Journal of Education and Health Promotion

Abstract Iran as a developing country is at risk of vulnerability to technological disasters. These types of
disasters occur frequently in last years and affected thousands of lives. Technological disasters
in Iran cause thousands of deaths, thousands of injuries, and millions of dollars’ economic loss in
recent years. We searched suitable keywords in national and international disaster databases for
gathering epidemiological data in these disasters in Iran. In addition, we searched suitable keywords
in scientific databases including Google Scholar, Scopus, PubMed, Web of Knowledge, Scientific
Information Database, Magiran, and Irandoc. After screening, only 19 articles discussed challenges
of technological disasters in the country. Road accidents, explosions and fires, mine accidents, and
railway accidents are common events in the country. After 2015, these types of disaster cause 823
deaths and injuries. Experience of response to these disasters showed that technological disaster
management in the country faces too many challenges including comprehensive and prospective
programs, weakness of necessary infrastructure for urban management, weakness in group work
and interorganizational coordination, lack of coherent involvement of people and nongovernmental
organizations, lack of information coverage during the disaster, volunteers in police service presence
at scene, and normalization of these events. Due to interorganizational nature of mitigation in
technological disasters, it must be developed coordination between various organizations to mitigate
these types of disasters.

Abstract BACKGROUND: One of the main psychological problems in hemodialysis patients is hopelessness.
Spiritual health leads the patients toward hope and goal in life. Given the importance of the issue
and the little research in this area, this study aimed to assess hope and its relationship with spiritual
health on hemodialysis patients in Rasht Razi Hospital of Iran.
MATERIALS AND METHODS: This correlational study carried out on 103 patients who admitted
in Rasht Razi Hospital Hemodialysis Center by simple random sampling. The data were collected
through Snyder’s Hope Scale and Spiritual Health. The psychomotricity of these questionnaires has
been confirmed in domestic studies. The data were analyzed by using descriptive and inferential
statistics (Pearson correlation coefficient).
RESULTS: The majority of the patients were male (59.2%), in the age group of above 60 (46.60%),
married (83.5%), with low income (60.2%), and under diploma (53.4%). The mean of hope score
was 36.36 (±9.10) that showed the high level of hope in the majority of the patients. The mean of
the total spiritual health score was 227.93 (±19.01) that indicates the high level of spiritual health in
hemodialysis patients. There was a positive and significant correlation between spiritual health and
its dimensions and hope (P < 0.05).
CONCLUSIONS: The results of this study approve the importance of spiritual health as an effective
variable on hope among hemodialysis patients. Hence, health‑care providers and clinical experts
are recommended to focus on spiritual health to increase hope among such patients.

Abstract INTRODUCTION: Hypertension has a direct relationship with the circulation, respiration, and function
of vital organs. Similarly, complementary therapy such as alternate nostril breathing exercise has a
direct effect on mental and physical health.
MATERIALS AND METHODS: This is a quantitative experimental research with randomized
controlled trial design. A total of 170 and 85 individuals were allotted to each group. Patients in the
study group were instructed alternate nostril breathing exercise two times a day (10 min duration
of exercise each time) for 5 days along with routine treatment, and patients in the control group
underwent routine treatment.
RESULTS: There was a marked reduction in systolic blood pressure (BP), diastolic BP, heart rate,
and rate pressure product after the continuous 5‑day alternate nostril breathing exercise in the study
group. P < 0.0001 demonstrated a statistically significant difference in systolic BP, diastolic BP,
heart rate, and rate pressure product that existed pre‑ and post‑assessment on 1st day and 5th day.
CONCLUSION: It can be concluded that regular simple alternate nostril breathing exercise effectively
reduces hypertension.

