Journal of Education and Health Promotion

Abstract INTRODUCTION: Inequalities persists in distribution, accessibility, and utilization of oral health
services between urban and rural population. One approach to lessen this inequality is by incorporating
rural outreach programs in the academic curriculum of health‑care professionals.
OBJECTIVES: The objective of the study was to evaluate the effectiveness of outreach
programs on academic development, personal development, and civic responsibilities of dental
students and also to assess the changes in the domain scores within and between genders
postintervention.
METHODOLOGY: The study population consisted of 100 dental students. The study methodology
followed a before and after without control informal experimental study designs. At baseline, the
participants were administered pretested structured questionnaire developed by D. Diaz Gallegos.
Intervention involved posting participants in various rural outreach activities and academic field visits in
various public health installations. Apostintervention questionnaire developed by Anu F. Shinnamon et al.
was administered to assess the change from the baseline. The change in domain scores was assessed
using paired and unpaired t‑test appropriately. P ≤ 0.05 was considered as statistically significant.
RESULTS: The baseline scores of academic, personal, and civic domains were 6.05 ± 2.44,
8.04 ± 2.84, and 6.36 ± 2.23 which increased to 6.52 ± 2.10, 13.56 ± 3.44, and 8.55 ± 2.71
postintervention, respectively (P ≤ 0.05). When comparing within genders, there was increase from
the baseline, and this change in the scores postintervention was statistically significant (P = 0.001).
The mean scores of all three domains between genders were statistically insignificant.
CONCLUSION: The outreach programs developed and enhanced the subject’s academic skills,
leadership qualities, self‑confidence, communication skills, managerial skills, and responsibilities
toward the rural community.

Abstract INTRODUCTION: Reviewing articles are one of the most important methods for maintaining and
improving the scientific quality of research outputs, especially in the field of health and medicine,
and are often accompanied with various challenges.
AIM: The current study was carried out to Health Promotion in the Review Process of the Health
Scientific Journals according to Explanation of Experts.
MATERIALS AND METHODS: This study has a qualitative approach and was carried out using
the content analysis method. Data were gathered through semi‑structured interviews with experts
with direct and related experiences with health scientific journals including editors in chief, internal
managers, editorial boards, authors’ council and members of national journal commission with at
least 2 years of continuous related work experience in journals and review of at least 10 articles.
Sampling was carried out using purposeful snowball sampling, and data were analyzed using content
analysis method. Lincoln and Guba tests were used to determine the validity and reliability of the
analysis based on the following four criteria – credibility, transferability, certainty, and verifiability.
RESULTS: Experts’ opinions were categorized based on criteria for reviewer selection with three
dimensions of technical expertise, ethical behavior, and orientation and order; reviewer selection
methods including emphasis on others and emphasis on self; and review problems in the Iranian
Health Science and Research Journals including incentive system, reviewer characteristics, and
structural problems.
CONCLUSION: Findings of the current study are usable for all Iranian Health Scientific Journals,
editors, editors in chief, and internal managers as well as lawmakers in the area of scientific research.

Abstract BACKGROUND: Health promotion is the process of enabling people to increase control over their
own health. Community involvement in social and environmental interventions tends to improve
people’s health and quality of life. Self‑help groups (SHGs) primarily focus on microfinancing, thereby
acting as a catalyst in bringing backward society to the mainstream. They possess huge potential
to influence the health of the community.
OBJECTIVE: The objective of the study is to assess the willingness among SHGs for the involvement
in health promotion activities and to assess their health information needs.
MATERIALS AND METHODS: A community‑based, cross‑sectional study was conducted during
September 2017 in rural Puducherry. All 86 SHGs in four selected villages were covered, and their
leaders were interviewed using a structured questionnaire on functioning of SHGs and their health
information needs. Willingness for health promotion activities was rated on an interest scale (1–100).
RESULTS: Among the 86 heads of SHGs interviewed, 81 SHGs (94.1%) were registered. They were
mainly involved in microfinancing. Health information needs expressed were cancer detection (45%),
diabetes (60%), hypertension (56%) and vector‑borne diseases (63%). When asked to rate
their willingness on an interest scale for health promotion activities, nearly 64% showed a great
interest (i.e., score > 60). Majority were willing to work for noncommunicable disease‑related activities
such as provision of drugs (86%) and for screening of various cancers (84%).
CONCLUSION: This study has shown that majority of SHG members have expressed willingness
for the involvement in health‑related activities, thereby can be utilized as an important resource for
health promotion in rural areas.

