Journal of Education and Health Promotion

Abstract INTRODUCTION: One of the probable risks of low birth weight (LBW) is low body growth at teenage,
and most of the parents are concerned about it. This study was conducted to compare the body
growth of girls at teenage in two groups.
METHODOLOGY: In this descriptive‑comparative research, the body growth of 350 girls (250
students having normal birth weight (NBW) and 125 students having LBW) at the ninth grade in
Isfahan, Iran, was studied. These students were chosen randomly out of 13 select schools from six
districts of education in Isfahan, Iran. The data were analyzed by Independent t‑test, Chi‑square
test, and Mann–Whitney U‑test.
RESULTS: This study showed that there is a meaningful difference in weight, height, BMI, and the
age of menarche. The highest weight, height, and BMI frequency (52.8 kg, 162.8 cm, and 3.31,
respectively) belongs to girls having NBW compared with girls having LBW (50.6 kg, 159.3 cm and
3.36, respectively) and Independent t‑test showed that weight and height average and body mass
index (BMI) of girls having NBW are higher meaningfully (P < 0.001). In addition, the girls having NBW
had reached the age of menarche at 12.36 ± 1.12 and 12.09 ± 1.01 at girls having LBW. Furthermore,
there was a meaningful difference (P < 0.001) between the ages of menarche.
CONCLUSION: Regarding the existence, it is recommended that the children having LBW should
be kept under special care. Of course, the resulted difference is not very important and concerning
for the parents, but further study is needed to reach the final conclusion.

Abstract BACKGROUND: Teledentistry is a rapidly forming subset of dentistry being used extensively in urban
as well as rural areas addressing problems related to cost‑effectiveness, efficiency, and quality in
delivering oral health‑care services. The present study aims to evaluate the knowledge, awareness,
and attitudes regarding teledentistry among the dental postgraduates of Kanpur city, India.
MATERIALS AND METHODS: A cross‑sectional descriptive survey was carried out on a total of
120 postgraduate students. A pretested, self‑structured, close‑ended questionnaire was administered
that consisted of 20 questions were included. The data collected was compiled in a systemic manner
and analyzed in terms of frequency (yes/no).
RESULTS: Only 77 postgraduate students responded, and it was observed that 74.4% of students
had knowledge regarding teledentistry and 79.2% of students contemplated to practice teledentistry
in the future. The overall awareness and attitudes regarding teledentistry were found to be 71.7%.
CONCLUSION: The knowledge, awareness, and attitudes were found to be satisfactory among the
postgraduate dental students.

Abstract BACKGROUND: According to the importance of health education and low capabilities and
competencies of health workers related to health education, designing and providing innovative
methods for teaching health education is necessary, so the study was designed and done with the
aim of reviewing articles related to innovative methods in teaching college health education course.
METHODS: A review of published articles was done to included innovative methods on college health
education course. The study was done by systematically searching appropriate database including
Google Scholar, PubMed, and Science Direct by using keywords.
RESULTS: Five article present innovative methods for teaching college health education course and
similar course, these studies were including usage of YouTube, simulation, smart mobile device in
social‑network‑based health education practice and patient feedback by using patient perception
questionnaire.
CONCLUSIONS: There are a few innovative studies related to college health education course, and
surprisingly there is only one study that used health education models/theories for designing college
health education course. Hence, we recommend the development of a comprehensive, systematic,
evidence‑based college health education course including mentioned methods for providing health
education and similar courses.

Abstract INTRODUCTION: Patients have different rights, one of which is their right to access health information.
The aim of this study was to identify patients’ rights to benefit from consumer health information
services using a qualitative method.
MATERIALS AND METHODS: The research method was qualitative using a Delphi technique.
The statistical population consisted of 12 specialists in the field of medical library and information
science and researchers and healthcare professionals. Eight dimensions and 42 items of patients’
rights were identified and were approved by Delphi panel.
RESULTS: Regarding patients’ rights to benefit from consumer health information services, eight
dimensions including the right to health knowledge, the right to access to health information, the
professional behavior of medical librarians with patients, content richness, information seeking
skills, awareness of new services and products, the ease of using health information centers, and
the professional behavior of healthcare professionals with patients were identified and approved.
CONCLUSION: Decreasing the gap between the health literacy of healthcare professionals and
patients is one of the duties of medical librarians and health information professionals. Establishing
of patient rights in the area of utilizing health information services is an important step in improving
the quality of services received by patients.