Abstract BACKGROUND: Although the World Health Organization has emphasized the need for reorientation
of hospitals toward health promotion (HP), HP in hospitals of Iran is a new concept. This study
investigated the concept of HP among health‑care professionals working in educational hospitals
of Isfahan, Iran, 2015.
METHODS: A descriptive exploratory qualitative approach was employed in this study, with
semi‑structured interviews to investigate HP concept. The study settings included four selected
educational hospitals affiliated to the Isfahan University of Medical Sciences. A purposive sample
consisted of 15 health‑care professionals who were participated in the study.
RESULTS: Most of the participants perceived HP as a concept synonymous to health education and
disease prevention. Other meaning attributes to HP were improved quality of life and well‑being,
clinical practice, individual and group approach to increase health, and holistic view to health. Some
empowerment strategies were described by participants, but most of the participants rarely went
beyond traditional health education strategy aimed at an individual target. A sizeable number of
participants used interchangeably the terms “health promotion” with “prevention,” “health education,”
and “hygiene”.
CONCLUSIONS: It seems that participants of this study had limited knowledge about HP. Health‑care
staff have a decisive role for reorienting hospitals toward HP; thus, there is a need for ongoing
in‑service training for health‑care professionals of hospitals to focus on HP.

Abstract BACKGROUND: Although prevention the birth of children with β‑thalassemia major (β‑TM) is an
important health issue, it is rarely explored. With this background, the study was designed to find
family planning practices and related factors of couples with children affected by β‑TM.
MATERIALS AND METHODS: This was a cross‑sectional, observational study, conducted among
324 parents with children affected by β‑TM attending a tertiary care health facility in Eastern India.
Data were analyzed using univariate and multivariable logistic regression using SPSS.
RESULTS: Of 324 parents, 89.5% were sexually active, 44.8% of which were currently using
family planning method to prevent the birth of another child with the oral contraceptive pill most
preferred (46.9%) followed by tubectomy (33.9%). Those who were sexually active, but not desirous of
a child were 223, of which 41.7% had the unmet need for family planning with religious belief (41.9%)
being the most predominant reason followed by unaware of methods (26.9%). In multivariable
analysis, religion, caste, per capita monthly income, mothers’ education level, and working status
were significant predictors of unmet need for family planning adjusted with others.
CONCLUSIONS: Burden of unmet need for family planning among the study population was
alarmingly high. Parents of the thalassemic children should be counseled in easily comprehensible
local language to increase the rate of contraception among them.

Abstract BACKGROUND: Disaster risk is a product of a combination of hazard, exposure, and vulnerability.
Governance in the health system is a multifaceted sphere, with political, economic, and legal
dimensions. Disaster risk governance is an analytical framework employed for assessing the
capacity of institutional governance. This study has been conducted to investigate the current
status of national strategy documents concerned with disaster risk governance in Iran through
document analysis.
MATERIALS AND METHODS: The investigated documents were collected through requests from
the secretariat and the archives. 102 documents were analyzed. Twelve documents in the domain
of accountability, 7 in participation, 9 in state and nonstate actor, 14 in knowledge sharing, 21 in
sustainable developments, and 19 documents in integrated risk management were analyzed. The
process of analysis included selecting documents and evaluating and analyzing them by content
analysis method.
RESULTS: Documents coded according to the main areas of policymaking in disaster risk governance
were analyzed, and sub‑component and related topics were deduced in each domain. The acquired
themes include unity of command, trustee, commitment, capacity prosperity, align strategy, information
synergy, knowledge enhancement, sustainable security, justice clarity, land use planning, climate
change adaptation, environment reform, wisdom, environment, diplomacy, capacity and coherence.
CONCLUSIONS: Disaster good governance is strengthened by the trustee, commitment, capacity
prosperity, align strategy, and organize. Information synergy and knowledge enhancement are
effective in the culture of prevention. Collective wisdom, diplomacy, and capacity coherence raise
the alignment of public organizations and the government in the risk management process.

