Journal of Education and Health Promotion

Abstract INTRODUCTION: In the Iranian Accreditation System, leadership and management standards have
been almost ignored and not paid enough and necessary attention to the structural components
and the infrastructures standards in management and leadership sections. Governing body, medical
staff, chief executive officer (CEO), and nursing management standards are inadequate and lack
accountability. These standards could lead to reform and finally provide the context for accomplishment
of an appropriate accreditation program.
MATERIALS AND METHODS: This is a descriptive, comparative, and qualitative study. It was done
in two phases. The first phase included literature review of the standards of the selected countries
followed by comparison of the standards of the board of trustees, medical staff, CEOs, and nursing
management standards to develop the primary framework for Iranian hospitals. In phase two, the
primary framework was validated true three rounds of Delphi technique.
RESULTS: Surveying the accreditation system standards in selected countries included the USA,
Egypt, Malaysia, and Iran. It was found that the management and leadership standards were classify
as governing body, medical staff, CEOs, and nursing management standards. The result of this study
provides a framework for improvement of the Iranian national accreditation program.
CONCLUSION: In regarded to the importance of the leadership and management standards in
reform and change and promotion of the health services quality, efficiency, and effectiveness, the
results of this study showed that the present standards of the Iranian accreditation assessment
system and guidelines lack the necessary infrastructures for implementing a successful national
accreditation program.

Abstract INTRODUCTION: This study was designed and implemented with the purpose of identify and analyze
the stakeholders in Iran’s Health Insurance System (HInS).
MATERIALS AND METHODS: This study was a mixed method study. The study setting was in the
field and consists of all organizations in the HInS. The study steps designed according to the Kammi
Schmeer stakeholder analysis model. The information was collected through semi‑structured and
structured interviews with 16 stakeholder representatives. The data collection tool was checklist
and matrixes that determined the characteristics of the stakeholders. Analysis of data was done by
Maxqda10 and Mactor software.
RESULTS: A total of 34 stakeholders were identified that were involved in nine main activities of
HInS. Major stakeholders have governmental nature. The Government, the Planning and Budget
Organization, the Ministry of Health, the Welfare Ministry, the Higher Health Insurance Council,
and the Medical Council were stakeholders who have high financial, decision‑making, and political
power simultaneously. The Parliament and the Health Commission, the Government, the Planning
and Budget Organization, and the Ministry of Health were stakeholders that had the most influence
on other stakeholders. Most of stakeholders have same position to the objectives of the HInS. The
insurer organizations had opposed position with the objective of integrity of the funds.
CONCLUSIONS: Stakeholders of Iran’s HInS are multiple and involved in various activities that
sometimes they are overlapping and parallel.  Regarding the same position of the majority of
stakeholders to the objectives, reforms are possible, provided that influential stakeholders participate
in policies making.

Abstract BACKGROUND: Hypertension is an important treatable public health problem both globally and in
India with an increasing prevalence significantly in both urban and rural population. It is one of the
leading causes of adult mortality and morbidity, but poorly controlled hypertension remains a major
health problem.
OBJECTIVE: The objective of this study was to find out awareness, treatment, and control
of hypertension among study population and association of hypertension awareness with
sociodemographic factors, if any.
MATERIALS AND METHODS: This study was conducted from May 2013 to April 2014 in the rural
community of Singur block, West Bengal. Data were collected with respect to sociodemographic
characteristics as well as records related to hypertension such as awareness, treatment, and control
of hypertension. Blood pressure (BP) measurement of individuals aged 20 years and above of both
sexes was done. Pearson’s Chi‑square test was performed to find out the association between the
categorical variables. SPSS 19.00 software was used for analysis.
RESULTS: Nearly 48.2% of the participants were aware of their elevated BP; 47.1% of the participants
were taking pharmacological treatment, mostly allopathic and only 8.8% had their BP under control.
A  statistically significant association was found between age, education, and socioeconomic
status (per capita income) with awareness of hypertension.
CONCLUSION: Lack of awareness of the disease and very low rate of control of hypertension
among those who were treated became the major issues. These findings emphasize the need for
dissemination of knowledge about the disease and counseling of the patients during treatment
continuation.

