Journal of Education and Health Promotion

Abstract

Abstract BACKGROUND: If we take the family as a circle, the disabled child is in the center of the circle and
weights on all communications in the family. Therefore, in this research, the experiences of all family
members are studied. The knowledge about families’ experiences helps the caregivers to have a
deep recognition of family status and individual and social relations.
MATERIALS AND METHODS: This was a phenomenological study. Participants were Iranian
families with disabled child and were selected by a goal‑oriented sampling. Data collection was
done through an unstructured interview. Interviews were transcript based. Data analysis was done
by Colaizzi’s method. Codes were extracted from the interviews and then the main concepts were
formed by organizing the formulated meanings into clusters of themes.
RESULTS: Data were being compiled from the 18‑h interview tapes and the verbatim transcription of
the interviews with the 12 study participants. Then, the researchers formulated the meanings of each
significant statement into 65 codes and organized the formulated meanings into following four clusters
of themes: 1 – protective structure, 2 – adjustment, 3 – social isolation, 4 – psychological tension.
CONCLUSION: The existence of a disabled child may lead to psychological and spiritual distress
and vast changes in every aspect of each member of the family.

Abstract CONTEXT: Multidose injection vials (MDVs) are prone to bacterial contamination, and their use has
been reported to be a potential source of infections.
AIMS: The aim of this study was to evaluate the knowledge and common practises of nursing staff
regarding the use of MDVs and its microbial contamination rate.
SETTINGS AND DESIGN: A pilot study was conducted in a super‑specialty hospital from June to
December 2016.
SUBJECTS AND METHODS: Information about knowledge and common practises of 100 nursing
staff posted in various Intensive Care Units (ICUs) with respect to the usage of single and MDVs,
respectively, was obtained and assessed. About 40 in‑use multidose injection vials containing
some remnants were collected from different ICUs. The volume of 1 ml content of each of these
vials was inoculated into a tube containing 15 ml thioglycolate broth and incubated at 37°C for
10 days. The broth was visually examined every day and subcultured onto blood, chocolate, and
Sabouraud Dextrose agar plates on alternate days within 10 days or any time that the appearance
seemed turbid. The microbial isolates thus obtained were identified using standard guidelines
and recorded.
STATISTICAL ANALYSIS USED: Descriptive statistics were used.
RESULTS: The study group members had sufficient knowledge about various aspects of handling
single and MDVs, respectively, such as hand hygiene, disinfection, checking of vial labels, and expiry
date. Low hand hygiene compliance rate of 55% was observed in all ICUs visited during this study.
The contamination rate of MDVs injection vials was 25% with Coagulase‑negative Staphylococcus
spp. being the most common isolate.
CONCLUSIONS: The use of MDVs is associated with the risk of contamination and nosocomial
outbreaks of life‑threatening bloodstream infections. Healthcare professionals must strictly
adhere to basic infection control practises as per standard guidelines to minimize the incidence of
hospital‑acquired infections.

Abstract INTRODUCTION: Sabbaticals were first offered by Harvard University in the late 17th century to
provide “renewal” for faculty members. In this period of career development, a professor might learn
new techniques, expand a research program, or finish off that book or pile of languishing manuscripts.
This article tried to organize lived experiences of a visiting scholar from Isfahan University of Medical
Sciences to Johns Hopkins University. The research aimed to study the context and conditions of
the sabbatical in an alternative academic setting.
METHODS: This article applies a narrative qualitative study integrated with Eisner critical and
connoisseurship approach as a combined naturalistic methodology.   Using narrative inquiry and
reflective analysis in form of observations and audit reports, written dairy notes and memos, the
content analyzed thematically and extracted the themes of lived experiences as well as lessons
learned and then have been transformed into tables.
RESULTS: Extracted themes from research sources are categorized into three main themes:
organizational and professional experiences; teaching, instruction, and curricular experiences; and
research and technology management experiences.   These are resulted in the explanation of the field and
events (description), discussion about them (interpretation), followed by concluding remarks (evaluation).
. It also represents research questions and findings in descriptive and interpretation phases.
DISCUSSION AND CONCLUSIONS: This article addresses some descriptions, interpretations,
and evaluations extracted from the experiences through answering the research questions. It
categorizes these practical lessons into three categories: (1) lessons about becoming a lifelong
learner, (2) lessons about remaining a professor, and (3) innovative experiences.