Abstract BACKGROUND: At present, there is no established national minimum data set (MDS) for
electrophysiology study (EPS) ablation, which has led to a lack of standardization and variable
assessment criteria in this context.
OBJECTIVE: The objective of this paper was to develop a MDS of EPS ablation as means of
establishing an information management system or clinical registry in this field.
METHODS: In this cross‑sectional and descriptive study, national and international cardiovascular
scientific literature were studied to establish an initial set of data elements. In order to its validity, the
population study composed of 15 cardiac electrophysiologists who asked to review the proposed data
elements and score them in order of importance using a five‑point Likert scale. The items scored as
important or highly important by at least 60% of the experts (average score of 3 and higher) were
included in the final list of MDS.
RESULTS: An MDS of cardiac EPS ablation was created with nine data classes, including
administrative data, past medical history, sign and symptoms, physical examinations, laboratory
tests, presenting status of heart conduction system, catheter ablation, postprocedure complications,
and discharge outcomes. For each category, required variables data and possible respondents were
determined.
CONCLUSIONS: Consensus was reached on a set of core data elements to standardize data
collection for cardiac EPS ablation in order to achieve quality improvement and effectiveness indicators
for the management of care process and health outcomes.

Abstract BACKGROUND: The tribals are considered as an underprivileged community who are dissociated
from the health‑care system. They are known to adhere to old, ancient methods of managing illness.
This study was undertaken to understand the issues and challenges in the tribal areas in seeking
healthcare.
MATERIALS AND METHODS: Cross‑sectional study was conducted during the year 2017 in a
nongovernmental organization‑based health center located in a tribal area of rural Maharashtra,
India. A total of 383 participants were interviewed using a semi‑structured questionnaire about
the health‑seeking behavior and utilization of health services in the study center as well as nearby
government facilities. Strengths, weaknesses, opportunities, and threats of the management of
diseases at the study center were also identified.
RESULTS: In the event of an acute illness, 40% preferred government hospital, 40% private, 16%
of study center, and 4% sought treatment from traditional healers. On comparison with nearby
government facilities, the study center was located far away, travel time and fare to reach was more
and was preferred by all over government facilities. The difference in user perspective about both
facilities was statistically significant (P < 0.00001). All of them trusted the staff and the services
provided at the study center completely. Around 97% thought the services were made according
to their convenience. About 59% spent on drugs and logistics after visiting the nearest government
facility, whereas only 10.8% admitted to having spent on drugs and logistics after visiting the study
center.
CONCLUSIONS: Faith‑oriented health‑care seeking behavior seems to dominate the health scenario.
It is influenced by realistic factors such as accessibility, affordability, and acceptability.

Abstract INTRODUCTION: Interoperability will provide similar understanding on the meaning of communicated
messages to intelligent systems and their users. This feature is essential for controlling and
managing contagious diseases which threaten public health, such as acquired immunodeficiency
syndrome (AIDS). The aim of this study was also designing communication protocols for normalizing
the content and structure of intelligent messages in order to optimize the interoperability.
MATERIALS AND METHODS: This study used a checklist to extract information content compatible
with minimum data set (MDS) of AIDS. After coding information content through selected classification
and nomenclature systems, the reliability and validity of codes were evaluated by external agreement
method. The MindMaple software was used for mapping the information content to Systematized
Nomenclature of Medicine‑Clinical Terminology (SNOMED‑CT) integrated codes. Finally, the Clinical
Document Architecture (CDA) format was used for standard structuring of information content.
RESULTS: The information content standard format, compatible selected classification, or
nomenclature system and their codes were determined for all information contents. Their
corresponding codes in SNOMED‑CT were structured in the form of CDA body and title.
CONCLUSION: The complex and multidimensional nature of AIDS requires the participation of
multidisciplinary teams from different organizations, complex analyzes, multidimensional and complex
information modeling, and maximum interoperability. In this study, the use of CDA structure along
with SNOMED‑CT codes is completely compatible with optimal interoperability needs for AIDS
control and management.

Abstract INTRODUCTION: Health care is considered as a human right, and fair financial contribution to health
care plays an important role in providing effective services for all members of society. This study
aimed at investigating the effects of targeted subsidy plan (since 2010) on equality in health‑care
financing in Iran from 2004 to 2014.
MATERIALS AND METHODS: This was a descriptive‑analysis, cross‑sectional study that was
conducted using data obtained from households’ expenditure‑income survey that is performed every
year by the Statistical Center of Iran. The Lorenz curve, Gini coefficient, and  Theil index were applied
to measure inequality in  healthcare expenditures (HEs). Furthermore, the Kakwani index was used
to examine inequality in health‑care finance during the study period. The analysis was performed
using Stata version 13.
RESULTS: Kakwani index was negative for all the studied years, except 2007. The value of this
index was equal to −0.032, −0.045, and −0.046 in 2004, 2008, and 2014 for rural areas and was
equal to −0.041, −0.029, and −0.0001 for urban areas, respectively. Despite the Kakwani index has
been negative for most of the years, which reflects regressive financing in health care, there is no
significant change in the trend of this indicator after the implementation of the subsidies. In addition,
this indicator is moving toward being positive (progressive) in urban areas in 2014, which represents
increased share of the poor in health payments.
CONCLUSIONS: According to the results, the targeted subsidy plan could not reach to its purpose in
health‑care system for supporting the poor from HEs. It is recommended for policy‑makers to design
a specific plan for health‑care financing and to allocate some defined resources such as taxes or
subsidies to health‑care sector.