Abstract INTRODUCTION: The healthcare program has opponents and supporters with its multiple policies
and also its difficult implementation, which requires that its barriers and problems be addressed
comprehensively and extensively. This study was conducted aimed to determine the service
provision challenges by healthcare providers, from their point of view, in selected comprehensive
health centers of Isfahan.
MATERIALS AND METHODS: The present study is a descriptive‑analytic one. One‑hundred
and ninety‑seven healthcare providers were selected by census sampling method from the
population of female healthcare providers in Isfahan comprehensive health centers in 2017. The
data collection tool was a researcher‑made questionnaire in the field of individual–professional,
managerial–organizational, and executive challenges. Data analysis was done by repeated measures
ANOVA and post hoc test.
RESULTS: The findings indicated that there was a significant difference between the mean score
of individual–professional, managerial–organizational, and executive challenges (P < 0.001) from
the point of view of healthcare providers. According to least significant difference post hoc test, the
mean score of individual challenges was significantly lower than that of managerial and executive
challenges (P < 0.001). However, there was no significant difference between the mean score of
managerial–organizational and executive challenges (P = 0.46).
CONCLUSION: Based on the results, healthcare providers have put forward several challenges during
the implementation of the healthcare program. Meanwhile, executive and managerial challenges
have been considered more than individual challenges. Considering that this could lead to improper
service provision to the clients, the role of policymakers in this program to remove obstacles and to
provide satisfaction to healthcare providers is emphasized.

Abstract INTRODUCTION: Self‑directed learning is a vital principle promoted in health profession’s education,
particularly with the increasing use of online learning methods. Likewise, reflection has been
recognized as an indispensable and formidable concept for learning which plays a positive role in
fostering students’ self‑reflection, critical thinking, and development of professional values and skill.
Hence, the present study was undertaken to identify the effect of reflective thinking on academic
performance among undergraduate dental students.
MATERIALS AND METHODS: Reflective thinking was assessed among 2nd‑, 3rd‑, and 4th‑year
undergraduate dental students and interns of a dental college and hospital in Hyderabad. Reflection
questionnaire assessed habitual action, understanding, reflection, and critical reflection on a 5‑point
Likert scale. The percentage of marks obtained in the last university examinations was considered for
academic performance. The completed questionnaires were analyzed using the Statistical Package
for the Social Sciences software (SPSS version 20). P < 0.05 was considered statistically significant.
RESULTS: A total sample of 263 individuals comprising 188 (71.5%) females and 75 (28.5%) males
participated in the study. Our findings showed that the four scales of reflective thinking, such as habitual
action (P = 0.0001*), understanding (P = 0.02*), reflection (P = 0.02*), and critical reflection (P = 0.01*),
showed statistically significant difference based on the year of study. However, no difference based
on gender was noted. Reflection (17.2 ± 2.41) and critical reflection (16.3 ± 2.77) mean scores were
highest among 4th years. Higher understanding (17.83 ± 1.78) and reflection (17.33 ± 2.01) mean
scores were observed among students who attained more than 75% in their academic performance.
CONCLUSION: Thus, the present study emphasizes the role of reflective thinking and its significance
in academic learning process.

