Journal of Education and Health Promotion

Abstract

Abstract BACKGROUND: Rape is a widespread and important issue in the field of public health, and its
victims require comprehensive and gender‑sensitive health services. Healthcare providers, especially
midwives, play an important role in the diagnosis and treatment of rape, and improving their knowledge
has been an essential factor in enhancing the quality of service provided.
OBJECTIVE: The objective of the study is to compare the impact of standardized patient‑based
training and team‑based learning on midwifery students’ knowledge for providing services to rape
victims.
MATERIALS AND METHODS: In this randomized quasiexperimental study, 75 midwifery students
of Mashhad School of Nursing and Midwifery were selected using available sampling method
and were assigned to two groups of standardized patient‑based training (n = 38) and team‑based
learning (n = 37). After performing pretest, standardized patient‑based training group and team‑based
learning group were trained separately for 6 h. One week after intervention, posttest was performed.
Data were collected and analyzed using the Academic Specifications Questionnaire and the
Knowledge Assessment Questionnaire. Significance level was considered at P < 0.05.
RESULTS: The two groups were homogeneous in terms of demographic characteristics. There was
no statistically significant difference between the two groups in the posttest in terms of knowledge
score (P = 0.079). However, there was a statistically significant difference in the level of knowledge
between the two groups (P = 0.037).
CONCLUSIONS: Given the effectiveness of both standardized patient‑based training method and
team‑based learning method on enhancing midwifery students’ knowledge for providing services to
rape victims, these methods can be used in students’ education.

Abstract BACKGROUND: Self‑directed learning readiness scale for nursing education (SDLRSNE) was first
edited in Fisher and King Learning, which was an alternative for self‑directed learning readiness.
OBJECTIVES: The present research aims at reinvestigating the subscale factor structure of this tool
and present evidence regarding its validity and reliability.
METHODS: In this cross‑psychometric study, 379 students completed SDLRSNE, with 29 items and
three subscales that were selected by conducting simple random sampling method, from among 1135
nursing and midwifery students at Islamic Azad University of Isfahan (Khorasgan), in 2015–2016
academic years. The data were analyzed using SPSS20 and Lisrel8.5 Software. The mentioned
data were studied by utilizing descriptive standards and inferential tests such as Cronbach’s alpha
coefficients, Spearman–Brown, Gutmann, and confirmatory factor analysis (CFA).
RESULTS: According to the proper fitness indicators, CFA of 29 items clearly distinguishes
self‑directing into three elements, including self‑management, desire for learning, and self‑control.
Results demonstrated that all three scale elements have high internal consistency coefficients.
CONCLUSION: Results exhibit that short‑form scale for self‑directed readiness in Fisher and
King learning is a valid and reliable tool for identifying the capabilities of the nursing and midwifery
student’s self‑learning.

Abstract BACKGROUND: Breast cancer is an increasing health problem in India. Screening for early detection
should lead to a reduction in mortality from the disease. Majority of the population, especially in rural
areas, contact health‑care system through primary health‑care workers.
AIM: To know the knowledge of breast cancer risk factors and methods for its early detection among
the primary health‑care workers in Shimla district, Himachal Pradesh.
MATERIALS AND METHODS: A descriptive cross‑sectional study questionnaire study was
conducted among primary health‑care workers (both males and females) in Shimla district,
Himachal Pradesh. The data were analyzed using SPSS software version 16. The statistical
tests used were t‑test, ANOVA, and Fisher’s exact test. P = 0.05 was considered statistically
significant.
RESULTS: Out of a total of 120 patients, there were 46 males (38.3%) and 74 females (61.7%).
The mean age of the population was 48.5 ± 5.3 years, with a range of 25 and 57 years. The mean
knowledge score percent of the present population was 71.04 ± 18.3. The mean knowledge score
was higher among males (73.9 ± 19.8) as compared to females (69.2 ± 17.2). Approximately 43.3%
of the participants had very good knowledge about risk factors followed by 31.7% having excellent
knowledge, 20% having good knowledge, and 5% having poor knowledge.
CONCLUSION: The overall mean knowledge percent about breast cancers among primary
health‑care workers in this study was very good, slightly higher among males and postgraduates,
but to make it universal, reinforcement of educational programs can be planned for them.

