Journal of Education and Health Promotion

Abstract BACKGROUND: Awareness of sources of information of mastectomy patients has an important role
in accessibility of reliable health information sources, thus, when they get information, they can be
effective in the treatment and self‑care. The present study aimed to identify the sources of information
used by women underwent mastectomy.
MATERIALS AND METHODS: The current practical research methodology was qualitative, and
research method was conventional qualitative content analysis was performed on 17 patients with
breast cancer undergone mastectomy. The sample targeted two hospitals were selected based on
criteria of Shaeid Mohammadi and the Persian Gulf and Omid Central chemotherapy in Babdar
Abbas. Data were collected by face‑to‑face semi‑structured interviews were conducted in winter
2015. Qualitative content analysis of data was performed at the same time of data collection.
RESULTS: Three themes were seemed (medical, interpersonal, and media) sources for explaining
the sources of information searching. Subcategories derived from the content of medical (physicians,
surgeons, and health workers of health facility centers), interpersonal sources (Family and friends,
peers), and media sources (printed, electronic, and Internet).
CONCLUSION: Given the importance of information on women underwent mastectomy, and their
priority in the use of medical sources, necessitates more attention of health system managers and
planners in providing essential information and their accessibility.

Abstract BACKGROUND: The aim of this qualitative study was to explore if the presence of a child in the
family was an opportunity or threat to the marital life.
METHODS: In this common qualitative content analysis, semi‑structured interviews with 20
participants were conducted. All of the interviews were recorded and then transcribed. The data
were categorized, and the main themes and sub‑themes were extracted.
RESULTS: Twenty transcription were analysed. The data analysis led to the development of the first
theme of “feeling evolution” with the category of “flourishing the motherhood sense,” and the second
theme of “strengthening the marital life” with the two categories of “the marital life stabilization” and
“efforts for a common goal.”
CONCLUSIONS: The presence of the child can lead to the feeling of development and stabilizing
the marital life. Furthermore, the presence of the child can facilitate or hinder marital satisfaction.
Given the challenges due to a lack of preparation of parents for childbirth, consultation and support
by family members or the society can help with adaptation with this life period and increasing the
positive effects of the presence of the child on parents’ relationships and marital satisfaction.

Abstract INTRODUCTION: Occupational stress is a main problem of healthcare workers, which significantly
affects their professional and personal performance. The aim of this study was to determine the
impact of a stress immunization program on occupational stress of midwives working in health centers.
MATERIALS AND METHODS: In this quasi‑experimental study, 80 midwives working in health
centers of Zahedan (2017) were divided into test and control groups based on random allocation.
The intervention involved a stress immunization program consisting of two workshops (each lasting
4 h) in two consecutive weeks, which was implemented for the intervention group. As data collection
tool, Health and Safety Executive Occupational Stress Questionnaire was completed in three steps
before, immediately after, and 1 month after the intervention. Data were analyzed using descriptive
and analytical statistics, independent t‑test, and repeated measures ANOVA.
RESULTS: The findings showed that mean stress score in the intervention group was increased
from 79.5 ± 9.7 before intervention to 104.5 ± 17.3 immediately after it, which was increased to
110.5 ± 18.3 1 month after intervention (P < 0.001). In the control group, mean stress score was
decreased immediately after as well as 1 month after the intervention, which was statistically significant
after the intervention and 1 month after it (P > 0.023).
CONCLUSION: The stress immunization program is an inexpensive and effective way to reduce the
stress of midwives; therefore, it is suggested to be used to effectively handle occupational stress
among midwives and to improve their quality of care.

Abstract BACKGROUND: Hemodialysis patients experience many issues in self‑care behavior. Patients
require to control of manage the issue to improve the self‑care. Educational intervention to behavior
change can be effective on self‑care behavior. This study was conducted to investigate the effect of
an educational intervention, based on the self‑Efficacy theory on promoting self‑care in hemodialysis
patients.
MATERIALS AND METHODS: Seventy hemodialysis patients recruited in this study and divided
randomly into intervention group (n = 35) and control group (n = 35) with convenience sampling in
2016 from Qom city, Iran. Data were collected before and 3 months after education using demographic
questionnaire, self‑efficacy, a valid researcher‑made questionnaire regarding to awareness and
self‑care. The educational intervention was performed for the intervention group in 4 1‑h sessions
over 2 months. The data were analyzed through Paired t‑test, Independent t‑test, Chi‑square, and
Mann–Whitney at the significant level of 0.05.
RESULTS: While variables in two groups did not show significant difference before education (P > 0.05),
a significant increase was observed in variables of self‑efficacy (P < 0.001), awareness (P < 0.001),
and self‑care dimensions (P < 0.05) between two groups after 3 months education.
CONCLUSION: The results of this research suggested that employing educational programs based
on the self‑efficacy theory can lead to the improvement of the self‑care behaviors in hemodialysis
patients.

