Journal of Education and Health Promotion

Abstract CONTEXT: Research experience helps an undergraduate student to understand published works, to
learn teamwork, and even to consider research as a career. Few medical institutions have attempted
to engage undergraduates in research experience. Competency‑based medical education has
emerged as a core strategy to educate and assess medical students worldwide.
AIMS: This study aims to develop and implement a competency‑based research methodology training
module for undergraduate students and find out students’ perception about this.
SETTINGS AND DESIGN: A cross‑sectional study of mixed design was undertaken in the Department
of Community Medicine, UCMS, Delhi, India.
METHODOLOGY: A competency‑based research training module was developed and implemented
with 4th semester undergraduate students posted in the department. Students’ feedback about the
module was obtained.
STATISTICAL ANALYSIS USED: For quantitative variables, means, ranges, medians, and
percentages were calculated. To find out students’ perception about the posting a qualitative analysis
was done.
RESULTS: The module was implemented with 25 students posted in the department in May 2017.
However, feedback was obtained from 23 students. About 83% of the students reported as highly
satisfied with the posting, 61% of the students mentioned that after completion of this posting, they
felt motivated to do further research. A qualitative analysis of the feedback showed that students
found the project helped them to enhance their knowledge and develop skills.
CONCLUSIONS: Competency‑based research methodology training can serve as a tool for teaching
research methodology to undergraduate students.

Abstract
CONTEXT: Information, specific tendencies, and skills are needed to provide oral care for the elderly
population, and these skills should be learned in dental schools.
AIMS: The aim of the study was to assess the status of geriatric dentistry education and meeting
the standards of facilities in dental schools in Iran.
SETTINGS AND DESIGN: In this cross‑sectional study, sampling was done by census method, and
all the 18 dental schools with a history of ≥6 years of establishment were selected.
MATERIALS AND METHODS: A checklist was prepared in two sections, including geriatric
dentistry education (existence of specific education module, considered time, specific department,
specific faculty members, continuing courses for dentists, relationship with geriatric nursing
houses, referral system, and specific clinics) and facilities and was distributed among dental
schools. The collected data were input into SPSS (Version 20.0. Armonk, NY: IBM Corp) and
analyzed descriptively.
RESULTS: After a regular follow‑up, 11 dental schools returned the completed checklists. Eight (72%)
of them had specific geriatric dentistry education module. Only one (9%) had specific faculty member,
continuing educational course, mobile clinic, and regular connection with geriatric nursing houses.
None of the dental schools had specific department, specific clinic for delivering care, and a referral
system from hospitals to the schools. There were no dental schools with a special transportation
system for the elderly and the staff to accompany the patients without attendants.
CONCLUSION: The status of geriatric dental education in Iran seems not adequate. Furthermore,
dental schools are not equipped with necessary facilities for delivering care to the elderly.

Abstract BACKGROUND: Observing professional behavior in clinical settings encounters many obstacles.
In this research, the effect of defects of the educational system in observing professional behavior
in clinical settings of Tehran University of Medical Sciences (TUMS) has been investigated.
MATERIALS AND METHODS: This qualitative content analysis study was conducted using focused
group discussions in TUMS. Twenty‑two focused group discussions with 182 faculty members,
medical students, and clinical staff were conducted. Conventional content analysis was used to
analyze the data.
RESULTS: One hundred and sixty codes (90 codes from the viewpoint of clinical staff and 70
codes from the viewpoint of faculty members and medical students) were extracted. The codes are
categorized into 4 categories and 17 subcategories. The categories include “educators’ imperfections,”
“inadequate initial training,” “lack of attention to continuous professional education,” and “lack of
passion for professionalism education.”
CONCLUSION: Greater efforts to empower educators, planning for the effectiveness of initial
education, and motivating employees might play a role in promoting the observance of professional
behavior in clinical settings. Professional behavior training should be considered at the entrance into
the system. This education should be strengthened by continuing theoretical and practical training and
addressed by proper supervision. It is also important to focus on attracting the attention of teachers
to their own model role in observing professional behavior by others.