Abstract INTRODUCTION: Today medical education is focusing on teaching human and communicational
skills, just like the basic theories in medicine. Making effective and efficient contacts and
communications are very important in nursing. Although these studies had shown that these skills
are poor among nurses. Due to this, it is important to teach these skills to all health‑care providers.
This study aimed to investigate the effect of communicational empowerment pattern on nursing
student’s communicational competency.
MATERIALS AND METHODS: This study was conducted on 78 senior nursing students who were
chosen randomly by the census method. Respondents were divided into case and control groups.
In case group, the communicational empowerment method was conducted and in control group,
no interventions were done. Data were collected by communicational competency questionnaire.
Data were analyzed using descriptive statistics, Pearson correlation, and t‑test through IBM, SPSS
version 19, United States 2016.  The significance level was considered 0.05 respectfully.
RESULTS: The mean age was 22.23 ± 1.80. In the case of marital status, a number of 63 respondents
were single and 15 were married. The mean score of communicational competency in case group was
112.38 ± 19.20 before intervention and 128.95 ± 11.98 after intervention. In control group, the mean
score of communicational competency before intervention was 107.55 ± 14.22 and after intervention,
it was 117.11 ± 15.37. There was not any significant relationship between case and control groups
in the mean score of communicational competency before intervention (P = 0.0187), but a significant
relationship was assessed between case and control groups in the mean score of communicational
competency after intervention (P < 0.001). The level named “Good” in communicational competency
was increased among respondents from 56.8% to 90.9%.
CONCLUSION: Using the communicational empowerment method in clinical education is possible
and it increases the communicational competency.

Abstract INTRODUCTION: Financial support system available to geriatric populations affects their adherence
level to the prescribed treatment leading to a rise in chronic disease burden.
OBJECTIVE: The aim of this study was to ascertain the disease pattern, health expenditure, and
adherence to the prescriptions among geriatric patients reporting to a hospital in North India.
METHODOLOGY: This descriptive, cross‑sectional study was conducted from July 2017 to June
2018. Patients who were 60 or above years in age, already diagnosed and were on treatment for
more than 3 months were included in the study. A total of 310 patients were selected using convenient
sampling method. Data were collected by a pretested and validated questionnaire.
RESULTS: The mean age of the patients was 66.16 years ± 5.37 years (54.8% males). Monthly
average family income was Rs. 15202.97 ± 1134.63. Overall, 25% of the treatment cost was met
through various social schemes (52% = pension scheme, 32% of patients had no such schemes
and only 2% through health insurance schemes). Rest was out‑of‑pocket expenditure. Common
diseases were hypertension (60.64%), diabetes mellitus (35.8%), cancer (28.38%), and coronary
artery disease (22.58%). More than half (52.9%) of the patients had two or more illnesses; about
35.8% of them were taking treatment for 1–5 years. Moderate adherence was observed among the
majority of the patients. Statistically significant (P < 0.05) difference in treatment adherence to the
prescriptions was observed.
CONCLUSION: Geriatric patients had many chronic morbidities. They had high out‑of‑pocket
expenditure and suboptimal financial support affecting their level of adherence to the prescriptions.