Abstract BACKGROUND: The integration of information and communication technology (ICT) in education
has been a major agenda of the Association of Southeast Asian Nations and its adoption has been
found effective in nursing education.
OBJECTIVE: This study aims to identify and review existing literature on ICT integration in nursing
education within the context of Southeast Asia and to identify the themes of these studies, ICT tools
of concern and the research methods adopted.
METHODOLOGY: A systematic review of six eligible literatures was conducted with thematic analysis.
The data for this systematic review of literature are from published studies based on the formulated
research question. Electronic databases of Medline, Scopus, PubMed, CINAHL, Mendeley, and
Google Scholar were searched and literatures retrieved and screened for eligibility. No date limit was
considered in the literature search. This systematic review utilized the Preferred Reporting Items for
Systematic Reviews and Meta‑Analyses.
RESULTS: The studies originated from the Philippines (n = 3), Malaysia (n = 2), and Singapore (n = 1).
One study originated from both the Philippines and Thailand. Four themes emerged from the thematic
analysis which include: (1) use of ICT to enhance teaching and learning in nursing, (2) challenges with
ICT integration in nursing education, (3) attitude and perceptions toward ICT integration in nursing
education, and (4) suggestions for improvement. The most important ICT tools were computers,
projectors, and internet. Majority of the studies were descriptive quantitative studies.
CONCLUSION: Despite increasing concern on the use of ICT in Southeast Asia, ICT integration
in nursing education has not been given significant attention. Governments of the Southeast Asian
countries should provide sufficient support for ICT integration in the various nursing institutions.
Institutional administrators are encouraged to key into the ICT trend and render their support when
and where necessary.

Abstract CONTEXT: Selecting variables is a fundamental step in evaluating comparative efficiency because
the results of measuring efficiency depend on the used variables.
AIMS: The aim of this study is to provide a comprehensive set of input and output variables for
measuring efficiency with an emphasis on application in general hospitals in Iran.
MATERIALS AND METHODS: This study comprised a literature review followed by a Delphi survey
process. After extracting the variables from the literature review in order to reach consensus on them
and identify the native variables, the researchers used the Delphi technique in three rounds. Thirty
Iranian hospital managers, in Alborz, Saveh, Qazvin, Qom, and Hamadan universities, participated
in this study. For analysis, the interquartile range (IQR) and median were used. IQR was used to
assess the agreement of Delphi panel members.
RESULTS: After literature review, nine indicators were identified as input variables and 11 indicators
were identified as output variables. After the proposed changes by Delphi members, 24 input variables
and 24 output variables were identified to measure hospital efficacy. Finally, ten variables were
selected as inputs and ten variables were selected as outputs to measure the performance of public
hospitals in Iran by using the consensus of the members in the Delphi panel.
CONCLUSIONS: This study proposes a framework for selecting the most appropriate variables for
measuring the hospital efficiency with an emphasis on nonparametric methods. Choosing variables
to measure hospital efficiency requires infrastructure such as an intelligent information system.

Abstract BACKGROUND AND AIM: The inability of women to demand from their husbands, for not smoking,
has been reported as a factor in exposure to cigarette smoke. This study aimed to investigate the
perceived barriers and self‑efficacy of pregnant women regarding second‑hand smoke (SHS) at home.
MATERIALS AND METHODS: This was a cross‑sectional study, and the sample size was 255
pregnant women who visited the health‑care centers in Isfahan, Iran, from July 2018 to September
2018, and were selected randomly and voluntarily. A questionnaire was designed to collect the
data about the exposure to smoke, perceived barriers, and self‑efficacy. The data were analyzed
using descriptive statistics (mean score and standard deviation), inferential statistics (nonparametric
Mann–Whitney and Kendall test), and Spearman’s correlation and regression.
RESULTS: The mean score of self‑efficacy in the exposure group was lower than that the other
group (P = 0.000). The mean score of perceived barrier was not a significant difference (P = 0.449).
Personal perceived barriers are the most important predictor of self‑efficacy of pregnant women
in exposure to SHS (95% confidence interval: 0.013–0.262) (P = 0.030). Kendall test comparing
items within the group and Mann–Whitney test comparing the two groups showed that personal
factors such as “Unaware of the dangers of SHS and protective measures” for notexposed women
and environmental factor “the lack of ban smoking law at home” for exposed women are considered
the most important barriers (P = 0.000). “Not being together a husband” (P = 0.293) and “going to
another place when smoking a husband” (P = 0.000) are the highest self‑efficacy items.
CONCLUSIONS: It is necessary to develop training programs to increase self‑efficacy to avoid
exposure to SHS and for both pregnant women and their husbands. It is also necessary to educate
and inform about SHS and protective measures against it and to set up “smoking ban law” at home
in our country to protect pregnant women.