Abstract BACKGROUND: Organ donation is considered to be a noble act. Medical and nursing students will
be the major healthcare providers in this field in the future. Hence, their knowledge, attitude, and
perception toward organ donation are essential to improve this field in the future.
OBJECTIVE: The objective of this study is to assess the knowledge, attitude, and perception on
organ donation among undergraduate medical and nursing students. This study brings forth the
basic understanding level of the medical and nursing students on the concept of organ donation.
METHODS: A cross‑sectional descriptive study was conducted among the first 4 academic years of
medical and nursing students in a tertiary care teaching hospital using convenient sampling. A total
of 620 students participated in this study. They were assessed using a pretested semi‑structured
self‑administered questionnaire. The data were analyzed using Statistical Package of the Social
Sciences version 19.
RESULTS: The median score on knowledge, attitude, and perception among the medical students
was 16 (14–17), 25 (23–28), and 41 (38–45), respectively, and among the nurses, the scores were
14 (12–16), 25 (22–27), and 39 (33–42), respectively. Almost half (46.9%) of the study participants
knew the definition for brain death. Twenty‑nine percent of the study participants knew about the
existence of law toward organ donation; more than half of those participants (52.7%) mentioned few
rules and regulation involved in the laws pertaining to organ donation.
CONCLUSION: Media is the major source for information. Only less than half of the study participants
were knowledgeable on the definition of brain death and existence of organ donation law. Although
they are in favor of organ donation, doubts still exist among few of the participants which could be
understood through further research in this field.

Abstract BACKGROUND: The psychological well‑being of midwives is very important in the context of providing
health services to two vulnerable groups of society, namely, mothers and infants. Therefore, the
present study was conducted aiming to investigate the effect of positive psychological interventions
on the psychological well‑being of midwives.
MATERIALS AND METHODS: The present study was a randomized clinical trial with pretest‑posttest
design along with a control group. The statistical population of the study included all midwives working
in community health centers of Mashhad City, Iran, which were first selected through cluster sampling
method from five health centers of the city, i.e. centers 1 and 3. Then, all centers and subsidiary
bases of these centers were listed, and the centers and bases were divided into two groups of
intervention and control by simple random allocation method. Sixty respondents were randomly
assigned to two equal intervention and control groups and responded to the Ryff’s Psychological
Well‑being questionnaire in two stages of pretest and posttest. Educational interventions based on
interventions, including Seligman’s PERMA model, in which psychological well‑being is defined in
terms of five domains namely positive emotions (P), engagement (E), relationships (R), meaning (M),
and accomplishment (A), were conducted in eight sessions of 2 h (two sessions per week). Data
were analyzed using independent t‑test, paired t‑test, Mann–Whitney test, and Wilcoxon test.
RESULTS: There was a significant difference between the posttest scores of the two intervention
and control groups in the total psychological well‑being variable (P < 0.001).
CONCLUSION: Given the findings of the study, it is suggested to use the Seligman’s PERMA model
to improve the psychological well‑being of midwives in health centers.

Abstract BACKGROUND: Overweight and obesity are one of the most public health problems in the world.
Considering obesity prevalence and its widespread health, economic, psychological, and social
consequences, this study aimed to explain the consequences of obesity among women and men in
the Kurdish region of Mukryan.
SUBJECTS AND METHODS: The present qualitative study was conducted in the Mukryan Kurdish
region in West Azerbaijan province in Iran from June 2017 to November 2017. Data were collected
by deep interview, focus group and dialogue with 111 obese and thin men and women and various
fields experts who were selected by purposive sampling, and analyzed by qualitative content analysis
technique of conventional type and Graneheim and Lundman steps.
RESULTS: Data analysis results were classified into two categories and 12 subcategories: Favorable
consequences of normal obesity (social acceptance, internalization of obesity, and reproduction
of the family institution), unfavorable consequences of extreme obesity (decreasing agency,
physical‑psychological dysfunctionalities, family fragility, prevalence of passive leisure, clothing
obligation, social objectivity, exogenous and endogenous social exclusion, imposing economic costs,
and devaluation of life).
CONCLUSION: With due attention to unfavorable consequences of extreme obesity on health,
illness, social issues and costs, simultaneously with the adoption of preventive approaches to obesity
through targeted policies in education, health literacy, promotion of sport culture, development of
sports context especially for women, improving recreational facilities, etc., appropriate planning and
interventions should be designed and applied for changing the behavior, culture, and community
beliefs in dealing with obesity phenomenon.