Abstract BACKGROUND: Many of the problems caused by aging can be delayed and the health of the elderly
maintained by improving and applying a healthy lifestyle during old age. Therefore, the researcher
has designed and implemented a study aimed “compare the impact of group motivational interviews
with multimedia education on improving lifestyle in the elderly.”
METHODS: This study is triple blind before and after clinical trial was performed on three groups of
thirty (n = 90) of the elderly with mean age 63.41 ± 6.88 who were members of the elderly centers
of Tehran city neighborhoods with average to unfavorable lifestyle score. The first test group was
subjected to group motivational interviewing during five sessions. The second test group was subjected
to distant multimedia training. No training was given to the third group as the control group. After
3 months, the lifestyle questionnaire was completed in three groups. The results were analyzed
by these techniques as statistical tests such as mean, standard deviation, relative frequency, and
absolute frequency were used. The inferential statistical tests such as paired t‑test and one‑way
ANOVA were used, respectively, to compare the pre‑ and post‑mean scores and in each group and
compare the mean scores of lifestyle dimensions in three groups.
RESULTS: Both motivational interviewing and multimedia education have been effective in changing
the lifestyle of the elderly, but according to the findings, motivational interviewing has a greater impact
on elderly lifestyle. The total lifestyle score in four areas such as nutrition, self‑care, mental health,
and physical activity was significantly different in the three groups after the intervention (P < 0.001).
CONCLUSIONS: Each educational program can somehow improve behavioral skills in individuals.
Effective teaching methods should address the learning difficulties and inability to learn during the
aging period. The results of this study can be a step toward the elaboration of strategies for education
and promotion of healthy lifestyle in the elderly.

Abstract BACKGROUND: Nursing is a scientific profession, based on theory and art of care. However, the
theory‑practice gap has become the biggest challenge of this profession and decreases the quality
of service both in teaching and practice. Thus, it seems necessary to search for these reasons in
situations such as emergency department – which has an effective role in patients’ health.
OBJECTIVES: The objectives of this study were to find the perceived reasons for the theory‑practice
gap in the process of emergency nursing education from the perspective of professors, nurses, and
students, as well as doctors, since they cooperate with nurses and students in the training environment.
METHODS: A qualitative study was carried out; this included 18 deep, semi‑structured interviews in
7 months with the people involved in the process of emergency department apprenticeship alongside
with observing the activities of stakeholders. The data analysis was done in accordance with content
analysis method including three steps of preparation, organization, and reporting.
RESULTS: The perceived reasons for theory‑practice gap were classified into 13  secondary
categories. At the end of data analysis, five main categories of student, instructor, environment,
culture, and the organizational process, and finally, two themes of “input” and “process” emerged.
CONCLUSIONS: Nursing students in emergency department face a number of challenges in
implementing theory into practice which stems from the faculty as an academic environment and
the hospital as an educational environment. These underpinning reasons for the theory‑practice
gap influence the quality of nursing education and care delivery in emergency department. Hence,
decreasing the theory‑practice gap lies in the amendment of any of these factors.

Abstract BACKGROUND: Scholarly research experiences during student life can make pharmacy students
capable of reaching the pinnacle of triumph with scientific skills.
AIM: The aim of this study is to assess the perception of pharmacy students and their inclination
toward scholarly research publications.
MATERIALS AND METHODS: A cross‑sectional web‑based survey was conducted among pharmacy
students across India, Malaysia, and Pakistan. A 21‑item questionnaire was distributed through
different social networking sites between July and September 2016. Descriptive and Chi‑square tests
were used to analyze the findings. A value of P < 0.05 was considered as statistically significant.
RESULTS: Of 543 pharmacy students approached, 348 participants from India, Pakistan, and
Malaysia were included giving a response rate of 64%. The study comprises 48.5% of males and
51.4% of females, studying a bachelor of pharmacy (44.5%), and from private institutions (94%).
Nearly, three‑fourths (76.4%) of the students had no publications but showed high interest toward
original research (87.4%). Most of the participants cited the reasons to engage in the scholarly
publication is too advanced research/share findings (74.1%), and to improve writing and research
skills (73.6%). Further, a significant percentage of students agreed that contributing to the literature
during student life as a valuable experience and publishing will provide them with personal fulfilment.
CONCLUSIONS: This study showed that most of the pharmacy students had positive perceptions
toward scholarly research activities to advance research and improve their writing research skills.
We recommend the pharmacy schools to incorporate scholarly activities in the curriculum to embark
research‑inclusive career.