Abstract BACKGROUND: The main issue for advancing any health system is human resources for
health (HRH); although efforts to address HRH shortage and performance have accelerated over
recent years, HRH is still a problem for delivering quality services. Addressing key governance issues
is essential for developing capable health workforce, and good governance should be an integral
part of planning and implementation of HRH.
MATERIALS AND METHODS: This is a qualitative study, undertaken in 2017. Data processing
included 14 in‑depth interviews with the experts of human resource management in medical
universities and the Ministry of Health and Medical Education. The sampling was carried out using
purposeful sampling method and continued until reaching data saturation. Data analysis was
performed using subject analysis method.
RESULTS: This study assessment of the human resource governance in ten principles includes
strategic vision, participation and consensus orientation, rule of law, transparency, responsiveness,
equity and inclusiveness, effectiveness and efficiency, accountability, intelligence and information,
and ethics. The result showed that although MOHME tries to reduce insufficient and unbalance’s
human resources and expand the capacity building in human resource planning, there are not enough
practical knowledge and skills among policy‑makers.
CONCLUSIONS: Strengthening human resource governance should have been among the priorities
identified in the health national strategy and government should have a long‑term perspective, and
all key factors in government, civil society, academia, and other stakeholders should participate in
human resource policy‑making and their participations should be accepted as a culture.

Abstract Results of previous studies about the effect of Kangaroo Mother Care (KMC) on hospital management
indicators (HMIs) (length of stay [LOS], readmission to hospital, parent satisfaction, and parent’s
preference for same postdelivery care) had high confusions. The aim of this study was to conduct a
systematic review and meta‑analysis of randomized controlled trials on the effect of KMC on HMI in
comparison with the conventional neonatal care (CNC). In this systematic review and meta‑analysis
study, required data were collected by searching the following keywords: “length of stay,” “readmission
to hospital,” satisfaction,” same post‑delivery,” “hospital management,” indicators, “skin‑to‑skin,”
“Kangaroo Mother Care,” randomized trial. The following databases were searched: Google Scholar,
PubMed, EMBASE, Scopus, and Cochrane. To estimate the hospital management indicators,
computer software Comprehensive Meta‑Analysis 2 was used. Finally, 18 articles were included
to analysis. The overall LOS standard different between groups (KMC vs. CNC) was − 0.91 days
(95% confidence interval [CI], −2.14–0.32, Q = 25.6, df = 10, P = 0.004, I
2 = 60.98). The overall
readmission to hospital standard different between groups was − 1.78% (95% CI, −1.21%–0.86%,
Q = 0.024, df = 1, P = 0.87, I
2 = 0.00). The overall parent satisfaction standard different between
groups was 5.3% (95% CI, −32.4%–43%, Q = 0.052, df = 2, P = 0.97, I
2 = 0.00). The overall standard
different between groups was 16.2% (95% CI, −24.7%–57.1%, Q = 0.040, df = 1, P = 0.84, I
2 = 0.00).
KMC improves HMI but not significantly. According to the current study result and other studies that
report positive effect of KMC on health status of the newborns and parents, implemented of KMC in
low‑ and middle‑income countries recommended.

Abstract BACKGROUND AND OBJECTIVES: Hypertension in pregnancy is one of the most important
unsolved problems in midwifery, and since it is the main cause of maternal death, preventive
intervention measures are essential to control this serious complication. This study aimed to determine
the effect of walking on gestational hypertension disorders in women prone to hypertension.
MATERIALS AND METHODS: This randomized clinical trial was conducted on 72 pregnant women
susceptible to gestational hypertension who were randomly (through a random number table)
assigned into two groups of 36. The pregnant women in the experimental group had walking program
for 20–30 min from weeks 14–34, four times a week. Data were analyzed, via independent t‑test,
Fisher’s exact test, and Chi‑square test.
RESULTS: The results indicated that in the experimental group, 2 cases with transient gestational
hypertension and 1 case of preeclampsia existed, and in the control group, 9 pregnant women
were with gestational hypertension and 4 pregnant women were with preeclampsia. Therefore, the
incidence of these two complications in the experimental group was significantly lower than the control
group (P < 0.05). Moreover, the mean systolic and diastolic blood pressures in the experimental
group were significantly lower than the control group (P < 0.05).
CONCLUSION: Based on the results, the moderate walking, as an easy physical activity, is
recommended for pregnant women susceptible to pregnancy hypertension.