Abstract INTRODUCTION: In peer‑assisted teaching (PAT) method, students are encouraged to prepare,
organize, and construct their learning program under the guidance of a teacher. The objective of the
present study is to assess the benefits and outcome of PAT on students’ understanding and knowledge
of one of the important and difficult topics, “physiological basis of electrocardiography (ECG).”
METHODS: A nonrandomized, interventional study was carried out in the department of physiology.
Five peer tutors were selected and trained in the basics of ECG by a senior faculty of physiology for
12–14 h sessions over the 6‑week period. These peer tutors then conducted a day‑long workshop
on five different subtopics of ECG, which was attended by 184 1st year medical students. Evaluation
of the workshop was done through pre/posttest 20‑item questionnaire score analysis and feedback
questionnaire using a 5‑point Likert scale items.
RESULTS: The average pre‑ and posttest scores were 6.6 ± 2.73 and 13.3 ± 4.73, respectively. The
average posttest scores were higher and statistically significant compared to pretest (R2
 = 0.4275;
P < 0.05). The class average normalized gain (g) for a posttest score was 101.5%. Of 184 students,
9.7% of students had >70% improvement from the pretest score, and 44.78% had more than 50%
improvement in their posttest scores.
CONCLUSION: We received a predominantly positive feedback for the usefulness of peer teaching
as a learning method. Thus, PAT was found to be a feasible and effective way of teaching the difficult
concepts in physiology.

Abstract Introduction: Today, the role of people in crisis management plans is of particular importance due
to the prepared community approach. It is difficult or impossible to attract public involvement due
to the low level of public perception of risk. Therefore, it is necessary to discover the status of risk
perception and its affecting factors. This study was conducted to investigate factors affecting the
strategies of disaster risk perception improvement.
Materials and Methods: This systematic review study was conducted in 2017 using extensive
electronic and library literature searches in the Web of Science, Scopus, and PubMed electronic
databases. The preliminary findings included 1030 studies. Out of 941 retrieved references, 925
references were excluded because they did not meet the objectives of this review or did not focus
directly on general population. Finally, 16 articles were selected for further investigation.
Results: The extracted variables were divided into four general domains: personal, psychological,
socioeconomic, and cultural factors. Personal characteristics included sex, age, marriage, level of
education, personal knowledge, and disaster personal experience. Psychological factors comprised
emotions (fear and insecurity), mental images (beliefs, attitudes), and internal and external control.
Cultural factors such as, belief, values, norms, faith, religious, and protective spirit were effective in
general perception of disasters risk. Socioeconomic factors such as, income, livelihood, insurance
coverage, trust, and fair access to land and resources were also influential. The strategies to improve
public disaster risk perception were educational, participatory, incentive, confidence building,
supportive, managerial and cultural ones. A family‑centered approach is recommended for the better
implementation of strategies.
Conclusion: The improvement of risk perception requires government planning in different fields
such as education, research, health, and culture, with an emphasis on social groups especially family.