eywords:

Abstract CONTEXT: Academic learning is the main source of stress among adolescents and is associated with
mental health problems; finding its determinants helps to know the risk factors that influence stress.
AIM: The main aim of the study was to assess the educational stress and their predictors among
adolescent girls.
SETTINGS AND DESIGN: A cross‑sectional study was conducted in ten colleges involving adolescent
girls pursuing preuniversity and university studies at Dharwad city, India.
SUBJECTS AND METHODS: The study included 314 randomly selected adolescent girls aged
between 16 and 19 years. The study was approved by the institutional ethics committee. Data
were collected by employing random sampling technique. Self‑administered questionnaires were
administered which included sociodemographic data sheet, personality inventory, intelligence
quotient (IQ) assessment, and educational stress scale for adolescents.
RESULTS: Mean educational stress was 50.04 ± 10.82 (range 16–80). There was a significant
association between educational stress and religion, father education, number of siblings,
combination of subjects, type of personality, and IQ. Regression analysis revealed that number of
siblings and extrovert neuroticism personality negatively predicted stress (beta = −0.115, P = 0.037;
beta = −0.242, P = 0.001) and considered as protective factors. Introvert neuroticism, Hindu religion,
illiterate father, and commerce combination of subjects positively predicted stress among adolescent
girls (beta = 0.160, P = 0.026; beta = 0.119, P = 0.028; beta = 0.125, P = 0.017; and beta = 0.278,
P ˂ 0.001) and considered as risk factors.
CONCLUSIONS: Findings help in better understanding of educational stress factors among
adolescent girls and consider them while developing stress prevention programs.

Abstract BACKGROUND: One of the psychobehavioral factors that can predict drug abuse in students is
anger. This study aimed to evaluate the association between anger and drug addiction potential in
medical students in Iran in relation to their gender and college.
MATERIALS AND METHODS: This descriptive and analytical cross‑sectional study was conducted
on 373 students of five colleges at Lorestan University of Medical Sciences in Iran. For collecting
data, Persian versions of state‑trait anger expression inventory‑2 and addiction potential scale
were employed. Data were analyzed in SPSS software using t‑test, one‑way ANOVA, and Pearson
correlation test.
RESULTS: There was a significant positive relationship between subjective components of anger
(sate anger, trait anger, anger expression‑out, and anger expression‑in) and addiction potential in
samples (P < 0.05), while anger regulation components (anger control‑in and anger control‑out) had
significant negative correlation with addiction potential (P < 0.05). Moreover, a significant difference
was found in mean addiction potential scores between samples based on gender and college. With
respect to mean anger scores, the difference between students based on gender was significant only
in terms of state anger and anger expression‑in, while we found no significant difference between
them based on college except in anger expression‑out (P < 0.05).
CONCLUSION: Subjective components of anger can predict drug addiction potential in medical
students. It is recommended that anger management programs should be provided to the medical
students as one of the most important community groups in the field of public health.

