Journal of Education and Health Promotion

Abstract

Abstract BACKGROUND: The contaminated hands of health‑care professionals (HCPs) is an implicated
vector in the transmission of potentially pathogenic organisms to vulnerable patients. The aim of
this study was to derive baseline data on hand hygiene (HH) practices among a cohort of students
at the Lagos State School of Nursing and to determine their perception about the adequacy of
instructions they receive.
MATERIALS AND METHODS: A descriptive, cross‑sectional study was conducted on a probability
random sample of 69 nursing students at the Lagos State School of Nursing at the Alimosho
Igando General Hospital. The knowledge, attitude, and practice as well as the perception of
the respondents on the adequacy of their infection control instructions were obtained using an
interviewer‑administered questionnaire. Data entry and analysis were done using SPSS software
version 20 (IBM Corp., Armonk, NY, USA), P < 0.05 was considered statistically significant. Multivariate
linear and logistic regressions were done to assess which factors were truly significant predictors,
with odds ratios (ORs) and 95% confidence intervals (CIs) specified as the measures of association
between predictors and outcome variables.
RESULTS: Majority of participants were ≤20 years old (50.7%, n = 35) and were in their second year
of study (44.9%, n = 31). Participants were least knowledgeable about the importance of discarding
gloves and not washing or reusing them (16 [23.1%]). The mean score on the Hand Hygiene Beliefs
Scale was 86.2 ± 9.0, with scores ranging from 23 to 88 out of a possible high score of 115. The
most positive health beliefs were associated with being a role model for HH (3.57 ± 0.52), while the
worst was associated with imitating bad HH practices performed by senior colleagues (1.29 ± 1.20).
Caring for a wound (60 [87.0%]) was most associated with the need for HH, while demonstration
and clinical practice were rated as the most effective teaching methods. Results of the multivariate
logistic regression analysis, with the outcome variable of good self‑reported HH practices, revealed
that the odds of appropriate behavior were higher if the student nurses were in their third year of
study (OR = 1.59; 95% CI: 1.01–2.45). An appropriate behavior was also more likely in student
nurses with a higher risk perception (OR = 1.54; 95% CI: 1.03–2.51).
CONCLUSION: Despite the overwhelming evidence that HH is effective in the prevention of
hospital‑acquired infections, its performance among HCPs remains far less than optimal. Since
students will someday be influencing future HH compliance behaviors of other health‑care workers,
the importance of HH should be adequately incorporated into their school curriculum.

Abstract BACKGROUND: Oral care of hospitalized patients is an important measure that aims to maintain
and promote the health of oral and dental tissues. This study aimed to investigate nurses’ attitudes
and practices regarding oral care of hospitalized patients in Riyadh, Saudi Arabia.
MATERIALS AND METHODS: A cross‑sectional, descriptive design was implemented. The research
instrument was a self‑administered questionnaire that was designed and distributed among 300 nurses
working at five hospitals located in Riyadh.
RESULTS: Totally, 226 questionnaires were completed (response rate: 75%). Almost all
participants (97.8%) think that providing oral hygiene is an important element of patient care and
90.7% think that nurses need to update their oral care knowledge and skills. Only 46% of the nurses
reported the presence of a policy for oral care at their hospital unit and 55.3% indicated that patients
are assessed for oral health at their department. About 56.2% of participants did not receive training
on oral assessment and provision of oral care and a few nurses (2%) received training on oral care at
their current job place. A large proportion of nurses (44%) expressed a desire to undergo training on
oral care of hospitalized patients. Gender, nationality, and previous training were the most important
predicators of a positive attitude.
CONCLUSIONS: The outcome of this study indicates a positive attitude among the surveyed nurses
toward provision of oral care for hospitalized patients. Current oral care practice in Saudi hospitals
is suboptimal. Saudi hospitals need to pay more efforts to train their nursing staff and issue clear
policies and guidelines regarding oral care of hospitalized patients.

