Journal of Education and Health Promotion

Abstract INTRODUCTION: The purpose of this study was to determine the status of observance of structural
standards in rehabilitation centers and nursing homes.
MATERIALS AND METHODS: This cross‑sectional descriptive study was carried out on 12 centers
of the nursing homes of Isfahan city during 2016–2017. The tool was a check. To complete the
checklist, the direct observation of the environment and the review of existing documents were used.
Data were analyzed by descriptive statistics and frequency distribution.
RESULTS:  The findings of this study shows that of 11 standards ofworkforce standards regarding
to health expert presence, nurse presence, therapist and extracurricular instructor presence, have
been observed innone of the centers, and the presence of social worker/psychologist in 50% of the
centers. Of the 21 standards relating to the physical environment, eight standards have not been met
in any of the centers. Of the 25 standards relating to the general conditions of building, 4 standards
have not been met in any of the centers. Of the 10 standard relating to the equipment and supplies
which are needed, 3 were not observed in any of the centers. Of the 10 standards relating to the
required services, except one, standards have been met in all centers. Of the 10 standards relating
to the general provisions, 7 are met in all centers of both types.
CONCLUSION: According to the findings, a significant percentage of standards have not been met
in any of the aging centers or just met in some of these centers. It is hoped that the results of this
study will enable authorities to promote standardization of nursing homes and rehabilitation centers.

Abstract Tobacco use causes many diseases irrespective of age and sex. More the addiction, more is the
occurrence of morbidity in terms of frequency and severity. This community‑based study was
conducted to find out any relationship between the morbidity associated with tobacco use and
nicotine dependence. In an urban slum – Alamganj, district Burdwan, West Bengal, India, from
January to October 2012 among 128 current adult tobacco users using Fagerström test for nicotine
dependence (FTND) questionnaire. Tobacco users were maximally suffering from chronic obstructive
pulmonary disease (COPD) (27.27%), gastritis (25.45%), and leukoplakia (25.45%). For individual
diseases, the difference in FTND score was significantly high in cases of gastritis, hypertension,
and COPDs. All types of morbidity were more common in the group of high nicotine dependence.
FTND score can be suitably used to assess nicotine dependence of the tobacco users, who can be
counseled accordingly to reduce the tobacco‑related morbidity and mortality.

Abstract BACKGROUND: Menopause and its complications could disturb the sense of well‑being and health
and affect the quality of life. The present study was performed to review the conducted interventional
study related to the quality of life in menopausal women in Iran.
METHODS: In the present systematic review, to achieve the intended studies, Iranian Registry for
Clinical Trials and Magiran, SID, Google Scholar, Scopus, PubMed, Proquest, ScienceDirect, and Web
of Science databases were searched using: menopause” and “quality of life” keywords without any
time limitations. Based on Jadad criteria, studies with a score of 3 or more were enrolled in the study.
RESULTS: From all the achieved studies at primary search, 12 were selected and enrolled in the
study. Reviewing the results of the studies showed that participating physical exercise, using products
containing phytoestrogens and isoflavones and participating in educational and counseling sessions
have an effective role in the improvement of quality of life in menopausal women.
CONCLUSIONS: Evidence indicated that from the existing strategies to improve the menopausal
quality of life, using complementary medicine is an efficient method and could be more effective
when consumed along with performing physical exercises and participating in educational programs.

Abstract BACKGROUND: Most infectious diseases result from a lack of knowledge and poor personal
hygiene. Hand hygiene, in particular, is one of the most common means by which pathogens are
transmitted. The aim of this study was to determine college student’s knowledge and awareness of
personal hygiene in Kuwait.
MATERIALS AND METHODS: A multi‑dimensional health assessment approach was followed
using a self‑administered questionnaire that was distributed among students of two colleges
(the College of Nursing and the College of Health Sciences). Item analysis was conducted on 33 items
of the questionnaire and measure five types of hygiene practices: hand hygiene, body hygiene, special
hair application, oral care, and clothes hygiene. The data collected in the questionnaires and results
were analyzed using statistical software SPSS version 23. Statistical analysis was performed using
ANOVA and Student’s t‑test. Internal consistency, reliability was good, with an overall Cronbach’s
Alpha value of 0.749.
RESULTS: Most respondents were female with 64%, while 80% of the college students were in the
age of <20‑year‑old. Twelve items were underhand hygiene practices, and four items under body
hygiene. Nine items were under oral care; three, items were under hair application. Three were
under clothes hygiene.
CONCLUSIONS: This study showed that female students had a better knowledge and were more
hygienic in hand hygiene, hair application, and body hygiene whereas, male students showed a
better oral hygiene practice. Nevertheless, this study shows that the hygiene questionnaire is an
acceptable and reliable measure of awareness and practice among college students.

