oral health
projects. The outcome of these projects is presented in the classroom to their peers through role
playing, posters, songs, games, etc., Finally, a discussion is stimulated by the teacher to encourage
children to express their feelings about oral health issues and thus experientially recognize the
importance of oral health. Experiential learning has been effectively used in health education and can
be a successful method for oral health education. For optimal results, a predetermined experiential
method structure has to be followed.