Abstract CONTEXT: In recent years, the media have had very massive effects on individuals, especially
children and adolescents. Hence, they should be able to use media rationally also be able to create
digital, multimedia texts, and attain media literacy. Media literacy is a skill based on understanding
and gives the audience the opportunity to use the media appropriately and critically.
AIMS: The aim of this study was to investigate the relationship between media literacy and mental
psychology of high school students in Semirom city.
SETTINGS AND DESIGN: This correlational study was conducted with the participation of 139
adolescent girls selected using multi‑stage random sampling, in Semirom city, Isfahan province,
the Central of Iran, in 2017.
SUBJECTS AND METHODS: Data were measured using researcher‑made media literacy
questionnaire, psychological well‑being Scales of Ryff.
STATISTICAL ANALYSIS USED: Data were analyzed using SPSS software and descriptive
statistics (Pearson correlations) were used. The statistical significant level was set as 0.05.
RESULTS: There was no significant correlation between family economic situation, parental
education, and media literacy score. Media literacy was significantly correlated with total psychological
well‑being (r = 0.165, P <   0.05), personal growth subscale (r = 0.216, P < 0.05), and self‑acceptance
subscale (r = 0.218, P < 0.05).
CONCLUSIONS: Considering the importance of psychological well‑being in adolescents’ life, the
design of educational interventions to increase media literacy is recommended.

Abstract INTRODUCTION: Hepatic sickness is a serious problem for human health. The researchers are
interested in using medicinal plants including barberry to cure many of these sicknesses. In this study,
the effect of hydroalcoholic extract of Berberis vulgaris leaf on hepatic protection was assessed in rats.
MATERIALS AND METHODS: Forty healthy male Wistar rats were divided randomly into five groups
(n = 8): Group 1 (healthy control), intraperitoneal injection of olive oil; Group 2 (hepatotoxic control),
intraperitoneal injection of carbon tetrachloride and daily gavage of distilled water; and testing groups,
intraperitoneal injection of carbon tetrachloride along with daily gavage of B. vulgaris leaf extract 40,
80, and 120 mg/kg of weight, respectively. After 6 weeks, the following were checked: enzyme level
of alanine aminotransferase (ALT), aspartate aminotransferase (AST), alkaline phosphatase (ALP),
as well as serum level of total protein (TP), albumin (ALB), and histopathological status of the liver.
RESULTS: The level of AST, ALP, and ALT was increased to 109 (IU/L), 95(IU/L), and 71(IU/L),
respectively, in hepatotoxic control group than healthy control group, and there was a decrease of
0.86 (g/dl) and 0.04 (g/dl) in TP and ALB levels, respectively. The B. vulgaris extract in every three
doses caused a significant decrease in hepatic enzymes level.   However, the TP had a significant
increase in 80 and 120 mg/kg of body weight. Regarding ALB, there was no significant difference
among these groups. The histopathological results were not conformed to biochemical findings.
CONCLUSION: Using the appropriate dose of B. vulgaris leaf extract can help the improvement of
laboratory symptoms of fatty liver.

Abstract BACKGROUND AND AIM: Prenatal mental health has been shown to be related with postpartum
depression. However, the role of mental and psychological factors in postpartum depression requires
especial attention. Furthermore, the relationship between demographic factors and postpartum
depression is contradictory. The study was aimed to identify role of prenatal anxiety and depression
and demographic factors with postpartum depression.
MATERIALS AND METHODS: A prospective cohort study was conducted with 303 pregnant women
who have gestational age from 28 to 36 weeks and referred to health‑care centers in Isfahan city
and follow‑up for 6–12 weeks after postpartum. Data were collected using the demographic form,
Edinburgh depression, and anxiety Spielberger questionnaire during pregnancy and Edinburgh
depression inventory in the 6th and 12th weeks after childbirth. Descriptive statistics and linear logistic
regression were used to analyze the data. In demographic factors, data were analyzed using the
Student’s t‑test, Chi‑square, Pearson and Spearman test and after the meaningfulness of regression
was used.
RESULTS: Results showed that the 6 and 12 weeks after childbirth, 61 patients (20/1%) and
33 patients (10/9%) had postpartum depression. The most important risk factors for depression
in the first 6 weeks were history of infertility (confidence interval [CI]: 0.56–0.767) (P = 0.018) and
history of depression (CI: 1.155–1.369) (P = 0.000) and in 12 weeks, postpartum were history of
depression (CI: 0.072–1.305) (P = 0.001).
CONCLUSION: Infertility and history of depression during pregnancy were two risk factors of
postpartum depression which should be taken into consideration during prenatal care.