Abstract BACKGROUND: As revealed by previous research studies, stress, lack of problem‑solving ability,
and weakness may influence the academic performance of students who study medicine or relevant
fields. It is necessary to provide students with consultation and academic advising to ensure their
support and welfare.
OBJECTIVES: The present study was carried out to evaluate the academic advisors’ communication
abilities and skills based on the views of the students living in the dormitory of North Khorasan
University of Medical Sciences, Bojnurd, Iran.
METHODS: The present analytical cross‑sectional study was carried out on 155 dormitory‑living
students who were majoring in medicine, nursing and midwifery, and health. The required data were
collected using a 17‑item research‑made questionnaire which evaluated the academic advisors’
communication skills in “oral and written,” “accepting and giving feedback,” “understanding others,”
“being a good listener,” and “effectiveness” fields. Descriptive statistics and Pearson’s correlation
coefficient test were utilized to analyze the collected data.
RESULTS: In the students’ opinion, as revealed by the results of the present study, the academic
advisors gained the lowest scores in “oral and written” (8.33 ± 1.58) field and the highest scores
in “accepting and giving feedback” (20.78 ± 9.36) and “understanding others” (22.73 ± 9.8) fields.
CONCLUSION: The students believed that the academic advisors had the lowest ability in “oral and
written” field; therefore, paid more attention should be paid to their communication skills, and their
“oral and written” skills should be evaluated.

Abstract BACKGROUND: Chest pain is one of the common causes for referrals to cardiologists, 50% of which
have no‑cardiac origin. The occurrence of chest pains is among the most important factors responsible
for psychological disorders. This study aimed to determine the prevalence of panic disorder and its
related factor in hospitalized patients with chest pain and normal angiography.
MATERIALS AND METHODS: In a cross‑sectional study, 144 patients who referred to Emam Ali
Cardiac Hospital of Kermanshah because of chest pain in 2013 and had a normal angiography during
admission were selected using census sampling method. The statistical indicators of Chi‑square
and logistic regression were applied.
RESULTS: From 144 patients with atypical chest pain, 95 were male (66%) and 49 were female (34%).
Overall, 41 patients met the criteria for panic diagnosis and thus, the prevalence of panic attacks
among patients with atypical chest pain was calculated as 28.5%. The results of multiple logistic
regression analysis showed that female gender, early age, and the being single were among the
predictive factors for the existence of panic disorder in patients with atypical chest pain and normal
angiography (P < 0.001).
CONCLUSIONS: Given the high prevalence of panic disorder in patients hospitalized for chest pain
with normal angiography, it is recommended to consider the importance of paying attention to this
disorder and identifying patients and referring them to professional psychiatrists.

Abstract AIM: The aim is to evaluate the knowledge, attitude, and practices of parents toward preventive
dental treatment modalities.
METHODOLOGY: A convenient sample of parents was selected randomly from four schools of
Udham Singh Nagar, India. The data were collected through questionnaire on dental preventive
modalities. The questionnaire includes questions pertaining to knowledge and practices toward pit
and fissure sealants, fluoride application, and dental visits. Questions pertaining attitude toward the
same were asked after the motivational program.
RESULTS: The majority of the parents were unaware that dental caries could be prevented by
preventive treatment modalities. None of their children had undergone preventive procedures.
Even after visiting dentist, 70% of parents were not informed about the preventive treatments by
their respective dentists. Even after our motivational program, around one‑third of the parents were
reluctant to accept preventive procedures for their children.
CONCLUSION: Parent’s knowledge about the preventive dental procedures for their children
was insufficient. Dentists are not encouraging parents about the benefits of preventive treatment
modalities. Based on our findings, promotional efforts encouraged 64% of parents to embrace
preventive procedures for their children. The present study emphasizes the need to educate parents
and their children.

Abstract BACKGROUND: Despite the importance of men’s role in prenatal care and its impact on the outcome
of a high‑risk pregnancy, in many countries, including Iran, men are not aware of their real needs.
Since the first step in designing any health plan is to identify the needs of the target population and
that no program can be effective without considering the actual needs of the target group, this study
aimed to identify men’s educational needs for participation in prenatal, childbirth, and postnatal care.
MATERIALS AND METHODS: In this descriptive cross‑sectional study, 280 men were selected
in Kashan city, Iran, in 2015. The sampling method was cluster sampling. The data collection tool
was questionnaire designed based on Mortazavi and Simbar’s studies that included demographic
characteristics of the subjects (14 questions) and their educational needs in terms of the content of
the training program, the training method, trainer, time, place of training, all of which were measured
by Likert scale and completed by the interview. Data were analyzed by SPSS software version 16
using descriptive statistics.
RESULTS: The findings showed that the mean age of the men participating in the study was
35.15 ± 5.83 years. Most men had high school education (45%). The three most important educational
needs of men regarding participation in prenatal and postnatal care were maternal nutrition (87.5%),
sexual health  (86.8%), and warning signs during pregnancy  (81.8%). Men preferred to receive
information from a physician (93.2%), before pregnancy (91.8%) in healthcare centers (90%). Family
was the most important source of information.
CONCLUSION: According to men’s suggestions, suitable educational programs must be implemented
by physicians in healthcare centers in classes of preparation for labor and childbirth or during prenatal
care.