Abstract BACKGROUND: Voluntary counseling and testing (VCT) is one of the main efforts for the prevention
of high‑risk sexual behavior, including HIV/acquired immunodeficiency syndrome (AIDS). The aim of
this study was to determine cognitive determinants related to voluntary counseling and HIV testing
among Iranian adults based on the integrative model of behavioral prediction (IMBP).
MATERIALS AND METHODS: This cross‑sectional study was conducted in 2018 among Iranian
adults with high‑risk sexual behaviors, including drug abuse and unprotected sex, in western Iran.
A total of 300 adults were randomly selected to participate voluntarily in this study. Participants filled
out a self‑administered questionnaire, including the background data and IMBP constructs. Data were
analyzed by SPSS version 21, using statistical treatments, such as bivariate correlations, Chi‑square
test, t‑test, and logistic regression at a 95% significant level.
RESULTS: Almost 73.3% of the participants had a history of VCT. The highest probability of VCT
use was in participants who were in high level of VCT skills (odds ratio: 9.635; 95% confidence
interval [CI]: 3.255, 28.514]), following environmental constraints (odds ratio: 6.274; 95% CI: 2.166,
18.171). Furthermore, the IMBP constructs accounted for 85% of the variations in the outcome
measure of the VCT use intention.
CONCLUSIONS: Based on the result, it appears that the design and implementation of educational
programs to improve upon skills and environmental constraints toward VCT use among adults with
high‑risk behaviors could be useful to the promotion of VCT.

Abstract BACKGROUND: Considering the high prevalence rate of congenital hypothyroidism CH in Iran, an
epidemiological study in each region would be helpful in understanding the etiology of the disorder
and providing preventative strategies in this field. This study aims to determine the prevalence of
CH in different cities of the Isfahan province.
MATERIALS AND METHODS: This descriptive and retrospective study was conducted among 918
primarily diagnosed CH neonates, who have been identified through the neonatal screening program
from 2009 to 2015. At the age of ≥3 years, treatment was discontinued for 4 weeks, and T4 and
thyroid‑stimulating hormone were measured. Permanent (PCH) or transient (TCH) was determined
from the results of the thyroid function tests.
RESULTS: From 389,101 screened neonates, 918 were diagnosed with primary CH. The overall
prevalence rate of CH was 2.36 in 1000 live birth (ranged 1.58–7.22 in 1000 live birth in different
cities). The highest prevalence rate of CH was reported in Ardestan, Khansar, Golpaygan, and Nain
cities with prevalence rate of 4.86–7.22 in 1000 live birth and lowest prevalence occurring in Fereydan,
Shahreza, Isfahan, and Mobarakeh cities with prevalence rate of 1.58–1.89 in 1000 live birth. In
392 cases which reached to 3 years of age, the rate of TCH was 47.45%. In Chadegan, Natanz,
Fereydunshahr, Shahinshahr, Najafabad, Dehaghan, Borkhar, and Mobarakeh, the prevalence of
PCH was <50%.
CONCLUSION: The current findings indicate that the incidence rate of both PCH and TCH are
high in Isfahan province with significant variability in different cities which could be due to the role
of different genetic, prenatal, and different environmental factors. These epidemiological data could
be used as baseline date to design more etiological studies.