Abstract INTRODUCTION: Health systems aimed to increase health utilization. Habits and behavior about
using health facilities, which is called health-seeking behavior, are different among different cultures
and influenced by different factors. The present study is aimed at investigating Iranian Southern
population health‑seeking behavior and its influencing factors.
MATERIALS AND METHODS: Asample of 397 people was selected using proportional stratified random
sampling for this cross‑sectional study. They were asked to fill a questionnaire about their health‑seeking
behaviors (seeking treatment, inattention to treatment, and self-medication) and socioeconomic factors.
Data were analyzed using regression models including linear, ordinal, and logistic regressions.
RESULTS: Near 80% of participants reported self‑medication and most of them prefer public hospitals
as their first point of contact with health system compared to others such as family physician. Using
linear regression revealed seeking treatment has significant relationship with age (P = 0.037), living
place (P = 0.018), and having complementary insurance (P = 0.013). Self‑medication behavior has
relation with age (P = 0.015), gender (P = 0.039), education years (P = 0.031), living place (P = 0.005),
having complementary insurance (P = 0.001), and satisfaction with health‑care providers (P = 0.003)
in logistic regression. Using ordinal regression, it was found that inattention to treatment has
a relation with education years (P = 0.044), living place (P = 0.042), having complementary
insurance (P = 0.049), and severity of illness (P = 0.031).
CONCLUSION: Southern population does not accept family physician as the first point of interaction
with the health system, and they prefer to go to public hospitals directly. Moreover, self-medication
is a prevalent behavior among the population and thus their acceptance of health care is low. Based
on the findings, it can be suggested providing more satisfying health care, increasing insurance
coverage, and informing population could lead to better utilization of health‑care services.

Abstract BACKGROUND: Growing interest in issues of attachment, sociocultural, psychological, and above
all clinical perspectives is also reflected in the emergence of research on “attachment style and
parental parenting style in referrals to addiction treatment centers.”
METHODS: This was a cross‑sectional study. Three health centers were selected randomly from
among the health centers of Neyshabur city in 2015–2016 year. The sampling was done so that all
individuals who had the characteristics of the research unit and had the consent to participate in
the study were justified by the researcher and completed questionnaire form. We used Chi‑square,
one‑way analysis of variance, Mann–Whitney, and Kruskal–Wallis tests.
RESULTS: In the present study, safe attachment scores in children with healthy parents were
significantly more than children with addicted parents.
CONCLUSION: Addiction has an important role in reducing attachment to children, and because
this decrease in attachment has dangerous consequences in child’s life.

Abstract PURPOSE: There are different learning styles adopted by medical education participants. The aim
of this study is to investigate which learning styles and approaches are preferred to be learnt by
medical students.
METHODOLOGY: It is a cross‑sectional study; 320 students were selected through stratified random
sampling. Visual, auditory, read/write, and kinesthetic questionnaire was used which measures
dimension of learning styles and approaches.
RESULTS: Majority of medical students have preferred (32%) for Kinesthetic modality; 26% for
Aural; Visual 21% and Reading/Writing 21%. The majority (53%) preference for Bimodal modality;
41% for Unimodal; 5% for Trimodal and 1% for Multimodal.
CONCLUSION: Medical education participants commonly used kinesthetic styles, and there is no
difference among different year of study; but, in learning approach, multimodal has increased as year
of studying increased. It suggests that curriculum of medical education should be revised according
to result of research.

Abstract BACKGROUND: Health beliefs play an important role in people’s willingness to participate in
health‑promoting behaviors. Given the role of beliefs in women’s function and the importance of
the benefits of mammogram, and because the predictors of a behavior are a major prerequisite to
codification of an effective prevention program, the present study was conducted with the aim of
predicting mammography based on Health Belief Model (HBM) in women in Khorramabad.
Materials and Methods: In this cross‑sectional study, 262 women referring to health centers in
Khorramabad, Lorestan province, in 2018, were selected by randomly sampling. The data collection
tool was a four‑part questionnaire including demographic information, knowledge on breast cancer
and mammography, Champion’s Health Belief Model, and Champion’s Self‑Efficacy Questionnaire
for Mammography. Validity and reliability of the tool were investigated and confirmed. Data were
analyzed by version 16 of SPSS software using descriptive statistics, Chi‑squared test, and multiple
logistic regression.
RESULTS: The mean (standard deviation) age of the participants was 49.26 (±7.79) years.
Seventy‑nine (30.85%) of the 262 participants reported mammography. Constructs’ sensitivity,
benefits, barriers, and perceived self‑efficacy were significantly different in terms of performing
mammography (P < 0.05). Participants with a history of breast cancer (odds ratio [OR] = 11.18, 95%
confidence interval [CI] = [3.73–33.46]) had lower perceived barriers (OR = 3.54, 95% CI= [1.77–7.09]),
were more likely to undergo mammography than women with no family history of breast cancer, and
had moderate‑to‑high perceived barriers (P < 0.001).
CONCLUSION: The results of this study indicate that health managers are required to pay more
attention to training and promoting screening methods. Understanding the barriers to mammography in
women by managers can help design and implement effective programs that enhance mammography
in women.