Abstract INTRODUCTION: One of the most important responsibilities of governments and relief agencies after
each natural disaster is to provide the victims with emergency food items. This is an inevitable measure
to save the lives of injured and the ones who are rescued. This is due to inadequacy and unreliability
of household and local food supplies. Selection of the type of food is a concern of managers of the
response management programs. The purpose of this study was to investigate the characteristics
of emergency food items provided after natural disasters in Iran from the key informants’ viewpoints.
MATERIALS AND METHODS: To conduct this qualitative study, we interviewed 26 experts in the
field of nutrition and response management in natural disasters through semi‑structured interviews.
Participants were selected using purposive sampling. The qualitative content analysis method was
further applied to analyze the collected data.
RESULTS: Analysis of interviews showed that the characteristics of emergency food provided after
natural disasters should be investigated in two categories: (1) nutritional considerations and (2)
functional characteristics. Nutritional considerations category comprised subcategories, namely,
formulas and special foods for emergencies, food diversity, nutritional needs of different groups,
food health and safety, and functional characteristics included subcategories of packaging, cultural
norms, and final price.
CONCLUSION: Managers, in relation to the emergency food items used after natural disasters,
should consider features including emergency formulas and food, food diversification, food health
and safety, packaging certificates, cultural norms, and final prices in response plans.

Abstract Globally, health is regarded as a booming industry with greater stress being laid on high quality,
accountability, and transparency. Traditional medical curricula rely primarily on clerkships during
the clinical period of study to train clinical skills, while the preclinical period is mainly used to teach
the basic sciences. In recent years, the early introduction of clinical skills training has received
increased attention. This review aims to identify and summarize teaching approaches of clinical
skills for medical students during preclinical years, namely,  (1) framing objectives  (2) learning
activities, and (3) evaluation strategies. Although the clinical tutor’s role is to ensure that students
receive effective preclinical skills through different modes of learning (lectures, presentations, and
problem‑based learning), the role of advanced technologies, namely, simulation‑based learning
platforms and gamification are found to be very successful. To improve the communication skills,
there is strong evidence in support of role plays, and similarly, for enhancing observation skills, an
introduction of fine arts in clinical skills training was found to be very useful. Medical schools worldwide
should give high priority to conduct faculty development programs on various aspects of training
and teaching modalities, evaluation strategies, and improving the evaluation of various clinical skills.
Students should be provided with sufficient learning opportunities including a well‑equipped clinical
skills laboratory and individual attention, and constructive feedback should be given to students for
building their confidence level during their learning process.

Abstract INTRODUCTION: Low quality of sleep is a common problem among hemodialysis patients. This
study was conducted to evaluate the effect of a cold dialysis solution on the quality of sleep in patients
undergoing hemodialysis.
METHODOLOGY: This double‑blind clinical trial was performed on 26 hemodialysis patients with
chronic renal failure and sleep disorders in the dialysis center of Sabzevar, Iran, in 2016–2017. Of the
26 patients, 13 each were allocated to the intervention and control groups. The patients in both groups
received 4 weeks of hemodialysis (3 sessions per week) using a standard solution with a temperature
of 37°C. In the next stage, the control group continued to receive the standard‑temperature dialysis,
while the intervention group received dialysis using a solution with a temperature of 35.5°C for
4 weeks (3 sessions per week). The Pittsburgh Sleep Quality Index was used to assess and compare
the quality of sleep before and after the intervention in the two groups. Data were analyzed using R
1.2.3 software, at 95% confidence level.
RESULTS: Although the mean scores of sleep quality were not significantly different between the
intervention (9.53 ± 3.12) and control (11.23 ± 3.37) groups at baseline, postintervention, significant
differences were observed (intervention group: 4.7 ± 4.55; control group: 10.61 ± 2.69; P < 0.001).
CONCLUSION: This study showed that dialysis with cold solution is a simple, cost‑effective, and
nonpharmacological method that can be used to improve sleep quality in patients undergoing
hemodialysis.