Abstract INTRODUCTION: For Muslim patients confronted with chronic diseases, spirituality is an important
resource for coping. These patients expect the health team to take care of the spiritual aspects. This
study aimed to explore the spiritual aspects of care for chronic Muslim patients.
MATERIALS AND METHODS: This qualitative‑descriptive exploratory study was conducted in
Isfahan, Iran, on a purposive sample of 25 participants, including patients, caregivers, nurses,
physicians, psychologists, social workers, and religious counselors. Data were collected through
semi‑structured interviews and analyzed through conventional content analysis.
RESULTS: The spiritual aspects of care for chronic Muslim patients fell into four main themes.
The first theme was religious aspect with the three subthemes of doing religious rituals, attention
to religious values, and providing the possibility of performing religious practices. The second
theme, i.e., pastoral aspect, consisted of three subthemes, namely giving consultation for finding
the meaning of life/death, helping to achieve intellectual transcendence, and improve the patient’s
communication with herself/himself and others. The third theme was psychological aspect, the four
subthemes of which included instilling calm to the patient, helping the patient to adapt, instilling hope,
and empathy. Finally, the fourth theme was a supportive aspect and included the four subthemes of
maintaining patient’s basic needs, continuity of care at home, creating awareness, and acceptance
and observance of patient’s respect.
CONCLUSION: Providing care based on the spiritual needs of chronic patients requires knowledge
and skills that the health‑care team need to provide through inter professional collaboration.

Abstract BACKGROUND: India is currently having a deceased donation rate of 0.05–0.08 per million
population. The National Organ and Tissue Transplant Programme have planned strategies to
improve organ donation by creating awareness and capacity building. There is great need to assess
the knowledge regarding organ donation among general population.
OBJECTIVE (S): Among the adult population (≥18 years) residing in urban slum of Puducherry to
determine the knowledge, attitude, and practice regarding organ donation.
MATERIALS AND METHODS: Community‑based cross‑sectional study was conducted during April
to May 2017 among 257 randomly selected participants in selected wards of urban Puducherry.
Data regarding knowledge, attitude, and practice were collected through pretested semi‑structured
questionnaire.
RESULTS: Mean (standard deviation) age of the study participants was 45 (15) years and
majority (57%) were female, 41% of them were educated more than secondary. Almost 90% of the
study participants have heard about organ donation. However, only 28% (95% confidence interval [CI]:
22.9–33.8) had adequate knowledge regarding organ donation. 58% (95% CI: 51.5–63.5) had positive
attitude toward organ donation. Practice regarding registration for organ donation was only 2.3%.
Knowledge regarding organ donation was more among joint family (odds ratio [OR] = 1.86, P = 0.02)
and middle socioeconomic status (OR = 2.40, P = 0.01). Positive attitude was more among those
who were educated above secondary (OR = 3.47, P = 0.001) and less among Muslim/Christian
religion (OR = 0.49, P = 0.03).
CONCLUSION: Less than one‑third of the study population had adequate knowledge regarding
organ donation. Even though more than half of them had positive attitude toward organ donation
only six individuals registered for organ donation.