Abstract INTRODUCTION: Health needs a lifestyle upgrade. Lifestyle is important because it affects the quality
of life and the diseases’ prevention. This study aimed to investigate the lifestyle and its relationship
with health‑care value of mid‑aged women.
METHODS: This descriptive‑analytic study was conducted on 287 middle‑aged women in Isfahan
in 2016. Samples were randomly selected among the centers as well as from those referring
to comprehensive urban health centers. Walker’s Health‑Promoting Lifestyle Profile II and a
researcher‑made health‑care value questionnaire were provided to mid‑aged women. Data were
analyzed using descriptive statistics, Pearson’s correlation coefficient tests, and multiple linear
regression (MLR) analysis.
RESULTS: The average health value score in women was 59.6 and the total lifestyle score was
57.9 out of 100, which is in the semi‑desirable range. The highest score among the lifestyle domains
was related to the interpersonal relationship (67.6) and the lowest score was related to physical
activity (39.4). Pearson’s correlation coefficient showed that there is a direct relation between the
health value score and the total score of lifestyle and all its domains (P < 0.001). MLR model showed
that the areas of responsibility (P < 0.001), interpersonal relationships (P < 0.001), and physical
activity (P = 0.01) have the highest predictive value for the health value score among the different
domains of lifestyle score.
CONCLUSION: Lifestyle and health value of mid‑aged women in Isfahan are in the semi‑desirable
range and lifestyle has a direct relationship with health value. Therefore, lifestyle enhancement can
enhance the health value and take steps to improve health in the community.

Abstract BACKGROUND: Breast cancer is a leading cause of deaths worldwide. In Pakistan, one in every
nine women develops breast cancer some time in her life. This high incidence of breast cancer and
the poor socioeconomic conditions of Pakistan make breast self‑examination (BSE) the best tool for
the prevention and early diagnosis of breast cancer. Therefore, the aim of the study was to assess
the knowledge, attitude, and practice of BSE among female college students of Karachi, Pakistan.
METHODS: A cross‑sectional study was conducted on 1000 students from June to December 2016.
Data were collected using a pre-piloted questionnaire, and SPSS (version 20) was used for data
analysis. Chi‑square test was used to determine the significance of the difference in knowledge
and attitude among participants who had performed BSE and those who had not. A P < 0.05 was
considered statistically significant.
RESULTS: The overall response rate was 90.9%. Although 71.4% of the women knew what BSE
was, only 33.1% had performed it. Majority of the participants considered that BSE is important in
the early detection of breast cancer. With 59.7% of the population having an adequate amount of
knowledge, 87.2% had a positive attitude toward BSE. A medical background was found to be a
significant predictor for adequate knowledge and a positive attitude toward BSE.
CONCLUSION: Despite a positive attitude found among the population toward BSE, its knowledge
and practice were inadequate. Educational interventions are required in Pakistan to encourage
young women to perform BSE regularly so that breast abnormalities can be detected early on and
mortalities can be minimized.

Abstract BACKGROUND: Proper distribution of general practitioners (GPs) is one of the challenges in all
health systems. This study aimed to investigate geographical distribution of GPs in public health
sector in Iran between 2010 and 2016.
METHODS: The study is a descriptive–cross‑sectional study. The population of provinces was
extracted from Iran’s National Statistic Center, while information on GPs was gathered from deputy
of statistic and information technology in Ministry of Health and Medical Education. Data analysis was
carried out using descriptive statistics, Gini coefficient (GC), and by drawing geographical distribution
map of GPs. Data analysis was performed by excel 2013, Stata V.14, and Arc GIS software.
RESULTS: The results of calculating the number of GPs per 100,000 population in Iran showed that,
in year 2010, Chaharmahal and Bakhtiari Province had the highest (10.39) and Alborz Province had
the lowest (0.66) number of per capita GPs. The highest number of GPs per 100,000 population
among Iran’s provinces belonged to Chaharmahal and Bakhtiari (8.97), while the lowest belonged
to Tehran (0.28) in year 2016. The GC was 0.31 in year 2010 and 0.283 for 2011. The lowest GC
belonged to year 2012 (GC = 0.272), while the largest coefficient belonged to year 2016 (0.356).
CONCLUSIONS: According to the results of this study, the distribution of GPs in public health sector
of Iran in between 2010 and 2016 showed inequality. Therefore, along with increasing the number
of GPs working in public health sector, it is necessary to pay attention to their distribution. Further
studies are needed to investigate inequality of GPs within and between the provinces.