Abstract INTRODUCTION: The number of elderly people is growing in different communities like Iran,
increasingly. Malnutrition prevalence is unknown among elderly patients with diabetes. Malnutrition
is a common risk factor in elderly people with diabetes that may affect their health.
SUBJECTS AND METHODS: This study is a random clinical trial. There are 200 samples in this
study chosen randomly and divided into two intervention and control groups (100 each). Data of
both groups were collected in the same way, before and 3 months after the intervention. Educational
intervention was based on pretest, baseline BASNEF model, and Mini Nutritional Assessment
questionnaire in four sessions.
STATISTICAL ANALYSIS USED: Descriptive indices were used to analyze the data while
Chi‑square, t‑test, one‑way ANOVA, and correlation tests were used to examine the relationship
between variables.
RESULTS: The results were significantly different after intervention (P < 0.05), but they were not
significantly different in control group after 3 months (P > 0.05). It was clear that 22% of samples
had normal nutrition (score >24), 29% of participants were exposed to malnutrition, and 51% of
samples were suffering from malnutrition. These numbers were 20% for normal nutrition, 30% for
exposing to malnutrition, and 50% for suffering from malnutrition in the control group, respectively.
Fifty percent of elderly people with diabetes suffered from malnutrition and almost half of them had
normal nutrition that was 20%.
CONCLUSIONS: BASNEF‑based nutrition education intervention improves nutritional behaviors in
addition to knowledge and attitude of elderly people with type 2 diabetes. It led to improve indices
of glucose control during 3‑month intervention.
AIMS: The aim of this study was to investigate the nutritional status of elderly people with diabetes
and the effect of educational intervention based on the BASNEF model on promoting nutritional
behaviors in the elderly with type 2 diabetes in Babol city, Iran.

Abstract BACKGROUND: Today, the scope of dental activities is a broad range from the needs assessment
for epidemiological studies to the implementation of comprehensive programs for the prevention of
oral diseases at various levels of the society. This study aimed to identify and prioritize the need
researches in the field of oral and dental health in a dental hospital in Tehran, Iran.
METHODS: This applied research was a mixed methods study carried out in Tehran, Iran, in
2018. The data gathering tool included a data collection form used for reviewing the documents,
a semi‑structured interview, and an open questionnaire. MAXQDA 10.0, Expert Choice 11.0, and
Technique for Order of Preference by Similarity to Ideal Solution (TOPSIS) software were used for
analyzing the collected data.
RESULTS: After analyzing the results of the qualitative phase, 171 research topics in 6 areas
were obtained, including 44 topics in “dental clinical care and treatment,” 37 topics in “health and
prevention,” 19 topics in “education and health promotion,” 37 topics in “management of dental care
delivery,” 16 topics in “policy and its requirements,” and 18 topics in “dentistry materials, equipment
and technologies.”
CONCLUSION: According to the results, it can be recommended that the research resources should
be allocated based on the priorities identified by the present study so that the studied hospital has
the highest dynamic performance in achieving its goals and objectives.

Abstract CONTEXT: Lifestyle modifications play a major role in controlling blood glucose levels among
diabetes mellitus for the prevention of its complications. Mobile phones can be used as an efficient
tool for improving the healthy lifestyle through health education.
AIMS: The aim of the study is to measure the efficacy of behavior change communication using
mobile calls in controlling blood sugar levels, increasing medication adherence, healthy diet, and
physical activity among diabetic patients.
SETTINGS AND DESIGN: A randomized controlled trial was conducted in an urban area of
Pondicherry between 50 (25 per arm) type 2 diabetes patients.
SUBJECTS AND METHODS: All participants were interviewed using a structured questionnaire.
Fasting blood glucose (FBG) was measured. Single‑time health education was given to both
groups. The intervention group received a mobile phone calls reminders thrice weekly for 2 months.
Changes in FBG, diet, physical activities, and adherence to medications were assessed after
2 months.
STATISTICAL ANALYSIS USED: Means and proportions were calculated. Chi‑square test and
paired t‑test were used to calculate the P value.
RESULTS: FBG increased significantly in the control group by 25.6 mg/dl (P = 0.03), whereas it
was only 6.5 mg/dl in the intervention group (P = 0.56). Adherence to medications was increased
significantly in both interventions (+21%) and control (+19%) groups. Number of fruits intake days
per week (+1, P = 0.01) and fruits serving per day (+0.5, P = 0.00) have increased significantly in
the intervention group. Recreational physical activity was increased in the intervention group but
not statistically significant.
CONCLUSION: Our study findings suggest that mobile phone calls might help to improve
glycemic control. It also suggests that it could improve the adherence to medications and
intake of fruits. In the future, studies with large sample size and longer intervention need to be
conducted.