Abstract BACKGROUND: Metacognition activation is described as a pillar of a driver in the learning process.
The current study investigated the effectiveness of a modified protocol of “student personalized
learning” (SPL) (integrating elements of differentiation approach) on metacognitive skills development.
MATERIALS AND METHODS: A cross‑sectional study was conducted among 22 bachelors during
the academic period of 2016–2017. A SPL program was designed in magnetic resonance physical
principles (16 courses of 2 h). The participants underwent pre‑SPL evaluation tests as to assess
their respective prior knowledge, learning style, and metacognitive skills. Attendant advisory meeting
allocated personalized educational planning and educational resources. During SPL, students were
regularly monitored by advisory supervising meetings. Descriptive statistics were used to describe
the features of the data (sums, frequencies, percentages, means, and standard deviations).
RESULTS: The results showed a visual learning style emerging as prevalent (61.9%). The completion
rate of SPL was 73%. SPL participants passed the educational module with a mean final examination
score reaching 16.72 ± 3 versus 10.7 ± 5 assessed by prior knowledge testing (P < 0.05). The
average global metacognition score enhanced from average to very good. Knowledge and control
of self, knowledge and control of process planning, and knowledge of process regulation increased
from average to very good levels.
CONCLUSIONS: The resorted SPL proved its efficacy in recruiting and developing metacognitive
skills. Nevertheless, knowledge and control of process‑evaluation metacognitive component needs
to be further investigated, especially when SPL relies on a short‑term program.

Abstract INTRODUCTION: As an important factor in the quality of nursing care, cultural competence of nurses
should be assessed to improve the quality of care provided. Nursing care is sensitive to culture;
therefore, it is necessary to design a tool for evaluation of cultural competence. In this regard, the
present study intended to develop a cultural competence questionnaire for Iranian nurses.
MATERIALS AND METHODS: In this methodological study, 350 nurses working in all educational
hospitals affiliated to Tabriz University of Medical Sciences were selected through convenience
sampling. Questions related to cultural care were selected by experts of this field, and a questionnaire
was designed and its validity and reliability were examined.
RESULTS: A 20‑item questionnaire was developed which assessed the three areas of learning and
education, awareness and knowledge, and skills. Cronbach’s alpha of the whole questionnaire was
0.912, and its validity based on the Kaiser–Mayer–Olkin Index was 0.891.
CONCLUSION: This study provides proper evidence regarding the strength of factor structure and
the reliability of the developed questionnaire; therefore, it can be considered as a scientific tool for
research, educational, and practical purposes in Iranian nurses.

Abstract INTRODUCTION: The system of safety management in higher education centers can prevent
the complications caused by harmful issues to students and bring their potential talents closer to
perfection. Therefore, this study aimed to design a safety management system (SMS) in higher
education centers of Iran in 2016.
MATERIALS AND METHODS: This study was a descriptive study of qualitative type. This study was
conducted in three independent phases, including (1) evaluating theoretical concepts, (2) developing
an initial system by determining the points of sharing and differentiation of the evaluated systems,
and (3) validating the SMS using the Delphi technique. Consensus on opinions and identifying
similarities and differences of reviewed studies have been used for qualitative data analysis, and
the descriptive statistics (sum of scores and mean) by means of SPSS version 21 has been used
for quantitative data analysis.
RESULTS: In the first stage, 108 indexes were identified by reviewing the studies and evaluating
the SMS in the world’s educational and noneducational organizations for the 12 main categories
of SMS. In the Delphi phase, 83 components were identified as a key index of the SMS in higher
education centers of Iran. Furthermore, the average mean of participants’ views on the dimensions
of the SMS for higher education centers has been 4.32, with the highest average mean of 4.59
related to the dimension of the facility and the firefighting department and the lowest mean of 4.10
for the student dimension.
CONCLUSION: The indexes presented in this study will provide a fairly complete tool for designing
SMS in higher education centers, which by applying it will provide a good opportunity to improve the
performance of these systems over time.

Abstract INTRODUCTION: Association of ABO blood type with body mass index (BMI) was explored in the
past studies, but literature on association of novel obesity markerssuch as total body fat and lean
body mass (LBM) is scarce. The present study aimed to evaluate the relationship of ABO blood
types with novel obesity markers in normal adolescents.
MATERIALS AND METHODS: A cross‑sectional study was done on 387 medical students. Bioimpedance analysis (BIA)‑derived novel obesity markers such as body fat percent (BFP) and lean
body mass (LBM) were recorded. Blood typing was done using slide‑agglutination method. Mean
and SD were calculated; analysis of variance and Chi‑square (χ2
) correlation were used to determine
the relationship between ABO blood types and obesity markers.
RESULTS: Highest propensity for BFP and LBM was seen in blood groups AB and B (25.09 ± 8.92
and 44.45 ± 6.91) respectively. Highly significant (P < 0.001) differences were observed in the values
of BFP and LBM in normal and obese participants across ABO blood types. Prevalence of obesity
did not show significant relationship (χ2 = 2.069; P = 0.913) with ABO blood types.
CONCLUSIONS: Unlike BMI, novel obesity markers (BFP and LBM) significantly differ across ABO
blood groups in normal and obese population. The findings suggest that ABO blood type might have
role in determining body composition. This will be helpful in recognition of the participants at the risk
of obesity on the basis of their blood groups.