Abstract OBJECTIVE: There is increasing evidence for declining the onset age of drug abuse worldwide. This
study was conducted to investigate the effectiveness of four educational methods including lecture,
presentation of poster and leaflet, presentation of video clip, and group/class discussion for life skills
training and changing in knowledge and attitude of adolescents toward drug abuse.
MATERIALS AND METHODS: In a pretest–posttest design, a sample of 897 girl and boy high
school students from the first grade (14–15 years old) were involved in this cross‑sectional study
conducted in Isfahan, Iran. After collection of pretest questionnaires, each educational method was
implemented separately for one class in one session (3 h) in each high school, and evaluation was
carried out immediately after intervention through posttest questionnaires by the same students.
RESULTS: According to paired t‑test, the video clip‑ and lecture‑based methods were significantly
efficient in changing the attitudes toward drug abuse in boy and girl students, respectively. Analysis
of covariance showed significant differences between girls and boys in pretest–posttest attitude
scores using group discussion‑based and video clip‑based methods.
CONCLUSION: Life skills training program through lecture‑based and video clip‑based educational
methods was considerably effective in changing the high school students’ attitude toward drug abuse
and addiction.

Abstract CONTEXT: Family planning is crucial for everyone within the reproductive age to promote the health
and welfare of every member of the family. For the medical students, it is essential to have core
knowledge, understanding of family planning concept, and competency in communication skills with
the patients. The final-year medical students are posted in Maternal and Child Health Clinics for
3 weeks to gain the knowledge and practical experiences on the primary healthcare in the community.
AIMS: The aim of this study was to explore the experiences of final‑year medical students on family
planning services offered at community clinics in Malaysia.
SETTINGS AND DESIGN: This was qualitative study.
SUBJECTS AND METHODS: This qualitative study used the data of the students’ reflection written
in the case reports on family planning. Coding, identification of subthemes, and themes were done
by two researchers independently using RQDA software.
STATISTICAL ANALYSIS USED: Thematic analysis.
RESULTS: Final‑year medical students who had exposure to the clinical services at primary care
clinic, regarding Malay word (Klinik Kesihatan) gained the learning opportunities during family planning
session such as learning by observation, clerking, and counseling the patients, understanding the
barriers to utilizing services and learning for their self‑improvement. These learning opportunities lead
to developing the positive attitudes on their learning experiences and the positive attitudes toward
the concept and services of family planning.
CONCLUSIONS: To have the better understanding of family planning services and provide the
better care to the community in the future, the clinical exposure at the primary care clinics should be
promoted for medical students in Malaysia.

Abstract INTRODUCTION: The importance of life skills and their application in promoting personal, family,
and occupational health in military personnel is well recognized. It is, therefore, important to identify
and assess life skills in military personnel with a valid and reliable tool. The present study aims to
develop such a tool and evaluate its psychometric features in military personnel.
MATERIALS AND METHODS: As part of a mixed study, a qualitative concept analysis study was
conducted using hybrid approach to redefine life skills in military personnel, and results obtained
were used to form a pool of items. Next, in a methodological study, psychometric evaluation,
qualitative and quantitative face validity, qualitative and quantitative content validity, and construct
validity (exploratory factor analysis), and reliability (using test‑retest and internal consistency) were
performed on the inventory.
RESULTS: Initial pool of items was designed with 156 items, which were reduced to 93, following
qualitative face validity, and further reduced to 80 after quantitative face validity (item impact score).
No further reduction was implemented after qualitative and quantitative content validity (content validity
ratio and content validity index ratio). Following construct validity (factor analysis), the remaining 80
items were summarized in 5 factors. Cronbach’s alpha for the 5 factors was found 0.7, and correlation
coefficient of test‑retest results exceeded 0.9 and was significant at 0.01.
CONCLUSION: Given the acceptable results of psychometric features, this tool can be used as a
valid and reliable tool for assessing life skills in military personnel.