Abstract BACKGROUND: Pregnancy is associated with negative psychological symptoms (NPS) and multidimensional pain. Therefore, the present study was conducted to determine the effect of the combination of Benson’s relaxation technique (BRT) and brief psychoeducational intervention (BPI) on multidimensional pain and NPS of pregnant women. MATERIALS AND METHODS: The present randomized clinical trial was conducted on pregnant women referred to Imam Reza and Motazedi Hospitals in Kermanshah, Iran. In this regard, 60 pregnant women were randomly allocated to intervention (n = 30) and control (n = 30) groups. The groups attended BRT and BPI educational sessions for 4 weeks, but the control group received no intervention. Subsequently, both groups completed Depression Anxiety Stress Scale‑21 and multidimensional pain inventory. RESULTS: The mean NPS (stress, anxiety, and depression) was significantly decreased in the intervention group (P < 0.001), while no statistically significant differences were observed in the control group (P > 0.05). The independent t‑test revealed a significant difference between the mean scores of intervention and control groups (P < 0.001). The mean multidimensional pain was significantly decreased in mothers after the completion of educational sessions (P < 0.001), and the independent t‑test results indicated a significant difference between the scores of the intervention and control groups (P < 0.001). CONCLUSION: The results of this study suggested that the combination of BRT and BPI can lead to a reduction in the NPS and multidimensional pain in the pregnant women. This intervention is recommended to be considered as part of a healthcare program in pregnant mothers. 

Abstract INTRODUCTION: One of the main criteria for students’ merit in their study process and reaching the
graduation step, is academic success. Therefore, identifying related factors can help the improvement
of academic success rate. The aim of this study was to examine the academic success and related
factors among the students of University of Tehran.
MATERIALS AND METHODS: This cross‑sectional study was done on 384 students of Tehran
University of Medical Sciences. Samples were selected through stratified sampling method. Data
were collected through questionnaires of academic success scale 39 that reliability and validity of
that were confirmed. Data analysis was done through SPSS18 software. Descriptive statistics and
independent t‑test, and correlation coefficient were performed at significance level of 0.05.
RESULTS: The mean academic success was 108.87(standard deviation[SD] =10.63) (69.78% of total score).
The mean academic success in male was 110.04 (SD = 11.75) and in female was 108.20 (SD = 9.91).
Independent t‑test results indicate that there is a significant statistical relationship between marital status and
the academic success (P< 0.05). The Pearson correlation test results showed that there was a statistically
significant relationship between average with academic success (r = 0.17, P = 0.001).
CONCLUSION: Considering the effect of demographic variables on the academic success rate,
academic success rate can be improved by planning to improve these factors.

Abstract BACKGROUND: Thalassemia is an inherited blood disorder which is one of the common genetic
disorders among children that is increasing worldwide.
AIM AND OBJECTIVE: This study aimed to identify clustering patterns among thalassemia‑affected
families based on their well‑being, transfusion interval, and risk factors using two‑step cluster
analysis (TCA).
METHODS: The study design is a descriptive, analytical cross‑sectional study. The study sample
consisted of 125 thalassemia children along with either one of the parents who referred to a
thalassemia treatment center of a pediatric hospital in Chennai, Tamil Nadu. The parents and
children were evaluated using the Ryff Psychological Well‑being Scale and Kidscreen Questionnaire
respectively. Data were analyzed using SPSS version 16.0 software.
RESULTS: Out of 125 parents, 86 were father (68.8%) and 39 were mother (31.2%). The mean
age of parents was 38 years. Similarly, out of 125 thalassemia‑affected children, the mean age of
children was 13 years. Six clusters were deducted from the TCA. Parents’ well‑being variable does
not have discriminating power to form cluster division. Three cluster formations were meaningful.
CONCLUSION: TCA, in this study, helps in finding the clusters of families with thalassemia‑affected
children associated with poor well‑being and familial risks, which require attention for medical
counseling.