Abstract INTRODUCTION: Cultural competence is the main component of cultural care; therefore, it is
necessary to be aware of its levels. The lack of a suitable tool that can measure cultural competence
levels among midwives led us to carry out the present study aiming to develop and validate a cultural
competence questionnaire for health promotion of Iranian midwives.
METHODOLOGY: This methodological study was performed on 302 midwives selected through
three‑stage cluster sampling method in 2018 in East Azarbaijan Province. The initial tool was designed
after qualitative study and searching similar studies. Then, the tool validity was assessed through
evaluating the face and content validity in midwives and performing survey and psychometrics.
Finally, the data were statistically analyzed by SPSS version 19 through exploratory factor analysis,
item analysis, Cronbach’s alpha coefficient, and Pearson correlation, at the significant level of <0.05.
RESULTS: The initial tool was constructed with 42 items in the five‑point Likert scale. By eliminating
9 items during face and content validation and 6 items during factor analysis, the final 25‑item
questionnaire was developed in five areas of theoretical and practical learning, clinical application,
cultural skill, cultural excellence, and cultural competence. According to Cronbach’s alpha, reliability
of the tool was at a good level (0.889) with a confidence interval of 0.95 (P < 0.001).
CONCLUSION: The cultural competence questionnaire for Iranian midwives, with five‑factor
verification and acceptable validity and reliability can be used in studies considering the components
of Iranian culture.

Abstract AIMS: Although chronic diseases are the most common and expensive health problems, they are
preventable too. Nurses play a key role in the care of these patients. One of the important roles
of nurses is consultation role. Due to the high impact of nurse consultant role on health promotion
and also the fact that this role is not fully understood in Iran, this study aims at clarifying the role of
nurse consultant.
MATERIALS AND METHODS: This is a qualitative study with content analysis approach conducted
through semi‑structured interviews in Isfahan University of Medical Sciences from April to December
2017. A total of 35 participants (11 patients, 9 nurses, 6 faculty members, 4 postgraduate students,
and 5 nursing managers) were included in the study. Sampling was done based on purposive sampling
method, and participants were asked to express their opinions about nurse consultant.
RESULTS: In this article, we discussed the following three categories and seven subcategories: (1)
nursing consultation as a treatment facilitator (nursing consultation as a way to reduce the treatment
course, nursing consultation as a way to reduce complications, and nursing consultation as a way
to reduce costs); (2) professional performance in nursing consultation (nursing consultation based
on problem‑solving and evidence‑based practice and management and teamwork in nursing
consultation); and (3) prerequisites for the nursing consultation role (supporting nurses and introducing
the role in decision‑making units and creating demand).
CONCLUSION: Nursing consultation has an essential role in patient health promotion. Therefore, it
is better that nurses and other health‑care team should be familiar with this vital role.