Abstract BACKGROUND: Sailors are exposed to sunlight as their job requires and are, in the long run, more
prone to different types of skin cancer. This study aimed to explore sailors’ experience of perceived
threat and to show protective behaviors against sunlight in the south of Iran.
MATERIALS AND METHODS: The present follows a qualitative approach and directed content
analysis in 2018–2019 among sailors who were selected purposively through an interview procedure.
Finally, 22 sailors and 3 patients with skin cancer with an experience of sailing were interviewed
until data satiation occurred. The data were collected through a semi‑structured interview based on
two constructs, perceived susceptibility and perceived severity of protection motivation theory, and
were instantly transcribed and read more than once by the present researcher. Simultaneously, the
data were entered into MAXQDA 10 for the primary categorization.
RESULTS: Data analysis results were classified into 5 categories and 12 subcategories: protective
attempts (change of work time and use of protectives), passivity in self‑protection (not showing
protective behaviors and not examining skin), inadequate perception of affliction risk (beliefs hindering
preventive behaviors and low sensitivity), perceived threat to personal and familial conditions (loss
of peace and loss of occupational‑familial positions), and threat to health (incurable disease and
perceived skin disease).
CONCLUSIONS: Awareness of these factors helps planners to choose the best preventive strategies
with a focus on correcting beliefs and promoting protective behaviors as well as examining and
screening sailors regularly to diagnose skin cancer. Moreover, to develop practical measures of
protective strategies against sunlight among sailors, the required steps should be taken. This can
help to reduce the rate of work‑related risks while exposed to sunlight in this population.

Abstract CONTEXT: An increasingly common complaint of staff nurses in hospitals is not receiving respect.
One of the strategies to create a healthy and positive work environment is to strengthen the respectful
behaviors among nurses.
AIMS: This study aims to explore the barriers of respect in nursing workplace.
SETTINGS AND DESIGN: This qualitative content analysis was carried out at the School of Nursing
and Midwifery of Golestan University of Medical Sciences.
SUBJECTS AND METHODS: The semi‑structured interview method was employed in this qualitative
study on 14 nursing staff in 2018. We transcribed the interviews verbatim and analyzed them using
the conventional content analysis approach.
RESULTS: Data analysis led to the emergence of 377 primary codes, 13 categories, and 4 themes.
The four themes were as follows: (a) feeling of ignored; (b) socio‑cultural conditions in society;
(c) lack of Support by Managers; (d) poor organizational climate.
CONCLUSIONS: Nursing managers can promote a healthy work environment in the nursing workplace
through recognizing these challenges and applying mitigation strategies and take benefits of their
consequences such as self‑efficacy, self‑confidence, and organizational commitment.

Abstract BACKGROUND: Academic performance of medical students is governed by various factors.
Personality traits such as core self‑evaluation (CSE) and locus of control (LOC) are a few of the
most important factors that could govern academic performance. The medium of communication is
another important factor, especially in a country with language diversity that could affect the academic
performance of the new medical entrants. The study aims to examine the effect of LOC, CSE score,
and English Language proficiency on the academic performance of undergraduate medical students.
MATERIALS AND METHODS: Ninety undergraduate medical students of a premier central
government medical institute of India has been recruited for the study after due ethical clearance
from the Institutional Ethical Committee. A standard questionnaire for all the parameters to be studied
had been filled by the participants. The academic performance has been judged on the basis of the
professional examination’s marks score.
RESULTS: The multiple regression analysis considering all the variables, the English language
proficiency appears to be the most important factor with R2 = 0.106 and P = 0.003. Most of the
academic performers have shown the dominance of internal LOC and moderately high CSE scores
though not statistically significant.
CONCLUSIONS: Language proficiency appears to be one of the most important determinants of
academic performance in the medical entrants of Indian subcontinent. LOC and CSE could be an
important yardstick for academic performance, but that needs to be confirmed with another study
with a bigger data set.