Abstract BACKGROUND AND AIM: Considering that the Qom University of Medical Sciences was a pioneer
to implement the health system reform (HSR) in the domain of health services and the lack of a
study that has addressed the challenges and strategies to promote the HSR in the health domain,
this study was designed to explain the structural challenges and its solutions in the health domain
of the HSR in the city of Qom, Iran, 2017.
MATERIALS AND METHODS: This study was a qualitative research. The health managers, the
health‑care providers, and the recipients of health services referring to the health centers in Qom were
the participants in this study who were selected using the convenience sampling method. The data
were collected using individual interviews and with the guidance of a semi‑structured questionnaire.
Collected data were analyzed by the qualitative content analysis method with an inductive approach.
After extracting the challenges of the HSR in the health domain through a qualitative approach, these
challenges were prioritized through Delphi’s technique in terms of relevance and resolving strategies.
RESULTS: From the perspective of the study participants, the structural challenges of HSR in the
health domain in order of importance and priority included problems due to the SIB system, defects in
the instructions, the disruptions caused by multitasking, poor service coverage, incomplete health‑care
packages, and the shortage of resources.
CONCLUSION: According to the findings of this study, we hoped that the HSR in the health area
can be improved to increase its success by modifying the guidelines and the coverage of services,
modifying the SIB system, providing requires resources, completing the service packages, and
solving the multitasking problem.

Abstract BACKGROUND: Assessing the clinical skills of prehospital Intermediate technician is considered
to be one of the priorities in dealing with diseases, which may provide an appropriate reflection of
the training programs. The purpose of this study was to compare the two methods of clinical skills
training of emergency intermediate technician.
METHODS: This quasi‑experiment was carried out on Kerman’s emergency medical technicians in
2017. Operational and clinical skills, such as cardiopulmonary resuscitation (CPR), triage, familiarity
with the equipment, and proper patient transportation methods, were taught in both electronic and
traditional methods on two groups, each consisting of 30 intermediate technicians. Finally, the
personnel’s satisfaction level with the two teaching methods was compared and analyzed using IBM
SPSS Statistics for Windows, Version 22.0. Armonk, NY: IBM Corp.
RESULTS: There was no significant difference between the theoretical test scores in both the
electronic and traditional methods in all the participants (triage, pulmonary resuscitation, familiarity
with equipment, and patient transportation). Furthermore, there were significant differences between
the practical test scores in both the electronic and traditional methods, in all the participants except
triage. There was a significant difference between learners’ satisfaction in both electronic and
traditional methods in two areas of teaching and course difficulty in CPR, equipment usage, and
methods of transportation.
CONCLUSION: According to the results obtained by the present study, the electronic educational
systems due to their inclusive and interactive nature are recommended to be employed in courses
that have more theoretical aspects such as triage. The traditional method is suggested in teaching
practical courses such as CPR that need more practical and clinical skills.

Abstract INTRODUCTION: There are no documented formal mentoring programs for medical students in
Nigeria. This study aims to determine the perception of undergraduate medical students at the
University of Jos on professional mentorship, with a view to informing University authorities on
creating and developing a mentoring program.
MATERIALS AND METHODS: A cross‑sectional study conducted in December 2017 in which
self‑administered questionnaires were distributed among the sixth‑year medical students in a
University in North‑Central Nigeria, eliciting information regarding biodemographic data, knowledge
of and experiences with mentoring, desired benefits of mentoring, and the willingness to participate
in a mentoring relationship. Data collected was analyzed with EPI Info statistical software®
version 7.2.1 (EPI Info, Center for Disease Control, Atlanta, Georgia, 2017).
RESULTS: In a class of 166, the response rate was 83.5%. Mean age = 27.4 years; standard
deviation = ±2.6 with a male: female ratio of 1.9:1. Moderate knowledge of mentoring was reported
by 47 (44.3%). Attitude toward mentoring was very positive in 23.6%. One hundred and four (98.1%)
students agreed mentoring are effective in developing potential. Nearly 95.3% agreed a mentorship
program would benefit medical students with 70.8% expressing high willingness to participate. A weak
positive statistical correlation between the age of students and those who expressed willingness to
participate was recorded (r = 0.04; 95% confidence interval (CI) = 0.6–1.16; and P = 0.05).
CONCLUSION: Sixth‑year medical students of the University of Jos have a moderate knowledge
of and a good attitude toward mentorship. The implementation of a formal mentoring program for
medical students at the University of Jos is strongly recommended.