Abstract CONTEXT: The knowledge about mental health problems among the general public is comparatively
quite low. The pilot study was conducted with an aim to increase the knowledge of the day‑to‑day
mental health problems which people can have among the mass.
AIMS: The aims of this study are (1) to assess the knowledge and attitude about mental health
problems of the selected sample and (2) to build the capacity in providing first aid for mental health
to the selected sample through training.
SETTINGS AND DESIGN: A cross‑sectional study was used in assessing the knowledge and skills
of the participants of the first aid for mental health problems. It was conducted in the institute itself.
SUBJECTS AND METHODS: A total of 89 participants were taken to participate in the cross‑sectional
study. Using a semi‑structured self‑administered questionnaire, a brief training, and a feedback form,
capacity building for first aid for mental health problems was provided.
STATISTICAL ANALYSIS USED: The questionnaires were analyzed using descriptive statistics.
RESULTS: The capacity building program for first aid for mental health problems appears to be
effective in improving the knowledge and attitude with regard to the mental health problems. The
findings from the program indicated lack of knowledge in understanding of mental health, knowledge of
causation, and treatment of mental health problems. Feedback of the training program indicated that it
improved the ability of the participants in recognizing persons undergoing mental health problems and
brought about a change in their beliefs about mental health, attitudes, and need for prompt referral.
CONCLUSIONS: The program was successful in increasing the confidence of the participants in
providing help to someone with a mental health problem and referring to appropriate mental health
professional. This shows that there is an immediate need for empowering general public with
knowledge and skills to provide support to people with mental health problems.

Abstract BACKGROUND: Adolescent girls experience physical, psychological, and social changes during
puberty. Lack of sufficient information, skills, and readiness to overcome this stressful situation make
them vulnerable. The present study aims to assess the level of knowledge, attitude, and strategy
used for coping with puberty crises of female secondary school students in Karaj, Iran.
MATERIALS AND METHODS: Five‑hundred and seventy female secondary school students from
Karaj, Iran participated in this cross‑sectional study. Knowledge, attitudes, and coping strategies of
adolescents about puberty were evaluated using various questionnaires. The obtained data were
analyzed using Chi‑square, Fisher’s exact, Kruskal–Wallis, Mann–Whitney, and Spearman tests.
RESULTS: The average age of participants was 15.28 ± 1.58 years old. About 85.1% of the
participants had high knowledge about puberty and 66.7% had a good attitude toward it. Nearly, 54.2%
of the girls used the avoidance‑oriented coping strategy. There was no significant relationship between
knowledge and attitude regarding selective strategies to cope with stressful situations in puberty.
CONCLUSION: According to the results, continuous training in secondary schools is necessary to
improve adolescents’ knowledge and attitudes toward puberty. Moreover, more training is required
to change the dominant avoidance‑oriented coping strategy to a task‑oriented approach, especially
at the first‑grade level in secondary school.

Abstract INTRODUCTION: Mental health is one of the focuses of the health assessment of different
communities and plays an important role in ensuring the dynamism and efficiency of each community.
Pregnancy is one of the most sensitive periods, in which mental health is effective. The mental health
of individuals is the result of the interaction of cognitive‑emotional ordering strategies and proper
evaluation of stressful situations. The aim of this study was to determine the relationship between
cognitive emotion regulation and the health of pregnant women.
MATERIALS AND METHODS: This is a descriptive and cross‑sectional study that was carried out on
200 pregnant women who were covered by Navab, Amir Hamzeh and Motahari centers in Isfahan in
2017 by available sampling method. The instrument was the Beck Depression Inventory, Goldenberg
Health, and Emotional Cognitive Order. Finally, the data were analyzed using the SPSS software.
RESULTS: The mean age of pregnant mothers participating in the study was 26.66 ±6.09 years. The results
of data analysis showed a significant positive correlation in relation to blaming others and disaster with
physical health, blaming others and rumination and catastrophes with anxiety, disaster with social health,
blaming others and rumination and catastrophes with depression, and also blaming others and rumination,
catastrophizing, and positive re‑focusing have a significant positive correlation with total health score.
CONCLUSION: Regarding the relationship between mental health and cognitive dysmenorrhea
during pregnancy, pregnant women carers can help with pregnant women by conducting educational
programs on health promotion and strive to maintain mental health and improve their quality of life.
Consequently, they will ensure the mental health of their future children.