Abstract AIM: The purpose of this study was to investigate the effects of delay in the operation and counseling
on postoperative complications and mortality rates in elderly patients.
METHODOLOGY: The present study was a descriptive cross‑sectional research. Population of this
study was the entire elderly hospitalized patients who aged over 55 years for emergency orthopedic
surgeries in a teaching hospital in Tehran. Surgery delays were then determined after examining the
checklists, and the relationship between the variables and surgery delays, number of preoperative
counseling, complications, and mortality rate was evaluated. Data were analyzed using the Mann–
Whitney U‑test and Pearson correlation coefficient in SPSS 18 at a 0.05 significance level.
RESULTS: Overall, 89.9% of the patients had counseling. The average hospitalization days were
5 days until surgery, and the standard deviation was 0.50. The mean counseling number was 5.5.
The relationship between number of counseling and surgical delays was significant. Delay in surgery
in this age group, mortality, and the chances of death have become 2.7 times more than who had not
a surgical delay. No significant relationship was observed between surgery delay and the incidence
of Deep Venous Thrombosis (P = 0.102), postoperative sepsis and Myocardial Infarction (P = 0.337),
embolism (P = 0.505), and postoperative Cerebrovascular Accident (P = 0.153).
CONCLUSIONS: The delay in surgery in the elderly causes an increase in mortality. Considering
the findings of this study and the importance of emergency orthopedic surgeries in the elderly, to
reduce the surgical delays and the mortality rate in the elderly, the establishment of a surgical team
for elderly patients in hospitals is recommended.

Abstract BACKGROUND: Clinical evaluations are not sufficient to adequately characterize the morbidity
associated with hemophilia. Quality of life (QoL) of hemophilics and associated factors is not well
explored in Indian research. The present study aimed to measure the QoL in hemophilics and its
association with socio‑demographic characteristics and other characteristics.
MATERIALS AND METHODS: A cross‑sectional study was conducted during June–November 2018.
Two hundred and one hemophilics (age ≥ 4 years) were interviewed with a pre‑tested schedule for
sociodemographic and other relevant variables. QoL was measured by Haemo‑QoL questionnaire for
different pediatric age groups and Haem‑A‑QoL questionnaire for adults and assigned health‑related
QoL scores. Score achieved in each dimension as well as total scores were transformed on scales
ranging from 0 to 100, high values indicate high impairment of QoL. Hemophilic arthropathy was
assessed using the World Federation of Hemophilia Joint Scores. One‑way ANOVA, independent
t‑test, Kruskal–Wallis test, and Spearman correlation analyses were performed using SPSS
version 16.
RESULTS: Mean Haemo‑QoL scores for 4–7 years, 8–12 years, 13–16 years, and >16 years were
43.92 ± 8.09, 37.37 ± 8.62, 32.79 ± 6.66, and 45.92 ± 6.30, respectively. Significant difference was
noted for QoL scores across different age groups, grades of severity, educational, occupational
categories, socioeconomic status classes, marital status, and presence or absence of target joint. Total
QoL scores, as well as scores in some of the dimensions, showed a significant positive correlation
with the World Federation of Hemophilia joint scores by Spearman correlation analysis.
CONCLUSIONS: Improvement of the joint health status by regular physiotherapy is needed to
improve the QoL of hemophilics.

Abstract BACKGROUND: Student satisfaction has an impact on student motivation, recruitment of new
students, and retention of existing students. Hence, it is important for researchers and academic
institutes to assess student academic satisfaction by valid and reliable scales. The aim of this study
was to rigorously assess methodological quality and psychometric properties of scales measuring
student academic satisfaction.
METHODS: In this systematic review, databases including Scopus, PubMed, ProQuest, ScienceDirect,
and Web of Science, and two Persian databases were searched using relevant keywords such as
academic satisfaction, student satisfaction, university satisfaction, campus satisfaction, academic
life experience, validation, and psychometric and factor analysis from 1970 to December 2018.
Considering eligibility criteria, studies were selected after titles and abstracts screening. The
methodological quality assessment was performed by the COnsensus‑based Standards for the
selection of health Measurement INstruments (COSMIN) checklist and the Terwee quality criteria.
RESULTS: Of 814 retrieved articles, 13 studies were included in the study. Based on the COSMIN
checklist, structural validity (84%), content validity (53%), and hypothesis testing (53%) were the
most reported properties. One study reported cross‑cultural validity, one for criterion validity, and
none reported measurement error.
CONCLUSION: The results of our study showed that in spite of ≥48 years of development in student
satisfaction scales; however, each scale has at least one “poor” psychometric property based on
the COSMIN checklist. Quality appraisal of scales is necessary after developing and performing
psychometric process.