Abstract INTRODUCTION: The development of information technology (IT) in education has led to the
expansion of new teaching and learning methods at universities. Implementation of E‑learning
programs at Iran’s universities as well as assessing the prerequisites and level of preparation of
learners to attend E-learning environments require extensive study. Therefore, this study examined
to investigate the challenges of E‑learning system at Tehran University of Medical Sciences.
METHODOLOGY: This study was a descriptive and cross‑sectional one that conducted in 2016_2017.
The statistical populations were all of the students that have an E‑learning course in Tehran University
of Medical Sciences, from whom, 300 were selected to participate in the study using a stratified
random sampling method. The tool of the study was a researcher‑made questionnaire. The data
were analyzed through SPSS software.
RESULTS: According to the findings of this study, about half of the participants (40%) had problems
accessing the technology, and only 26.4% of the participants had good preparation for the use of
E‑learning system. Furthermore, a significant difference was found between the challenges of skill
and culture of the participants (P value = 0.01).
CONCLUSION: Success in the implementation of E‑learning educational system as one of the main
approaches in managing knowledge and educational needs of higher education organization will not
be achieved without identifying the different skill, technical and cultural challenges. To overcome this
challenge, establishing IT infrastructure and standards, using experiences of the leading countries
in the field of E‑learning, creating proper culture, and familiarizing learners and teachers to the
development and use of E‑learning materials are necessary.

Abstract BACKGROUND: Clinical education is the heart of professional education in nursing. The perspective
of nursing students and clinical nursing educators as the main owners of teaching–learning process
are of determinants affecting clinical education process. This study was conducted to explore and to
describe the clinical education problems and strategies to improve it from the perspective of nursing
students and clinical nursing educators.
MATERIALS AND METHODS: The study was conducted using a descriptive qualitative method in
2017. Participants included 35 baccalaureate nursing students and 5 clinical nursing educators from
nursing faculty of Isfahan University of Medical Sciences, Isfahan, Iran. Participants were selected
using purposeful sampling method. Data were collected through semi‑structured individual interviews
and used qualitative content analysis for analysis.
RESULTS: The 2 main categories, 7 subcategories, and 19 sub‑sub categories extracted from
interviews. The two categories were “challenges of clinical education in nursing with four subcategories:
fear, insufficient readiness of student, incompetency of clinical educators, unpleasant atmosphere
of clinical environment,” and “strategies for improving clinical education of nursing with three
subcategories: the use of nursing education models and methods, improvement of communication
between faculty and practice, and holding orientation stage at the beginning of training.”
CONCLUSIONS: The findings show that clinical strategies, including employing experienced clinical
educators, attempting to enhance the learning environment, developing the relationship between
faculty and practice, participation of clinical nurses in clinical education, paying attention to entering
behavior, and holding orientation stage at the beginning of training, can improve clinical education
of nursing.

Abstract INTRODUCTION: The use of social media to disseminate major communications, particularly for
campaigns related to days of health importance, is becoming much popular. The use of Twitter,
Instagram, and Facebook is gaining an integral place in public life online with hashtag campaigns.
OBJECTIVES: The objectives of this study were to assess the characteristics of hashtag campaigns
related to health in social media and to compare three different campaigns in three commonly used
social media platforms, namely, Twitter, Instagram, and Facebook.
METHODOLOGY: This was a cross‑sectional study which analyzed contents of three health‑related
campaigns in Instagram, Facebook, and Twitter. The campaigns were #let’s talk (World Health day
2017), Hands up #HIV prevention (World AIDS day 2016), and #No tobacco (World No Tobacco Day
2017). Public posts related to each were searched from three platforms and assessed separately.
Source, publicity, credibility, reach outs, and other characteristics were assessed among each
campaign and comparison was also done among the three social media.
RESULTS: Out of 812 posts, 507 (62.4%) were related to the study. Facebook posts were more
related (67.33%), popular (45.05%), and authenticated (28.22%). Among the campaigns, # let’s talk
was more credible (96.33%) and authenticated (33.94%). Also in that, 57.79% from individual source
and 79.82% were awareness related.
CONCLUSION: Posts in social media related to hashtag campaigns are more credible, related, and
less popular. These factors have to be considered for the campaigns to become an effective tool.