Abstract BACKGROUND: Due to exhaustive working climate, health‑care professionals (HCPs) are highly
exposed to emotional strain and work‑related stress that leads to burnout syndrome (BOS).
AIM: We aimed to explore the prevalence of BOS among HCPs and delineate the factors that
contribute to developing this emerging threat in HCPs working in Gondar University Hospital (GUH).
METHODS: A cross‑sectional study was conducted among HCPs using a self‑administered validated
questionnaire containing sociodemographic and job characteristics, symptoms of burnout using
Astudillo and Mendinueta questionnaire, and Maslach Burnout Inventory scale. The prevalence
of BOS was assessed by summation of answers to all 19 items with a range of 0–57. HCPs who
scored >23 were considered as burned out. Pearson’s correlation analysis and multivariate logistic
regression were used to assess the relationship between BOS and job factors. Data were analyzed
using descriptive and inferential statistics.
RESULTS: A total of 250 HCPs were approached out of which 248 responded (response rate –99.2%).
The overall prevalence of burnout was 13.7% and majority of the respondents experienced
debility (52.8%), self‑criticism (56%), and depressive symptoms (46%). BOS symptoms were
significant with age (P = 0.008), number of patients treated per day (P < 0.001), and HCPs working
in shifts (P < 0.001). Higher mean levels of emotional exhaustion (5.4 ± 1.2) and inefficacy (5.1 ± 1.7)
were noticed than cynicism (4.8 ± 2.0). Male HCPs, being single and years of experience, were
determinant factors for all the three dimensions of BOS, whereas profession was significantly
determinant for emotional exhaustion (P < 0.01).
CONCLUSION: The prevalence of BOS among HCPs working in GUH was 13.7%. Being male,
unmarried, and years of experience were significant risk factors for all the three dimensions of BOS.
Pragmatic measures are recommended to prevent stressful challenges for the physical and mental
well‑being of the HCPs in GUH.

Abstract BACKGROUND: Cardiovascular diseases are the major public health problem in many countries
and are responsible for more than half of the deaths in above 50‑year‑old women. The most common
curable risk factor of these disorders is hypoestrogenemia resulting from menopause. The present
study aimed to investigate the effect of melatonin on plasma lipid levels in menopausal women.
MATERIALS AND METHODS: The present double‑blind, placebo‑controlled, clinical trial was
conducted in 2013–2014 on 240 menopausal women between 40 and 60 years old referring to
the Gynecology and obstetrics clinics of Shiraz University of Medical Sciences who were randomly
divided into two groups. The intervention group received 3 mg melatonin tablets and the control
group received the placebo for 3 months. The data were gathered using the demographic information
questionnaire and lipid profile test before and 3 months after the intervention. Then, the data were
analyzed through the SPSS statistical software (version 16). The repeated measures analysis of
variance, the least significant difference, the independent‑sample t, the Chi‑square, and Fisher’s
exact tests were done for data analysis.
RESULTS: The two study groups were similar regarding the demographic and clinical variables
at the beginning of the study. In the melatonin group, the amount of triglyceride increased from
140.34 ± 48.29 before the study to 151.24 ± 54.60 3 months after the intervention and no significant
difference was observed between the two groups in this regard (confidence interval [CI] = 95%,
P > 0.05). In addition, no significant difference was found between the two groups concerning
low‑density lipoprotein cholesterol level (CI = 95%, P = 0.125).
CONCLUSION: Melatonin was not effective in reduction of lipid levels. However, further controlled
studies are needed to be conducted on the issue.

Abstract INTRODUCTION: Childbirth fear is one of the major problems during pregnancy and postpartum,
and it assesses the sense of management coherence in stress. Therefore, the present study was
conducted to compare the association between the sense of coherence and childbirth fear in high‑risk
and low‑risk pregnant women.
MATERIALS AND METHODS: This was a cross‑sectional correlation study performed on 440
low‑risk and high‑risk pregnant women referred to health centers in Isfahan in 2016. Sampling was
carried out in several stages and clustered and accessible. The data gathering tool was Sense of
Coherence and Fear of Childbirth Questionnaires.
RESULTS: The results showed that in high‑risk pregnant women, the mean score of the sense of
coherence was 108.23 and the fear of delivery was 41.7, and in low‑risk pregnant women, the sense
of integrity and fear of delivery were 19.109 and 42.25, respectively. In addition, the results of t‑test
showed that there is no significant relationship between the fear of delivery in high‑risk and low‑risk
pregnant women (P = 0.056), while there is a significant relationship between sense of coherence
score in high‑risk and low‑risk pregnant women (P = 0.02).
CONCLUSION: Having the desired level of success, happiness, well‑being, ability to cope with stress
and overcoming psychological crisis, and pleasant social relationships can increase the sense of
coherence in pregnant mothers.