Abstract BACKGROUND: Young people’s attitudes toward marriage have been undergone changes in
recent years and it seems to be contradicting in the struggle between conservative and modern
liberal attitudes. The purpose of this study was to evaluate the attitude of new grooms toward intact
hymen in Kerman.
MATERIALS AND METHODS: This cross‑sectional study has been conducted on 790 new grooms
in Kerman, Iran. In this study, we examined the attitudes in two aspects of sexual norm and personal
attitude toward premarital relationships in new grooms. The sampling method was purposive sampling
and the data were analyzed using t‑test and analysis of variance.
RESULTS: The results of this study have showed a more conservative sexual attitude toward
the sexual norms of premarital sex. The average score of the participants in the sexual norm and
personal attitude was, respectively 15.86 and 48.15, indicating that their conservative views have
been overcome. Most of the samples (90%) have believed in required preserving virginity before
marriage, and 82% believed in virginity as the most valuable asset of the girls. In this study, the
conservative attitudes of men were inversely related with their age and were directly related with
perceived sexual norm and the level of affinity to religious affairs.
CONCLUSION: According to the results of this study, conservative attitudes toward premarital
relationships are predominating in new grooms, but this is not generalized. The conservative attitude
of new grooms may have harmful effects on their interpersonal behaviors after marriage, which
requires purposeful training.

Abstract INTRODUCTION: The consequences induced by the natural disasters such as damage to food
systems and destruction of livelihood‑related infrastructure can threaten the food security of the
people. Hence, food security measures are one of the most important responses concerning the
management of natural disasters. This study was conducted to identify the challenges of food security
response following natural disasters in Iran.
MATERIALS AND METHODS: This study was conducted using a qualitative approach. The data
were collected through semi‑structured interviews with 29 key subjects; selected using purposive
sampling. The qualitative content analysis was run to analyze the data collected.
RESULTS: Based on the findings of this study, food security response challenges following the
occurrence of natural disasters in Iran were classified into three main themes:  (1) underlying
challenges, (2) challenges of process and resources management, and (3) challenges of organizing
and coordinating. These themes consisted of 11 subthemes.
CONCLUSION: Following the occurrence of natural disasters, the management challenges, as well
as the lack of coordination and organization between the stakeholders, are the serious challenges
to achieving food security. Meanwhile, underlying challenges like climate change in the context of
unsustainable living conditions of the vulnerable people have aggravated the food security response
challenges.

Abstract CONTEXT: Vision is the most important sense for interpreting the world and when sight is impaired,
especially in childhood it can have detrimental effects on one’s life. To maintain the oral health status
of such group requires special approach.
AIM: The aim of this study is to evaluate the impact of Braille text and verbal, oral hygiene instructions
on the oral health status of visually impaired children.
SETTINGS AND DESIGN: A prospective nonrandomized before and after comparison trial without
any control group was conducted among 165 children aged 7–19 years residing in one of the blind
schools in Delhi.
MATERIALS AND METHODS: A questionnaire was developed to record the source of oral health
knowledge and practices. Oral health status of the children was evaluated by recording plaque
index (PI) and gingival index (GI) scores at 1, 3, and 5 months intervals. Periodic reinforcement of
oral health education was performed with the help of instructions in Braille language.
STATISTICAL ANALYSIS: Paired t‑test and McNemar tests were used to assess the difference
between the scores before and after oral health education.
RESULTS: Among completely blind children, the mean difference of PI and GI score from baseline
to the last evaluation was found to be 0.56 and 0.28, whereas among partially blind children, it was
found to be 0.58 and 0.25, respectively. All the above values were statistically significant (P < 0.001).
CONCLUSION: Visually impaired children irrespective of the degree of blindness could maintain an
acceptable level of oral hygiene when taught using Braille text for instructions. However, continuous
motivation and reinforcement at regular intervals are required for the maintenance of oral health status.