Abstract BACKGROUND AND OBJECTIVE: Stroke is the second leading cause of death worldwide and
the number of stroke cases has increased remarkably over the last 20 years. This study aimed at
identifying predictors of with 6‑month mortality of first‑ever stroke patients and the factors contributing
to it in East Azerbaijan province.
MATERIALS AND METHODS: A closed cohort study was carried out from April 2014 to
December 2014. All cases of first‑ever diagnosed stroke were included in the study. Any transient
ischemic attack, silent brain infarctions, and the stroke cases which were neither associated with
trauma, blood disease nor with malignancy were excluded from the study. The variables of this study
include participants’ demographic characteristics, stroke severity National Institutes of Health Stroke
Scale (NIHSS), and stroke risk factors. Patients were followed up within 6 months. To determine the
survival time, the log‑rank method was applied to compare intergroup differences. The tests include
the univariate and multivariate analysis Cox regression. P < 0.05 were considered as statistically
significant.
RESULTS: A total of 576 cases of stroke were included in this study. Average age of ischemic and
hemorrhagic stroke was 70.15 ± 13.0 and 67.79 ± 12.69, respectively. Case‑fatality rate (CFR)
of stroke patients was 49.2 and 21.7% in hemorrhagic and ischemic stroke types, respectively.
Factors contributing to stroke mortality events include the severity of stroke (NIHSS categories
15–19 and ≥20), age over 65, being female, high body mass index and hyperlipidemia. In the
final model, the severity of stroke (with NIHSS 15–19 with hazard ratio (HR) 4.22 (95% confidence
interval [CI] 2.36–7.56) and NIHSS ≥20 with HR 5.34 (95% CI: 2.81–10.12) and age above 65 with
HR 1.61 (95% CI: 1.02–2.51) were the most important predictors of 6‑month mortality.
CONCLUSION: Severity of stroke by NIHSS was the most prominent factor in stroke patients’
mortality. By increasing the follow‑up time, a better evaluation of the predictors of mortality after
stroke can be achieved.

Abstract INTRODUCTION: Nausea and vomiting in pregnancy is the most common medical complication in
the first trimester of pregnancy. That associated with a wide range of physical and mental symptoms
for the patient and his family and can affect the quality of life of women’s life. In addition, the training
to improve knowledge, in adjusting diet and lifestyle, and leading to decrease nausea and vomiting.
Due to the positive characteristics of training using the small groups, this study was applied with the
objective of “The effect of small group teaching on quality of life in pregnant women with nausea
and vomiting.”
METHODS: This study was applied based on intervention, on 59 nulliparous women with nausea
and vomiting who referred to obstetrics ward of selected health and treatment centers in Neishaboor
County. The training was presented by a researcher in group intervention in 8 sessions, each 45–30 min
in small groups (3 groups 10 members). The control group received routine care. The study
instruments (nausea and vomiting of pregnancy quality of life questionnaire) and (modified‑PUGE)
form. The results were analyzed using the Wilcoxon test, Mann–Whitney, and t‑test.
RESULTS: Research units were no statistically significant difference of personal data, at the beginning
of the study, and before intervention, was not differences between the mean change scores of
postpartum stress disorder in two groups (P = 0/192). While the mean quality of life score in the
intervention and control groups was statistically significant difference after intervention (P = 0.001).
Quality of life score in the intervention group had statistically significant difference before and after
the intervention (P = 0.001).
CONCLUSION: Training in the intervention group with small group strategies has more effective in
comparison to conventional training of nausea and vomiting.