Abstract BACKGROUND: Human resources are the most important tool in agility of organization and is
considered to be the most valuable asset of any organization. Agile emergency system can reduce
production costs, increase market share, fulfill the needs of patients, and most importantly, it reduced
the mortality and morbidity from diseases and crashes.
OBJECTIVE: The purpose of this study was to determine the correlation of human resource agility
with performance of the staff of Tehran Emergency Center (TEC).
MATERIALS AND METHODS: This research is a descriptive‑correlational study and 285
operatives from TEC, with a population of 1100 were selected according to Morgan table and
simple random sampling. The data of this research were collected using human resource agility
capabilities questionnaire and Patterson job performance questionnaire. SPSS/18 software and
descriptive‑inferential tests were used to analyze the data.
RESULTS: The results show that the correlation between organizational agility and employee
performance is 0.754 and is significant (P = 0.01). The correlation between the employee performance
and intelligence and knowledge (0.512), multiple competencies (0.61), knowledge management (0.57),
empowerment culture (0.524), and information system (0.63) in significant level (P = 0.05).
CONCLUSIONS: The agility of the staff of the TEC is correlated with their performance. Due to the
sensitivity of the work of TEC staff, it is recommended that they are planning in such a way that
they acquire the agility of themselves and their organizations by acquiring the necessary skills at all
levels, especially the operational level.

Abstract PURPOSE: Noncommunicable disease (NCD) prevention is emerging as a public health priority in
developing countries. For better health outcome in these countries, it is necessary to understand the
different community‑based interventions developed and implemented across the world.
OBJECTIVE: The objective of the current review is to identify the best strategies used in
community‑based health intervention (CBHI) programs across the world.
MATERIALS AND METHODS: For review, we searched in PubMed and Google Scholar with the
keywords “community based,” “health interventions,” “health promotions,” “primary prevention,” chronic
diseases,” “lifestyle‑related diseases,” and “NCD.” Data were extracted using predesigned data
extraction form. CBHI studies detailing their intervention strategies only were included in the review.
RESULTS: Out of 35 articles reviewed, 14 (40%) were randomized control trials, while 18 (51.4%)
were quasi‑experimental design. Individual level (n = 14), group level (n = 5), community level (n = 6),
and policy level (n = 4) intervention strategies were identified. Twenty‑three (64%) studies were based
on interventions for 1 year and above. Twenty‑eight (80%) studies were intervened among specific
populations such as Latinos and so on.
CONCLUSION: Successful programs advocate for a package or a chain of interventions than a single
intervention. The type of interventions at different levels, namely individual, group, community, and
policy levels vary across studies, but individual, and group level interventions are more frequently used.

Abstract BACKGROUND: The educational environment has been confirmed as crucial factor for active
learning. Team‑based learning (TBL) is an interactive teaching method which improves students’
perceptions and performance.
OBJECTIVES: The comparison of the team‑based learning method through lecture‑based approach
on health education curriculum in public health students
METHODS: A quasi‑experimental study was conducted among 23 public health students of bachelor
degree and 14 public health students of associate degree to teach communication and Health
Education in Qom University of Medical Sciences from January 2015 to Jun 2016. Students of
bachelor degree selected TBL and students of associate degree preferred the traditional lecture‑based
method. In the current study, educational outcomes were defined as educational environment
and academic performance. At the last session of the semester, the educational environment and
academic performance of both groups were evaluated. Data were analyzed by SPSS version 20.0
using Chi‑square and Mann–Whitney test.
RESULTS: The mean and standard deviation of individual test score between the two groups showed
significant difference based on Mann–Whitney results (P = 0.036). The mean of final examination score
in TBL group was significantly higher than the traditional lecture group (P < 0.021, Mann–Whitney).
Our findings showed that in TBL group, 78.3% of students’ perceptions were in very favorable
condition while it was only 28.6% for students of the traditional method.
CONCLUSIONS: TBL method improves students’ perceptions about each area of educational
atmosphere and also provides opportunities to innovate which lead to active teamwork among
learners, and it can effectively enhance students’ academic performance.