Abstract CONTEXT: The general dentist must not only have a broad biomedical and clinical education but
also be able to demonstrate professional and ethical behavior as well as effective communication
and interpersonal skills. In addition he or she must have the ability to evaluate and utilize emerging
technologies, continuing professional development opportunities, and problem‑solving and critical
thinking skills to effectively address current and future issues in health care. But the extent to which
the core competencies are taught and the students’ level of proficiency in these competencies in
Indian scenario is to be explored at large.
AIMS: The present study aims at assessing the self‑perceived level of competencies and their
importance for future practice and the extent to which the competencies are taught in the curriculum
among interns of dental college in Pondicherry, India.
SETTINGS AND DESIGN: The cross‑sectional observational study was conducted among dental
interns of Indira Gandhi Institute of Dental Sciences, Pondicherry.
SUBJECTS AND METHODS: A total of 72 interns participated in the study. A short version of the
Freiburg Questionnaire to Assess Competencies in Medicine” was used in this study. Questionnaire
has three sections with same set of questions, which the student had to rate: (i) To what extent do
you have the following competencies at your disposal? (ii) To what extent will your future job require
the following competencies? and (iii) To what extent is competencies taught to you? After the results
were obtained a focused group discussion with the responders was done. Focused group discussion
consisted of open questions to the groups in all the four domains and the responses of the students
were scribed.
RESULTS: In all four domains, self‑perceived level of competency was not satisfactory. However, all
students stated that the competencies were highly relevant for their future practice. Despite this, most
of the competencies are not taught to necessary extent in the curriculum. The results of the present
survey revealed that the participating students perceived deficiencies in all domains of competencies.
CONCLUSIONS: These results indicate that the core competencies are still barely integrated into
dental curricula and that further research in this field is needed.

Abstract INTRODUCTION: Aging and chronic diseases associated with nutrition are increasing in the world;
therefore, access to a tool for assessing nutritional literacy in the elderly is necessary. Therefore,
the present study was carried out with the aim of psychometric evaluation of nutritional literacy in
the elderly.
MATERIALS AND METHODS: This study was carried out to psychometric testing of the Nutrition
Literacy Scale (NLS), through the validity and reliability of the tool in 280 elderly people (60 years of
age and older) in Tehran. The validity of this tool was determined through the methods of translation,
face and content and reliability of the tool through the methods of test–retest and internal consistency.
Finally, the tool was analyzed using SPSS software version 16.
RESULTS: In this study, content validity index (CVI) was calculated for each item; CVI average
was 0.86.5. To determine the reliability of the tool, interclass correlation coefficient was calculated
by measuring the instrument’s stability, and it was 0.92. Exploratory factor analysis confirmed the
existence of six factors in the questionnaire, which was named nutritional information, healthy
nutrition, calorie intake, organic foods, saturated fats, and unit size, which explains 43% of the total
variance. Furthermore, in the internal consistency assessment, the questionnaire was completed
by 280 elderly people, and the Cronbach’s α coefficient was 0.80.
CONCLUSION: Based on the results obtained in the reliability and validity assessment, NLS in
Iranian elderly has a desirable reliability and validity. This questionnaire has been translated into
Persian for the first time. The results of this study provide a standard tool for assessing nutritional
literacy status in Persian language communities.