Abstract BACKGROUND: Educational justice is one of the fundamental dimensions of social justice, and the
progress of each society depends on its realization. Since students are engaged in the educational
process, recognizing their viewpoints can provide useful guidance to correct existing problems. The
purpose of this study is to investigate the observance of educational justice from the viewpoint of
medical students in southeastern Iran.
METHODOLOGY: This cross‑sectional study was carried out on 200 students of Zahedan University
of Medical Sciences, southeastern Iran, in 2017 by stratified sampling. The tool for measuring
organizational justice was a questionnaire. The validity of the questionnaire was confirmed by
content validity method, and its reliability was confirmed by Cronbach’s alpha (0.8). Descriptive
statistics (frequency and percentage), Chi‑square test, and analysis of variance (ANOVA) test were
used to analyze data.
RESULTS: The mean age of students was 21.7 ± 2.91 years. Fifty percent of students assessed
the educational justice as good to excellent, and based on a general score, educational justice was
observed in 73.2% of cases. The one‑way ANOVA showed a significant difference between the scores
of educational justice from the viewpoints of students in different faculties of Zahedan University of
Medical Sciences (P < 0.001).
CONCLUSION: According to the results, students’ needs for achieving educational justice have
been identified in this study. This study can provide useful guidance to correct existing problems and
help policymakers in Zahedan University of Medical Sciences to achieve a full educational justice.

Abstract BACKGROUND: The patient handover process is in fact a valuable and essential part of the care
processes in the hospitals. This can be a factor in increasing the quality and effectiveness of medical
care. Incorrect and incomplete handover can increase the percentage of errors and cause serious
problems for patients. The aim of this study was to identify the handover challenges concerning
safety and quality of health services.
MATERIALS AND METHODS: A systematic review was conducted according to the Preferred
Reporting Item for Systematic Reviews and Meta‑analyses guideline. The key words “challenges
of patient handover” or “challenges of patient handoff” were used in combination with the Boolean
operators OR and AND. The ProQuest, Ovid, Doaj, Magiran, SID, Scopus, Science Direct, PubMed,
and ISI were searched.
RESULTS: A total of 263 articles were extracted, and 20 articles were selected for final review.
The results of selected articles indicated that there are various challenges such as communication,
noncoordination, nonuse of checklist, poor management, time management, and other things. These
studies reported that communication was the main challenge of handover process.
CONCLUSIONS: Hospitals try to provide a lot of services to the patients and other customers in a
safe and healthy environment. Lack of communication among the incoming and outgoing nurses in
handover process is one of the main causes of reduced safety and quality of services and patient
dissatisfaction.

Abstract BACKGROUND: Simulation is one of the strategies which are suggested and used to reduce stress
and anxiety in clinical student education. This study aimed to determine the effect of simulation‑based
training method on psychological health promotion in operating room students in their educational
internships.
MATERIALS AND METHODS: This study was a clinical trial. Research population was operating
room students at Semnan University of Medical Sciences. A demographic questionnaire and the
Spielberger’s Situational Anxiety Inventory were used as data collection tools. Students were divided
into two intervention and control groups randomly. Situational anxiety was measured before the
intervention and on the 1st and the last days of the internship. The data from the two groups were
compared by using the Mann–Whitney and Friedman statistics at the significant level of 0.05.
RESULTS: There was a significant difference between students’ situational anxiety scores in the
experimental and control groups on the 1st day of internship after education by simulation (P = 0.481).
There was a significant difference between the students’ anxiety scores in the two groups on the last
day of the internship (P = 0.008).
CONCLUSION: Simulation of the operating room environment before the internship cannot reduce
the operating room students’ situational anxiety on the 1st day of internship, but it can reduce their
situational anxiety during the internship and significantly reduce it at the end of internship compared
to those who are not in the simulated environment.