Abstract BACKGROUND: Safe‑driving behaviors of taxi drivers are fundamental to health. The present
research aimed to predict the taxi drivers’ safe‑driving behaviors based on the theory of planned
behavior (TPB) and habit.
MATERIALS AND METHODS: The present research is of a descriptive/analytical cross‑sectional type
conducted on 184 taxi drivers in Bandar Abbas who were selected through a multiple‑stratified sampling
method. Data collection instrument was a questionnaire comprised of two sections (demographic
information and the constructs of TPB.
STATISTICAL ANALYSIS USED: The data were later on analyzed via SPSS ver 19 and Pearson’s
correlation coefficient as well as multiple regressions.
RESULTS: The mean age of the participants was 45.1 (standard deviation [SD = 11.1) years, and
they had an average experience of taxi driving for 10.3 years (SD = 7.5). Subjective norms, perceived
behavioral control, and habits were the predictors of one’s intention of driving safely (r2 = 0.30,
F = 18.7, P < 0.001). Moreover, attitude, perceived behavioral control, and habits were found to be
the predictors of safe‑driving behaviors (r2 = 0.19, F = 8.1, P < 0.001). Finally, habits showed to be
a stronger predictor of safe‑driving behaviors than attitude and perceived behavioral control.
CONCLUSION: Consideration of individuals’ behavioral habits and correction of unsafe habits, focus
on the adverse effects of unsafe‑driving behaviors, goal setting to change incorrect driving habits,
attention to influential groups in altering unsafe‑driving behaviors, and careful monitoring of abiding
by the rules are suggested to promote safe‑driving behaviors.

Abstract BACKGROUND AND AIM: One of the methods for involving breast cancer patients in their own
treatment is to provide them with credible and simple information. To provide this information, it is
first necessary to investigate health information‑seeking behaviors of these patients including their
information needs, sources, barriers, and attitudes regarding health information.
METHODS: This is an applied type study using survey method. The statistical population included
female breast cancer patients referring to Seyed‑Al‑Shohada Hospital of Isfahan (60 patients). Data
gathered through questionnaire.
RESULTS: “Self‑care,” “emotional‑psychological support information,” and “treatment length
and chance of relapse” were the most sought‑after health information by patients. “Brochure and
catalog provided by hospital,” “other cancer patients,” and “physicians and nurses” were the most
important information sources. “High cost of information sources,” “Lack of response from treatment
personal (physicians and nurses),” and “lack or trust in website information” were the most important
information‑seeking barriers. Regarding attitude, participants stated that health information can help
them in areas such as “controlling their conditions,” “adapting to their conditions,” “stress and anxiety
control,” and “preforming their social roles” and “hopefulness.”
CONCLUSION: Credible and relevant information can help patients to seek their treatment with
renewed motivation and energy. This information should be provided for the patients from various
sources such as brochures and websites according to their information‑seeking abilities and health
literacy with low cost. The knowledge of library and medical information experts can be used for
evaluation and creation of easy‑to‑understand information sources.

Abstract INTRODUCTION: Family planning and contraception is the effective strategy to reduce maternal
mortality, child mortality, abortion, and unwanted pregnancies. Since the medical students are the
future doctors, it is important to have proper knowledge and training on family planning services. This
study aimed to explore the effect of teaching‑learning process at maternal and child health (MCH)
clinics on the students’ knowledge, perceptions toward contraception methods, and family planning
counselling.
METHODS: This quasi‑experimental study was conducted in the private medical institution in
Malaysia. The same questionnaire was used to administer twice, before and after the posting.
Moreover, a qualitative question on the issues related to family planning and contraception utilizations
in Malaysia was added to the after posting survey. The quantitative data were analyzed using IBM
SPSS (version 20) and qualitative data by RQDA software.
RESULTS: A total of 146 participants were recruited in this study. Knowledge on contraception
method before posting was 5.11 (standard deviation [SD] ±1.36) and after posting was
6.35 (SD ± 1.38) (P < 0.001). Thematic analysis of the students’ answer revealed four salient
themes, which were as follows: (1) cultural barrier, (2) misconception, (3) inadequate knowledge,
and (4) improvement for the health‑care services.
CONCLUSIONS: The teaching‑learning process at the MCH posting has an influence on their
perception and upgraded their knowledge. It also reflects the role of primary health‑care clinics on
medical students’ clinical exposure and training on family planning services during their postings.