Abstract CONTEXT: Academic stress among adolescents is a significant contributor to a variety of mental
and behavioral disorders. Holistic stress management interventions equip adolescents with good
mental health and improve academic performance.
AIM: The aim of the study is to evaluate the effectiveness of holistic group‑based stress management
program in reducing academic stress, depression, anxiety, and improving well‑being among
adolescent girls.
SETTINGS AND DESIGN: Randomized control trial was adopted and the study was conducted at
selected colleges of Dharwad city, Karnataka, India.
MATERIALS AND METHODS: Two hundred and thirty adolescent girls were randomly selected
and assigned to either experimental (n = 115) or control group (n = 115). Both group participants
were initially assessed for academic stress, depression, anxiety, general stress, and well‑being.
The experimental group participants participated in eight sessions of holistic group‑based stress
management program over a period of 1 month. The intervention comprises of body–mind–spirit
strategies focusing on techniques to handle stressful situations, accept responsibility for their own
well‑being, and take charge of self‑health. Control group participants did not receive any intervention.
Postintervention assessments were conducted for all the participants on monthly intervals for 6
months.
RESULTS: Over 6 months follow‑up compared to control group, the experimental group participants
showed statistically significant decrease in academic stress (F = 131.60, P < 0.01, n2
G = 0.14),
depression (F = 156.70, P < 0.01, n2
G = 0.13), anxiety (F = 190.50, P < 0.01, n2
G = 0.16), general
stress (F = 166.10, P < 0.01, n2
G = 0.16), and improvement in well‑being (F = 156.40, P < 0.01,
n2
G = 0.13).
CONCLUSIONS: These findings indicate that holistic stress management program has a positive
effect on reducing stress, anxiety, depression, and improving well‑being.

Abstract BACKGROUND: Human immunodeficiency virus (HIV) is a kind of behavioral disease in that
adopting behavioral changes is the only way to control and stop the epidemic. The aim of this study
is to investigate the effect of education base on the health belief model (HBM) on health‑seeking
behavior among HIV‑positive women.
MATERIALS AND METHODS: This study is a paralleled, randomized controlled clinical trial done
with control group among HIV‑positive women who were registered at the voluntary and counseling
testing center of Imam Khomeini hospital in Tehran. Data were gathered by using information obtained
from the Motivation‑Skill‑Behavior questionnaire and demographic data. The women were divided by
permuted block and were randomized into two groups. Interventional group participated in six HBM
educational classes and used routine counseling guidelines, but the control group used only routine
counseling protocol. Data were collected before, immediately after, and 3 weeks after interference
among all participants. Data were analyzed by using SPSS software version 16.
RESULTS: According to the results and statistical test, before intervention, the mean score of
knowledge was not significantly different in the two groups, but after intervention in the interventional
group, test result and follow‑up increased statistically significantly (P = 0.000). Both groups had
increased mean score of knowledge, and there is significant trend in level of knowledge(interventional
group 20.79 ± 1.88, control group: 17.36 ±2.44) and there was a significant increase in mean attitude
follow‑up score (P < 0.001).
CONCLUSION: According to the result of the present study, counseling base on HBM by trained
educator can increase information‑motivation‑skill‑behavior among women living with HIV.

Abstract BACKGROUND: Health‑promoting behaviors are essential beliefs and actions to develop and
sustain the adolescent health; however, people with inadequate health literacy have poorer health
status. This study aimed to determine the effect of a problem‑based learning (PBL) health literacy
program on improving health‑promoting behaviors among female students (15–18 years) at high
schools in 2018–2019.
METHODS: This study was a quasi‑experimental intervention one which carried out on 377 girl
students using a cluster sampling method of intervention (n = 183) and control (n = 194) groups. The
intervention was performed in four educational sessions of PBL health literacy program using related
scenarios for 90 min. Data were collected through demographic variables, the Health Literacy Measure
for Adolescents, and the Health‑Promoting Lifestyle Profile II. Participants filled the questionnaires
immediately and 3 months after the intervention in both the groups.
RESULTS: There were significant differences comparing the mean score of health literacy
dimensions in numeracy (P < 0.001), use (P < 0.001), communication (P < 0.001), access (P = 0.03),
self‑efficacy (P < 0.001), and total health literacy (P < 0.001) after intervention. These differences
also observed in numeracy (P < 0.001), use (P = 0.03) and total health literacy (P < 0.001) in
follow‑up between the intervention and control groups. The mean scores of health‑promoting lifestyle
dimensions in all dimensions immediately after intervention (P < 0.001) and follow‑up (P ≤ 0.006)
showed significant differences between the two groups, while the intervention group revealed a
higher mean scores.
CONCLUSION: It seems that PBL health literacy and practicing real‑life scenarios can improve
the adolescent lifestyle. It is recommended to examine the effectiveness of the program for other
health‑related behaviors among other populations.