Abstract OBJECTIVE: Self‑efficacy is an individual’s self‑perception of one’s ability to perform competently
and to achieve a task or goal effectively. In the nursing field, self-efficacy can be useful in predicting
performance, job satisfaction, or well-being. Therefore, due to the importance of this issue, this study
aimed to determine the effect of educational workshop on nurses’ self‑efficacy along with follow‑up
in patient training.
METHODS: The study employed a single group quasi‑experimental study with a pretest/posttest
design and was conducted in one educational hospital supervised by the Kerman University of Medical
Sciences in 2016. Nurses’ self‑efficacy was analyzed through a researcher‑made questionnaire
prior and after the workshop and along with the follow‑up period (n = 20). Data were analyzed using
descriptive statistics including mean and standard deviation and analytic statistics such as Pearson
correlation coefficient, independent t‑test, paired t‑test, and ANOVA with P ≤ 0.05.
RESULTS: This study showed that 1 month after educational workshop, the score of self‑efficacy
dimensions increased (P < 0.05). Furthermore, results showed that after a 3‑month follow‑up period,
self‑efficacy score increased in comparison to preintervention self‑efficacy score. Results showed that
the total score means of self‑efficacy before the workshop was 59.01 ± 14.91 while postworkshop,
self‑efficacy score means was 79.83 ± 11.90.
CONCLUSION: The present research results presented that educational workshop may enhance
self‑efficacy among nurses. According to the obtained results, it is recommended that the Ministry
of Health, Treatment and Medical Training, in cooperation with nursing institutions responsible for
nursing and medical in‑service education adopt necessary measures to enhance self‑efficacy among
employees in addition to improving patient training condition at medical processes through similar
workshops or conducting related studies.

Abstract BACKGROUND: Teaching religious principles can inevitably strengthen the mothers’ motivation
and may improve the infant’s growth indices. This study aimed to investigate the effect of teaching
religious principles on the infants’ growth and development from birth up to the age of 3 months.
METHODS: In a randomized controlled tria1, 84 primiparous women who had average or weak
religious attitude were randomly divided into intervention and control groups in 2013. The intervention
group attended six 90‑min sessions of religious education held once a week. The control group
received the routine pregnancy care. Data were collected through physical growth indices and
Denver’s questionnaire.
RESULTS: A significant difference was found between the intervention and control groups regarding
the head circumference at birth (34.61 ± 1.51 vs. 32.97 ± 6.98). Besides, a significant relationship
was observed between religious knowledge before delivery and infants’ development in gross motor
skills (P = 0.047, r = 0.114) and major motor skills (P = 0.019, r = 0.359) at 1 month of age, and
also language skills (P = 0.015, r = 0.119), major motor skills (P = 0.008, r = 0.404), and fine motor
skills (P = 0.035, r = 0.425) at the age of 3 months in the intervention group.
CONCLUSION: Training the pregnant mothers regarding religious principles was effective in some
indices of infants’ physical growth and development.

Abstract BACKGROUND: Knowledge of medical students about research has been little explored. Although
there has been a practice of medical research among undergraduate level, the practice is not universal
and there have been potential barriers and difficulties in carrying out the research. The present study
was done to find the perception and attitude toward medical research and to assess the practices
and potential barriers in carrying out medical research.
METHODOLOGY: This cross‑sectional study was conducted among 344 medical school students
of a medical college in Chennai, Tamil Nadu, in 2018. Systematic random sampling was used.
The study tool was self‑administered questionnaire including questions on knowledge, barrier, and
5‑point Likert scale for assessing attitude. Adequate knowledge (>70% correct answers) and positive
attitude (>25 score) were considered.
RESULTS: Among the 344 study participants, only 127 (36.9%) of students had adequate knowledge
and 68 (19.8%) had positive attitude toward medical research. Regarding practice of research, only
34.3% had conducted a research and only 17.4% had published in journals. Difficulty in choosing
topic, difficulty in collecting data, and allocation of time amidst academic activities were considered as
a barrier by 41.6%, 40.7%, and 45.9%, respectively. Association of adequate knowledge and practice
was statistically significant for age (P = 0.000), gender (P = 0.000), and academic year (P = 0.000).
CONCLUSION: Adequate knowledge and positive attitude were lacking in majority of students.
Barriers could be addressed by support programs and sensitization toward research.