Abstract BACKGROUND: Advances in scientific research necessitates updating of the curriculum and
the Medical Council of India now Board of Governors have proposed a new competency‑based
undergraduate curriculum for the Indian Medical Graduate. The authors wanted the views of medical
students about basic sciences teaching in the form of feedback, their perceptions and attitudes toward
the basic sciences and their opinions about the relevance of these subjects, and finally any ideas
about improvement in teaching of basic sciences.
MATERIALS AND METHODS: The present cross‑sectional study was conducted in two medical
colleges of Northern India and 250 medical students from each medical school were the study
participants. Students of the 1st year were not included, but interns were included. A pretested
questionnaire having twenty questions with answers in the form of “yes” and “no” was used. Chi‑square
was the test of significance.
RESULTS: Almost all the participants considered the basic sciences as an integral part of medical
curriculum and a higher number of Government Medical College respondents opined that their
knowledge made it easier to understand clinical subjects (P < 0.05). However, higher proportion of
ASCOMS (Acharya Shri Chandra College Medical Sciences) of respondents emphasized that the
focus should be on clinical subjects and that current student–teacher ratio be increased (P < 0.05).
Majority of the respondents labeled Anatomy having the immense syllabus, while Physiology was
designated as more relevant and having a better recall during clinical discourse (P > 0.05).
CONCLUSION: Basic sciences lay strong foundation for subsequent clinical learning. Medical
education is best taught with hybrid use of lectures, tutorial, group discussions, audio‑visual aids, and
integrated teaching. The new proposed competency‑based curriculum and the Attitudes, Ethics and
Communication Module are likely to improve the overall medical education and health‑care scenario.

Abstract BACKGROUND AND AIM: Customer’s satisfaction is one of the main goals of the health system
because it is effective on the desire of external customers for using the services of the health system
and also the quality and quantity of the provided care for the internal customers and eventually the
health of the society. Considering the importance of the subject, the present study was designed
to determine the customers’ satisfaction with the health system reform plan in the field of health.
MATERIALS AND METHODS: Participants in the present content analysis qualitative study were 22
technical and operational managers and 118 health‑care providers, and 15 recipients of health services
referring to the health centers in Qom; who individually answered the questions of the interview
guide. The gathered qualitative data were analyzed using conventional qualitative content analysis.
RESULTS: Customers’ satisfaction with the health system reform plan was categorized into six
themes of decreased trust of the caregivers, wasting caregivers’ time in the health units, increased
provision of services to the caregivers, decreased motivation for work, occupational burnout, and a
sense of petition in the care providers.
CONCLUSIONS: Although external customers were satisfied with some services of the health
system reform such as providing various free services, follow‑up the patients, and beautification
the environment of the health centers; but there are multiple weaknesses in this plan that would
cause dissatisfaction in the external and internal customers. More studies seem necessary to better
determine the different aspects of the satisfaction in the caregivers and care.

Abstract BACKGROUND: Smoking hookahs is one of the most preventable risk factors for non communicable
diseases. It is also considered as the gateway to youth addiction. Planning and training to prevent
this health problem is considered an important priority. The aim of this study was to determine the
predictive factors for preventing hookah smoking (PHS) in the youth of Sirjan city, based on the
protection motivation theory (PMT).
MATERIALS AND METHODS: This research was a cross‑sectional study conducted in 2018, and
participants were chosen by simple random sampling. Data were collected by a researcher‑made
questionnaire which was valid and reliable and was designed based on the PMT constructs. This
questionnaire was completed by 280 young people in Sirjan, Iran. Data were analyzed through
descriptive statistics, Pearson correlation coefficients, and linear regression.
RESULTS: Pearson correlation coefficients showed that there was a significant correlation between
protection motivation and the structures of the PMT, except for the response cost structure.
The strongest correlation was between protection motivation and self‑efficacy (r = 0.502) and
fear (r = 0.470). The structures of the PMT predicted 36.5% of PHS, and fear (β =0.27) was the
strongest predictor of PHS.
CONCLUSION: The results of this study show that the constructs of the PMT can partially predict
PHS. This theory can be used as a tool for designing and implementing educational interventions to
prevent hookah smoking among the youth.