Abstract INTRODUCTION: As an integral and the most important part of medical education, clinical education
provides the opportunity to prepare medical students as professionals. This study explores the
standpoints of informants concerning the optimal conditions for clinical education and its components,
including learning opportunities, clinical settings, and clinical tutors, with the aim to improve clinical
teaching and standards.
METHODS: The study design is built on qualitative content analysis with the directed approach. The
participants were selected using purposive sampling with maximum variation, and the data were
collected through online focus group discussion (FGD) and semi‑structured individual interviews
conducted either face‑to‑face or on the telephone.
RESULTS: Twenty vice‑chancelleries of education and medical education planners from across the
country participated in this study. Concepts resulted in four main categories: educational settings,
tutors, creating learning opportunities, and learning situations. The concepts were sorted into 15
subcategories, also 21 subclass 1 and 14 subclass 2. The most extensive subcategories comprised
variety of educational settings, teaching team conditions, and learning strategies.
CONCLUSION: Optimal conditions for clinical education are associated with the use of educational
settings close to the real workplace of general practitioners such as general inpatient settings,
outpatient settings, and emergency department. Moreover, optimal conditions require the provision
of learning opportunities by organized team of tutors and team member empowerment along with
policy‑making and planning on the national scale by the Ministry of Health in consideration of local
conditions.

Abstract INTRODUCTION: Immunization against vaccine‑preventable diseases in adults is the need of the
hour. The student nurses by virtue of training are the frontline health workers dealing with patient
care. They are exposed to maximum risk of contracting the diseases. Vaccine awareness is not
a part of their induction training program. It is necessary to plan preventive measure related to
vaccination in their interest.
AIM: This study aims to assess awareness and practices of nursing students related to adult
immunization.
MATERIALS AND METHODS: It is a cross‑sectional study, conducted on nursing students of
School of Nursing in Mumbai, over a period of 4 months. Universal sampling technique was used.
Sample size was 271. A semi‑structured interview schedule was used for data collection. Data were
analyzed in Microsoft Excel.
RESULTS: The awareness about the vaccines was as follows: hepatitis B (98.1%), hepatitis A (72.3%),
rabies (90.4%), H1N1 (74.9%), dT (52%), meningococcal (33.6%), human papillomavirus (49.8%),
vaccines during pregnancy  (88.2%), varicella  (76.4%), typhoid  (54.6%), cholera  (52.8%),
rubella (79.7%), travel vaccines (63.5%), Japanese encephalitis (69%), haemophilus influenzae
b (40.9%), and pneumococcal (43.5%). About 87.8% of students have received TT at 10 years of
age and 83% have received TT at 16 years of age. Hepatitis B vaccine was taken by 64.5%, out
of which only 35% students received complete three doses. Majority of them could not answer the
correct doses, availability, and cost of these vaccines.
CONCLUSIONS: The awareness and practices about adult immunization are found to be inadequate.
Nurses should be appraised about theory and practical aspect of immunization as an immediate
solution. Furthermore, considering the importance of this topic, the induction training program
of nursing students should include awareness on adult immunization and emphasize their own
vaccination. The annual health checkup of students should ensure the compliance of vaccines such
as hepatitis B.