Abstract INTRODUCTION: Tobacco epidemic is one of the biggest public health threats the world has ever
faced. Tobacco use is a significant public health problem worldwide and the single‑most preventable
risk of human health. Mass media anti‑tobacco advertisements can reach large sections of the society
and increase awareness about the harms of tobacco use and increase quit attempts.
METHODOLOGY: This cross‑sectional study was conducted to find out the awareness of anti‑tobacco
advertisements and to assess the influence of anti‑tobacco advertisements among 16 to 18‑year‑old
students in Belgaum city. A self‑structured, close‑ended, 26‑item questionnaire was distributed to 600
preuniversity students. The questionnaire consisted of sociodemographic data, tobacco usage status,
questions related to awareness about anti‑tobacco advertisements, and influence of anti‑tobacco
advertisements on attitude toward tobacco use. Frequency distributions and percentages were
examined for each item and Chi‑square test was used.
RESULTS: Majority of the study participants (89.4% males and 86.7% females) were aware of the
anti‑tobacco advertisements. Television and movie theaters were considered as the most effective
means for anti‑tobacco advertisements. Nearly 90.8% had noticed the statutory warning which is
shown during tobacco products’ usage on television/movies. Almost 78.35% of males and 90.6%
of females had a positive change in attitude toward tobacco use due to influence of anti‑tobacco
advertisements.
CONCLUSION: There is an increased awareness on anti‑tobacco and this has been proved to be
effective in motivating them to quit tobacco as well as stop them from initiating tobacco use.

Abstract CONTEXT: Infertility is one of the major stressful events in individual life, especially women.
Self‑efficacy means a person can perceive a potentially threatening and stressful situation as being
amenable to influences of personal control.
AIMS: This study was conducted to determine the acupressure effects on self‑efficacy and pregnancy
rate in infertile women under in vitro fertilization (IVF)/intracytoplasmic sperm injection treatment.
SETTINGS AND DESIGN: This study was a randomized controlled trial in infertile women. It performed
at Milad IVF Center, Mashhad, Iran, from September 2015 to August 2016.
MATERIALS AND METHODS: The sample size was 144 participants. The participants were
randomly divided into three groups: real and sham acupressure and control groups. Acupressure
performed on the H7 and P6 acupoints on both the hands. The infertility self‑efficacy scale was
completed before and after intervention. Beta‑human chorionic gonadotropin hormone assay was
measured to determine pregnancy. Data analysis was done by Chi‑square, Fisher’s exact, paired
sample t, Kruskal–Wallis, and ANOVA test and general linear model and multinomial logistic. Levels
of significance were reported at P < 0.05.
RESULTS: The mean age of women was 30.84 ± 5.34 years. The ovulation factor (P = 0.02) and
spouse’s job (P = 0.05) were statistically significant difference between the groups. The score of
self‑efficacy and frequency of clinical pregnancy were no significant difference among three groups.
Using linear regression, only the score of primary self‑efficacy (before intervention) was in a significant
relationship with self‑efficacy after the intervention (P < 0.001).
CONCLUSION: To our results, we recommend more research for assessing acupressure effects
on self‑efficacy and clinical pregnancy rate in infertile women.

Abstract INTRODUCTION: Personal growth initiative (PGI) is an “intentional involvement in changing and
developing as a person.” A student who has higher level of PGI is said to show higher academic
performance because higher level of PGI might increase the student’s contribution and achievement
in life.
AIM: This study aimed to explore the association between academic performance and PGI among
undergraduate dental students.
METHODS: A cross‑sectional study was carried out among 287 2nd, 3rd, 4th year dental students
and interns of Panineeya Institute of Dental Sciences, Dilsukhnagar, Hyderabad. Personal growth
was evaluated by Personal Growth Initiative Scale‑II (PGIS‑II) along with their university academic
performance in the last year. SPSS package version 21.0, Kruskal–Wallis test, and Mann–Whitney
U‑test were used for comparison among variables.
RESULTS: A significant difference (P = 0.05) was observed for PGIS subscale “readiness for
change,” with a higher mean score among 4th‑year students (3.59 ± 1.07). However, females showed
higher mean score for all subscales of PGIS except “Using resources” and total PGIS, but there is
no significant gender difference. While higher mean scores for all subscales and total PGIS were
observed among students who attained > 75% in their last year university examination, significant
difference was observed for subscale “Intentional behavior” (P = 0.02) only.
CONCLUSION: PGI scale plays a crucial role among students to experience increased levels of
well‑being, develop them positively, and adapt to adverse situations.