Abstract BACKGROUND: Marital satisfaction, as one of the elements of family health, is affected by various
factors such as social norms, customs, and expectations. Sexual self‑efficacy as one of the important
aspects of female sexual affairs may be related to the marital relationship. The aim of this study was
to evaluate the related factors of marital satisfaction in Torbat Heydariyeh, Iran.
METHODS: This research was a cross‑sectional study performed on 350 married women in the
reproductive age referred to health centers in Torbat Heydariyeh, Iran, in 2018. The data collection
tools were Evaluation and Nurturing Relationship Issues, Communication, and Happiness Marital
Satisfaction Questionnaire and a sexual self‑efficacy questionnaire derived from Schwarzer general
self‑efficacy scale. The data were analyzed with Pearson’s correlation coefficient and linear regression.
A P < 0.05 was considered statistically significant.
RESULTS: The mean age of the participants was 30.85 ± 7.56 years. Most people had high sexual
self‑efficacy (51%) and relative and intermediate marital satisfaction (68%). There was also a
significant relationship between sexual self‑efficacy and marital satisfaction (P = 0.001). According to
the linear regression test, only three variables of sexual self‑efficacy, dyspareunia, and socioeconomic
status explain 12% of the variance of marital satisfaction in women (P < 0.05).
CONCLUSION: The results indicated that sexual self‑efficacy, dyspareunia, and socioeconomic
status have significant relationship with marital satisfaction. Due to the significant relationship between
sexual self‑efficacy and marital satisfaction, some interventions to improve this aspect of sexual life
may increase the satisfaction of individuals from marital life.

Abstract CONTEXT: Rabies is a viral zoonotic infection of the central nervous system. Annually more
than 59,000 people die of rabies worldwide; human rabies can be prevented by using proper
postexposure prophylaxis. A major component of successful rabies surveillance is well‑educated
medical professional.
AIMS: The aim of this study is evaluate the effect of concept mapping as an active teaching method
on medical students’ knowledge about rabies prophylaxis.
SUBJECTS AND METHODS: It was a pre‑ and post interventional study carried out on 80 medical
interns. Our intervention included Group 1 – trained by concept maps – and Group 2: – trained by
book reading. Data gathering tool was the researcher‑made questionnaire that consisted of seven
open‑ended questions that assessed the interns’ knowledge about animal bite surveillance.
STATISTICAL ANALYSIS USED: Students’ scores of pre‑ and posttests have been analyzed with
paired t‑test and independent t‑test.
RESULTS: Comparing the pre‑ and posttest scores of students in two groups by paired t‑test showed
that interventions have been effective in both the groups; posttest scores of both groups had increased
significantly (P < 0.001). Score mean difference in concept map group was significantly higher than
book reading group based on independent t‑test (P = 0.001).
CONCLUSIONS: It seems that concept mapping as a visual training tool for transferring the concepts
to medical students is more appropriate than the other traditional ones like book reading, but more
research is needed to be sure that active methods are better than traditional ones.

Abstract INTRODUCTION: Proper empowerment of medical students in encounter with the complexities of the
clinical environment is one of the requirements for health services. In this regard, the development of
problem‑solving skills, critical thinking is essential for medical education. The purpose of this study
was to investigate the effect of designing a blended training program on the practice and clinical
reasoning of midwifery students.
MATERIALS AND METHODS: In a quasi‑experimental study with control group, 41 undergraduate
midwifery students were randomly assigned to two intervention and control groups by four blocking.
In the first group, the 15‑h workshop was held in the traditional teaching method and in the second
group in the blended method, about three emergency aspects of midwifery. Data were collected
and analyzed through objective structured clinical examination and clinical assessment evaluation
before and after the educational intervention.
RESULTS: The mean and standard deviation of the age of participants were 23.54 ± 2.19 years.
The mean score of clinical practice before the beginning of the study in the integrated training group
was 16.68 ± 5.49 and at the end of the study was increased to 35.75 ± 4.54, which was significant
between the two groups (P = 0.035). The clinical reasoning score was changed at the beginning of the
study in the blended training group of 6.77 ± 3.57 and at the end of the intervention was 11.58 ± 2.83.
There was no significant difference between the two groups (P = 0.81).
CONCLUSION: The results showed that the use of blended methods in comparison with conventional
education can improve clinical practice, but the improvement of students’ ability in clinical reasoning
requires more effort.