Abstract BACKGROUND: The successful application of the information systems in the health‑care domain
requires a reasonable recognition of the factors affecting the acceptance and use of such systems.
The study aimed to investigate the factors affecting the acceptance and use of an integrated health
system (IHS) in Isfahan primary health centers.
MATERIALS AND METHODS: It was an applied and descriptive–analytical survey conducted in
Isfahan, Iran. Research population included all IHS’s users in the health centers no. 1 and 2 of
Isfahan city from which a sample of 320 individuals were selected in total. Data were collected using a
questionnaire developed based on the Unified Theory of Acceptance and Use of Technology model.
Data were analyzed using partial least squares (PLS) method and SmartPLS software.
RESULTS: The users’ behavioral intention to use the IHS system was influenced by performance
expectancy, effort expectancy, and social influence, but it was not significantly related to facilitating
conditions. Behavioral intention to use the IHS also had a significant relationship with the use of
system. Furthermore, performance expectancy was the most important predictor.
CONCLUSIONS: According to the findings, if the system users perceive the positive role of system
in performance improvement, its convenience to use, and positive attitude of others toward it, their
willingness to accept and use system will increase. Furthermore, it was important for the users that
the system helps them in resolving their daily work‑related problems and making rational decisions.

Abstract BACKGROUND: Health literacy is a combination of reading and listening skills, data analysis,
decision‑making, and the ability to implement these skills during the necessary health situations.
This study was conducted with the purpose of determining the effect of educational intervention on
health literacy and its impact on health‑promoting behaviors of the health ambassadors in the health
and treatment centers of the health network in Kazeroon (Fars province, Iran).
MATERIALS AND METHODS: The present study is a quasi‑experimental study using before‑after test
procedure on 256 health ambassadors. Random systematic sampling method was used and to assess the
health literacy, Montazeri’s health questionnaire was used, also the standard questionnaire (health‑promoting
lifestyle profile‑I) was applied to determine the status of the health‑promoting behaviors. Two questionnaires
were filled out by the health ambassadors before and following the intervention. Data analysis was
performed using SPSS software 22, through t‑test, ANOVA, and Pearson correlation.
RESULTS: The mean health literacy scores of the ambassadors before educational intervention
were 79.22 which increased to 95.49 after intervention. Moreover, the results of the study showed
a direct significant correlation of health literacy with all the dimensions of health‑promoting behavior
questionnaire before and after the intervention (P < 0.001).
CONCLUSIONS: Educational interventions can be used to enhance the health literacy of health
ambassadors and have a significant impact on improving health‑promoting behaviors.

Abstract CONTEXT: Health system reform plan refers to conducting some fundamental, systematic, and
sustainable changes.
AIMS: The aim of the present study was to evaluate different required inputs of Iran Health
Transformation Plan from experts’ viewpoints.
SETTINGS AND DESIGN: The data of this qualitative study were collected using semi‑structured
interviews.
SUBJECTS AND METHODS: The purposive sampling method led to 18 participant selection and
then they were interviewed. Interviewees were assured about confidentiality of information.
STATISTICAL ANALYSIS USED: The thematic analysis method and MAXQDA software were
employed for analyzing the data.
RESULTS: There were 4 main themes and 35 subthemes extracted including management
requirements for health development plan, human resources, information resources, and financial
resources. Each theme had subthemes such as “resource allocation,” “development of required
standards for human resources,” “human resources’ motivation,” “failures in IT infrastructures,”
“hospital information management software,” “guidelines and instructions,” “costs controlling,” and
“financing the plan”.
CONCLUSIONS: Results of the present study put significant emphasis on the path of improving
the effectiveness and efficacy of applying the discussed inputs, which can be a light for revising
past policies and taking better future steps, it also can be a resource guide for policy‑makers and
managers of the health‑care system.