Abstract INTRODUCTION: Responsibility in the higher educational system requires the universities to be
sensitive on students’ needs and expectations. The purpose of the present study was to examine the
educational service quality among health information technology (HIT) students in Isfahan University
of Medical Science based on the SERVQUAL model.
METHODS: This was a descriptive cross‑sectional study and carried out at the Management and
Medical Information Sciences faculty of IUMS in 2018. Sixty‑eight undergraduate and postgraduate
students of HIT participated in this study. For collecting data, the standard SERVQUAL questionnaire
was used. The collected data were analyzed using SPSS version 20 software in descriptive level.
RESULTS: Findings showed that there was a positive gap in overall dimensions of educational
services quality (mean discrepancy of expectations and perceives). Most mean of service gap was
contributed to responsiveness dimension 1.06 (0.98 standard deviation [SD]), following that empathy
1.04 (0.97 SD), assurance 1.00 (0.83 SD), reliability 0.83 (0.76 SD), and the least gap was seen
intangibles 0.61 (1.02 SD).
CONCLUSION: According to the current gaps in all quality dimensions, as well as high amount of
expectations in comparison with students’ perception, it is required to evaluate higher education
quality through implementing students’ knowledge skill and creative abilities. Therefore, to improve
the quality of educational services at the Faculty of Management and Medical Information, all
dimensions, especially the responsiveness dimension, should be considered.

Abstract BACKGROUND: Difficulty with reading fluency has been increasingly acknowledged as a significant
aspect of reading disabilities which is called dyslexia. To investigate this important issue, this
research aims to examine the impact of an intervention program on reading fluency of dyslexic
students.
MATERIALS AND METHODS: The research is an experimental one. The population of the study
included all the second‑ and third‑grade male and female students in the city of Ilam, Iran, among whom
68 students were recognized to be dyslexic using a screening inventory reading test (IRT) developed
by Shafiei et al., in 2009, they were selected using purposeful sampling method. The students were
equally divided and assigned into a control and an experimental group. The experimental group
received the Barton intervention program for 10 weeks. The reading fluency test was administered
for the measurement of reading fluency in pre‑ and post‑tests. Data were analyzed using descriptive
statistics (mean and standard deviation) and paired t‑test.
RESULTS: The analysis of the finding through t‑test found a statistically significant difference between
the control and experimental groups after the intervention program at P < 0.01.
CONCLUSIONS: The results revealed that the students who received the intervention program of
the experimental group were improved in terms of their reading fluency.

Abstract INTRODUCTION: Social factors such as culture, race, education, belief, and living and working
environment can be part of the causes of diseases or influence the natural history of a disease.
MATERIALS AND METHODS: We have adopted the Harden’s ten questions of curriculum
development framework approach to assess the social impact of medical curriculum of Faculty of
Medicine, Gezira University (FMUG), among the Integrated Program of Field Training, Research, and
Rural Development course. We have assessed the objectives and aims of the course and critically
analyzed how these will meet the need for social sciences to be integrated into the curriculum.
RESULTS: The recommendations about social and behavioral sciences are well implemented in the
curriculum of FMUG. The curriculum promotes early exposure to the community learning. The ten
questions of Harden for curriculum or course assessment are satisfactorily covered in the Integrated
Program of Field Training, Research, and Rural Development course at FMUG. In addition, the
course is also fitting well with criteria suggested recently for increasing competency in social medicine
within the medical school curriculum. Importantly, the course is part of the social sciences that well
integrated through the duration of the curriculum.
CONCLUSION: The Integrated Program of Field Training, Research, and Rural Development course
at FMUG satisfy most of the competency for social medicine. Therefore, taking all these factors
into consideration, it is possible to suggest that further research is needed to establish whether the
model of FMUG in social sciences can be exemplary for universities in Africa and the Middle East.

Abstract A spiritual well‑being‑based nursing intervention may boost older adults’ resilience‑based recovery. Its
potential contribution may have positive knock‑on effects: controlling skyrocketing healthcare costs;
reducing the productive population’s social burden of supporting the older adults; and alleviating a
generational conflict. However, healthcare policy‑makers are still skeptical about investing in those
healthcare resources which would develop and implement a spiritual well‑being‑based nursing
intervention for older adults. It is time for nurse scientists, as front‑line gatekeepers for patients’
omnidirectional well‑being, to escape from thinking within the box by actively addressing first the
feasibility, then the direct and indirect effectiveness on actual patient outcomes, and finally the cost
efficiency of a spiritual well‑being‑based nursing intervention for the added benefit of easing the
decision‑making of healthcare policy‑makers.