Abstract INTRODUCTION: Factors affecting labor pain include physiological, psychological, and social factors,
among which psychological factors refer to attitudes and beliefs about labor pain. Hence, the present
study was conducted to determine the relationship between attitude toward labor pain and length of
the first, second, and third stages in primigravida women.
MATERIALS AND METHODS: This cross‑sectional study was performed on 230 pregnant
women who were referred to hospitals affiliated to Isfahan University of Medical Sciences in a
two‑stage sampling in 2018. In the beginning, the participants completed the questionnaire of
demographic/fertility characteristics and attitude to labor pain (25Q), and at the next stage, the
researcher completed the form of labor information including length of the labor stages. Data were
analyzed by SPSS software version 22 and Pearson correlation coefficient, Student’s t‑test, one‑way
ANOVA, and general linear regression.
RESULTS: The mean (standard deviation) of the attitude to labor pain was 53.96 (1.9), and the
length of the first stage was 10.01 (0.3) (h), the second stage was 1.6 (0.4) (h), and the third stage
was 15.9 (1.7) (min). One hundred and eighty‑three (79.6%) had negative attitude and 47 (20.4%)
had positive attitude toward labor pain. There was a significant positive correlation between attitude
toward labor pain and length of the first (P = 0.001, r = 0.37) and second stages of labor (P = 0.001,
r = 0.24).   There was no significant between length of third stage of labor and attitude toward labor
pain (P = 714).
CONCLUSION: The results showed that the majority of primiparous women had a higher (negative)
attitude toward labor pain, which was associated with  longe the first and second stages of labor.

Abstract INTRODUCTION: Food handlers with poor personal hygiene and lack of awareness in preventing
foodborne diseases working in hospitality sectors or hospitals could spread foodborne infections.
OBJECTIVE: Our study objective was to ascertain the impact of a video‑based educational
intervention program and administrative measures on improvement in personal hygiene of food
handlers in hospital.
METHODOLOGY: We conducted this pilot study among all 103 food handlers who were working in
a tertiary care hospital. A checklist‑based scoring and physical examination were conducted by the
investigator for the food handlers. After baseline scoring S1, intervention 1 and 2 was implemented,
and score was obtained as S2 and S3, respectively. Descriptive statistics was calculated, and score
was compared by repeated measures ANOVA test using SPSS‑22 software.
RESULTS: Our study revealed that a total of 19.2% of food handlers had health complaints. More than
half (54.8%) admitted that they had suffered from any kind of illness since last 6 months. Common illness
was viral fever (40.3%) followed by typhoid (5.7%), dengue (4.8%) and urinary tract infection (3.8%).
Most of the food handlers had long hair (62.5%) followed by long nail (57.69%). Nearly, one‑fifth (20.1%)
of food handlers nail was infected with fungus. Worm was found in 14.4% cases by stool examination.
Statistically significant (P < 0.05) improvement in score was observed after each intervention.
DISCUSSION: Poor hygiene (Score‑1 = 23.76) was observed at baseline study although there
was a mechanism in place for a yearly health checkup and regular (6 monthly) hygiene training.
After interventions (video‑based training and administrative measures), the score was improved to
Score‑3 (42.57). Statistically significant(P< 0.05) differences in hygiene score were observed for variables
such as state of residence, education level, and working experiences (inside or outside the hospital).
CONCLUSION: It is possible to improve personal hygiene among food handlers using video‑based
interactive training methods and administrative measures with no extra or minimal cost.
RECOMMENDATIONS: This “piggyback” approach of training can be imparted in addition to routine
training measures among the food handlers for improving their personal hygiene in the hospital setting.

Abstract