Abstract INTRODUCTION: Indian national law namely Cigarettes and Other Tobacco Products Act (COTPA)
exists since 2003 and aims at protecting all the people in our country, but smoking is still prevalent
among people. This study was aimed to assess awareness, attitudes, and practices regarding
prohibition of sale of tobacco products near educational institutions of Nellore city, India.
MATERIALS AND METHODS: A  descriptive cross‑sectional study was conducted in degree
colleges of Nellore city of Andhra Pradesh. The study population includes institutional personnel
(student, teaching staff, nonteaching staff, and workers) of selected degree colleges of Nellore city.
A structured questionnaire was designed for this study which was validated by Davis criteria; reliability
was assessed by test–retest design. The questionnaire was divided into five parts consisting of
demographic details (age and gender), smoking behavior, knowledge about tobacco control laws,
attitudes toward the law and policies, and practices followed in the institution. Logistic regression
analysis was used to find out the association between different independent variables to tobacco
usage among institutional personnel.
RESULTS: Among the study population (n = 400 [100%]), 75.8% of the teaching staff do not know
that there should be a board in the institution saying that “sale of tobacco product in an area within
the radius of 100 m of educational institution is strictly prohibited,” 82.2% of the study population were
not aware to whom should they report, 96.3% of the study population accepted that strict execution
of COTPA law saves life, the participants who answered no to strict implementation of COTPA law,
and to punish the person who is violating the COTPA law are susceptible to 0.28, and 0.14 times
greater odds to be a smokeless tobacco user, respectively.
CONCLUSION: The study concluded that there was lack of knowledge about smoke‑free legislation
among the study population and a high support for strict implementation of COTPA.

Abstract AIM: Worldwide, the adoption of electronic patient recording system is increasing among many
parts of the health sectors.  Although paper‑based recording of patients’ information was a routine
in many departments of dental schools, easy destruction of collected information and the costs of
its conversion to electronic data, limited the availability of updated data at the department of dental
public health. This paper aimed to explain the project of designing a system for Electronic Oral Health
Recording (EOHR) in Isfahan dental school. The initial testing of system among dental students is
reported too.
METHODS: A situation analysis was conducted among the faculty members and dental students
dealing with the Department of Oral Public Health. The content of EOHR was developed based on
the WHO STEPwise model for chronic disease surveillance systems. The system was developed as
an application for smartphone and a web‑based database. The spiral model was applied in software
development which was accomplished by the object‑oriented programming method. After that, alpha
and beta testing were done in target population. Data were compiled during the interview and oral
examination by 40 dental students among 200 schoolchildren. It has been stored as a data bank
following the network connection.  The pitfalls of the system during its usage in dental public health
course were evaluated as well.
RESULTS: The baseline analysis of situation generally revealed a perception of need to change the
existing paper‑based recording system among the dental students and the academic members; it was
summarized in five areas as follows: benefits restrictions, structural barriers, perceived advantages
and feasibility. The application was designed and completed as six pages interface including
demographic and follow‑up page, socioeconomic status of family, oral health‑related behavior,
dental and gingival status, and quality of life. Drawbacks, such as nonresponded items, common
assumptions, student registration page on the mobile, and modification in the output Excel file for
analysis variables, have been resolved.
CONCLUSION: A  software application and web‑based database were designed regarding the
characteristics of Agile Unified Process development and educational dental setting. This system
should be improved and established gradually.

Abstract INTRODUCTION: In communication process, feedback plays a major role. Usually, a formal/informal
feedback is collected from students on their experience and understanding about the tasks given by
the mentor to assess the learning process. Receiving high‑quality feedback (positive or negative)
is valuable from multiple perspectives. Students may or may not enjoy sessions on innovative
teaching–learning methods; in that case, feedback helps to modify it into a more effective and
acceptable method of teaching.
METHODOLOGY: With an objective to understand the students’ perception on a smartphone app
in community‑based research, a cross‑sectional study was planned among undergraduate students
posted for the re‑orientation of medical education. Epicollect5, a mobile app, was used for data
capture. Students were requested to submit their feedback by using the same app which they had
used during the survey. The received feedback was analyzed and presented in proportions.
RESULTS: Students shared that the new tool was easy to install (97.5%), user friendly (100%),
saved time in data collection and data entry (100%), and they also missed the usual practice of
paper‑based questionnaire survey (12.5%) and data entry in excel sheet (7.5%).
CONCLUSION: The students liked and enjoyed the paperless method of data collection and entry
which saved time and improved the quality of the data. They were also interested to learn more on
the designing or framing the questionnaire in app and planned to use the app in future research. The
feedback conveyed the immense welcome for new technology by the students into medical curriculum.