Abstract INTRODUCTION: The main aim of this study was to explore the socioeconomic determinants of
health‑care and emotional needs among older adults.
MATERIALS AND METHODS: In this cross‑sectional study, 350 older adults were randomly selected
from five geographical regions in Isfahan, 2016. A self‑administered checklist was employed to
collect health‑care and emotional need data among older adults residing day‑care centers. Data
were analyzed using logistic regression through STATA/SE (version 14).
RESULTS: The highest proportion of older adults lived with income 285–855 USD monthly and
insured by social security insurance. Illiteracy, loneliness, and low level of income were more
prevalent among female older adults than male ones. The emotional needs of single/widow (odds
ratio [OR] = 0.299), divorced (OR = 0.133) older people, not having children (OR = 0.811) or
grandchildren (OR = 0.684), and illiterates (OR = 0.689) were discovered to be lower than their
counterpart groups. As the elderly got older, their health‑care needs were met more. Older adults
covered by military insurance have their health‑care needs met as much as 21% (OR = 1.215)
greater than social security insurance.
CONCLUSIONS: Regarding health‑care needs, economic and monetary factors are still important
in meeting this type of needs as well as education and social insurance. While regarding emotional
needs, nonmonetary and noneconomic factors, including social network, are important determinants
for the satisfaction of emotional needs.

Abstract INTRODUCTION: Preeclampsia is the most common medical complication in pregnancy; along
with bleeding and infection, it is one of the three causes of death in pregnant women. Most of these
deaths were due to delays in the diagnosis and improper midwifery management and care. On
the other hand, the quality of midwifery education has a profound effect on the proper provision of
services. Therefore, the present study has been done to compare the effect of simulation‑, blended‑,
and lecture‑based education on simulated midwife performance in the management of preeclampsia
and eclampsia.
MATERIALS AND METHODS: This three‑group clinical trial study was performed on 90 midwives
of selected hospitals in Mashhad in 2016. Midwives were divided into three groups of simulation‑,
blended‑, and lecture‑based education using the random number table. The simulation group was
trained for 6 h at the Center for Clinical Skills, the blended group was trained for 4 h by lecture, and
6 weeks through the educational website, and the lecture group was trained for 6 h through lecture.
An objective structured clinical test was performed before and 2 weeks after the intervention. Data
were analyzed using SPSS Version 16 software and descriptive statistics, paired t‑test, one‑way
ANOVA, and Wilcoxon and Kruskal–Wallis tests. Significance level was considered to be P < 0.05
in all cases.
RESULTS: The mean score of midwives’ performance was not statistically significant before education
in all three groups (P < 0.05). The mean score of midwives’ performance was significantly increased
in all three groups 2 weeks after education (P < 0.001), and the results of intergroup comparison
showed that the mean score of performance in the simulation group was significantly higher than the
blended group and the lecture group (P < 0.001), and it was higher in the blended group compared
to the lecture group (P < 0.001).
CONCLUSION: Education increased the midwives’ simulated performance in preeclampsia and
eclampsia. The performance of the management of preeclampsia and eclampsia in the simulation
educational group is more than that of the blended and lecture groups, so we can use the simulation
education which is a self‑centered method.

Abstract OBJECTIVES: The objective of this study is to examine efficacy of text message reminders and to
educate and promote safe personal listening device (PLD) use in young adults.
METHODS: Three hundred and eighty‑seven urban college students from an urban university
located in New York City, New York, participated in this pre‑ and postsurvey 6‑month
study (September 2016–March 2017). One hundred and ninety‑eight students assigned to Group 1 (safe
PLD use) received biweekly informative and humorous text reminders to encourage safe PLD use; 189
students assigned to Group 2 (controls) received monthly text messages related to the importance of
their participation in the study with no mention of responsible PLD use. The Kruskal–Wallis test was
used to analyze the pre‑ and postquestionnaire data; outcomes were considered significant at P < 0.05.
RESULTS: Participants who received text message reminders reported significant (H[1] = 86.7,
P < 0.001) change in increasing responsible PLD use; no significant change was reported by
controls (H[1] = 0.002, P = 0.96). Females assigned to Group 1 reported modified PLD use more
(H[1] = 6.7, P < 0.01) than males, suggesting a gender effect. Participants who received the bi-weekly
text reminders rated them as helpful in promoting responsible PLD use; participants assigned to the
control group who did not receive biweekly text reminders indicated the reminders could have been
helpful in promoting safe PLD use.
CONCLUSIONS: Text message reminders were reported and appear effective in motivating
responsible PLD use in young adults.