Abstract BACKGROUND: Adolescence is considered an important stage in the onset of high‑risk behaviors.
Identity styles have significant pathological effects in various aspects of high‑risk behaviors. The
present study was conducted aiming at investigating the association between high‑risk behaviors
and identity styles in adolescents.
MATERIALS AND METHODS: The present cross‑sectional research studied 384 girls and boys
studying in the second grade of High School in Babol in 2018. Data collection was done through a
demographic questionnaire, Mohammadkhani’s Risky Behaviour Questionnaire, and Berzonsky’s
Identity Style Inventory. Data analysis was performed using Chi‑square test, Pearson’s correlation
coefficient, and linear regression analysis. P ≤ 0.05 was considered statistically significant.
RESULTS: The mean age of adolescents was 17.21 ± 48.4 years (aged 16–19 years).
Aggression (23.4%), relationship with the opposite gender (14.5%), smoking cigarettes and
hookah (10.9%), consuming alcohol (9.3%), suicidal thoughts and attempts (5.7%), running away from
home (3.9%), and consuming psychotropic substances (1.8%) were among the most common high‑risk
behaviors observed in the adolescents. The scores of high‑risk behaviors were negatively correlated
with the identity scores of informational style (4.56 ± 3.107), normative style (4.45 ± 2.581), and
identity commitment style (4.15 ± 2.245) and positively correlated with the scores of diffuse‑avoidant
style (4.15 ± 3.089). Regression analysis showed that only the informational style had a negative
and significant correlation with high‑risk behaviors.
CONCLUSIONS: The present study showed significant prevalence of high‑risk behaviors and its
relationship with identity styles in adolescents, which requires regular and planned health education
intervention at schools.

Abstract BACKGROUND: Role play is an educational method that is widely used for skill training because it
forces students to think about people who play their role. Therefore, the present study was conducted
with the aim of determining the effect of role‑playing method education compared to traditional method
education on the performance of nursing students in advanced cardiopulmonary resuscitation.
MATERIALS AND METHODS: This is a semi‑experimental study in which 70 nursing students in
Isfahan University of Medical Sciences were randomly divided into two groups (35 students in each
group): role‑playing method and traditional method. The performance of nursing students in advanced
cardiopulmonary resuscitation was evaluated using a performance checklist before and after training,
in both groups. Data were analyzed by SPSS 14 software using descriptive and analytical tests of
independent t‑test and paired t‑test.
RESULTS: The paired t‑test showed a significant difference between the mean performance scores
after intervention between case and control groups, respectively (P = 0.01). Furthermore, independent
t‑test showed that there was a significant difference between the mean score of clinical performance
in the two educational groups (P = 0.01).
CONCLUSION: The results of the research show the effectiveness of role‑playing method, which
leads to improved performance of the students in advanced cardiopulmonary resuscitation. Therefore,
this method can help the teachers to plan for the modification of educational programs in the
course of apprenticeship and internship and improve the management skills of students’ advanced
cardiopulmonary resuscitation.

Abstract BACKGROUND: Professional behavior of physicians is under scrutiny by medical associations,
media, and patients; therefore, medical students are expected to be self‑directed learners rather than
the passive ones. One of the useful strategies for professional development and life‑long learning of
students is self-regulated learning. Self‑regulation concept and lifelong learning commitment are in
the heart of medical practice. Therefore, this study aimed to evaluate the validity of Self‑Reflection
and Insight Scale (SRIS) to inspect the medical students’ readiness for self‑regulation.
MATERIALS AND METHODS: SRIS was translated according to the Sousa and Rojjanasrirat
guideline. To examine the reliability and validity evidence of the scale, 136 medical students from
Tehran University of Medical Sciences completed the questionnaire. Internal consistency and
intraclass correlation were used to examine the reliability evidence, as well as qualitative content
validity, and confirmatory factor analysis and exploratory factor analysis (EFA) were used to examine
the construct validity of the scale.
RESULTS: The content validity of the scale was verified. Cronbach’s alpha and the Interclass Correlation
Coefficient value for the four‑factor model was 0.87 and 0.79, respectively. Goodness‑of‑fit indices
displayed acceptable and poor values (P = 0.0001, χ2 = 373.51, df = 167, Root Mean Square Error
Of Approximation = 0.096, standardized root mean square residual = 0.12). EFA was conducted; a
well‑structured model was achieved through the EFA. The new four‑factor model was extracted as
the best model by performing EFA.
CONCLUSION: SRIS Persian version is saturated with four factors and has desirable content validity
and constructs reliability.

Abstract INTRODUCTION: Organophosphate compounds (OPCs) are suspected to make changes in
reproductive function by oxidant/antioxidant balance disruption in the brain, consequently impairing
hypothalamic, pituitary endocrine functions, and gonadal processes. The aim of this study was to
investigate the effects of occupational exposure to OPCs on the reproductive system of farm workers,
in Hamadan, Iran.
MATERIALS AND METHODS: A comparative study was conducted in rural farmers and urban men
aged 20–40 years. After sampling and analysis of semen quality parameters (such as sperm count,
sperm motility, progressive sperm motility, and sperm morphology), serum butyrylcholinesterase (BChE)
activity (a specific biomarker in OPCs exposure), as well as total antioxidant capacity, nitric oxide,
and lipid peroxidation levels for both semen and serum samples were determined. In addition, serum
samples were analyzed for reproductive hormones, including follicle‑stimulating hormone, luteinizing
hormone (LH), and testosterone.
Results: Our findings showed that the number of sperms (P = 0.04), their motility (P < 0.001), and
progressive status (P < 0.001) in rural farmers were significantly lower than the urban population. In
addition, a significant decrease was observed in BChE activity (P < 0.001) and LH level (P < 0.001),
and also a remarkable increase was found in testosterone level (P = 0.0014) in the serum of rural
farmers compared to the urban population. Along with a decrease in semen total antioxidant
capacity, a positive significant correlation was found between sperm motility and semen antioxidant
capacity (r = 0.45; P < 0.05).
Conclusion: Exposure to OPCs may affect reproductive outcomes through impairing hypothalamic
and/or pituitary endocrine dysfunctions and gonadal processes in farmers.

Abstract BACKGROUND: Preliminary evidence indicates that subclinical cardiometabolic abnormalities are
present in apparently healthy nonobese young adults. Poor dietary habits may be a contributing factor.
OBJECTIVE: The objective of this study was to examine the presence of cardiometabolic
abnormalities in apparently healthy college students and to assess the relationship between diet
quality and cardiometabolic risk factors.
METHODS: Cross‑sectional anthropometric, lipidemia, and glucose tolerance, blood pressure, and
dietary Healthy Eating Index (HEI) data were collected (April 2015). Participants were undergraduate
students. Ordinary least squares regression was used to examine associations between diet quality
and cardiometabolic risk factors.
RESULTS: Participants (n = 147) were primarily nonHispanic Caucasian between 18 and 22 years
and largely nonobese (95.0% of females, 85.1% of males). Total HEI score was 56.1 ± 16.1 for
females and 53.2 ± 15.0 for males. Mean biochemical and clinical outcomes fell within normal limits.
However, 71.0% of females and 80.9% of males met ≥1 or more metabolic syndrome criteria. HEI
was not related to health outcomes.
CONCLUSIONS: Cardiometabolic abnormalities are present in a large proportion of apparently
healthy undergraduates which may place them at risk for future cardiometabolic complications. There
was no relationship between diet quality and cardiometabolic health.