Abstract INTRODUCTION: Smoking is one of the leading factors of mortality in Malaysia. Most youngsters start
at adolescence, fascinated by the concept of smoking. Interventions that harness the broad availability
of mobile phones, as well as adolescents’ interest in their appearance, may be an innovative way
to advance school‑based prevention. This study aims to determine the perceptions of facial‑aging
apps among secondary school students.
METHODOLOGY: For this research, descriptive cross‑sectional study using simple random sampling
method was used. Population sampling was targeted toward three government schools. The total
number of respondents is 383, with all of them aged between 13 and‑ 16 years of age. Legal
considerations were taken to maintain the confidentiality of respondents. The specific objectives
are: 1. To determine the level of change of intention on smoking, 2. To know the perceived reactions
of the peer groups on the appearances of students as nonsmokers, 3. To determine whether the
students learned new benefits of nonsmokingand, 4. To measure the impact of a facial‑aging app
among students.
RESULTS: The number of respondents who smoke was 40 (10.4%), while the number of respondents
who do not smoke was 343 (89.6%). About 89% of the respondents agree that their three‑dimensional
selfie image motivates them not to smoke. In addition, 87.8% of respondents admit that the perceived
reactions of their classmates make them think that they look better as nonsmokers. After learning
the effects of smoking, about 86.4% of the respondents acknowledged that they would educate
their peer groups. Furthermore, 85.9% of the respondents found this “Smokerface” app enjoyable.
CONCLUSION: The facial‑aging intervention was effective in motivating Malaysian pupils to stay
away from tobacco use. Thus, the analysis on the study of facial app usage in smoking prevention
among youngsters concludes that most of the adolescents concur that the “Smokerface” app helps
in the prevention of smoking among youths.

Abstract INTRODUCTION: Employed women experience a wide range of stresses that will potentially impact
on their quality of life, mental status, and marital satisfaction. The aim of this study was to determine
the relationship between the above components in employed women.
METHODS: The statistical population of this cross‑sectional descriptive‑analytical study
was 124 married employed women of Khorramabad Health Center. The WHO Standard
Questionnaire (SF‑36), Perceived Stress Questionnaire (COHEN questionnaire), Marital Satisfaction
Questionnaire (ENRICH questionnaire 47), and Demographic Information Questionnaire were used
to collect data. Information was analyzed by SPSS software.
RESULTS: Most of the participants in the research had a good (45/2%) and very good (34/7%)
quality of life. Most of them reported high (57/1%) and very high (15/3%) levels of marital satisfaction.
Furthermore, the majority of women participating in the study had a low level (64/5%) of perceived
stress. There was a significant inverse correlation between perceived stress and marital satisfaction
(r = −0/446, P < 0.001) and quality of life (r = −0/612, P < 0.05). There was a direct correlation between
marital satisfaction and quality of life (r = −0/449, P < 0.05). Linear regression analysis showed that
the importance of quality of life and perceived stress scores, respectively, were significant predictors
of marital satisfaction score. There was no statistically significant correlation between the total score
of quality of life and marital satisfaction with demographic variables; only a weak relationship was
found between perceived stress and family monthly income (r = −0/184, P = 0/04).
CONCLUSION: The findings of this study indicate that quality of life and perceived stress can be
significant predictors of marital satisfaction in married employed women.

Abstract INTRODUCTION: Work‑related musculoskeletal symptoms are a major health issue in many
occupations all over the world. Past researches on hospital workers have mainly been focused on
nurses, and not many studies have examined musculoskeletal symptoms among doctors in various
specialties. The work of surgeons can involve high levels of mental concentration and very precise
movements that can be categorized as mild‑to‑moderate physical demands.
OBJECTIVE: To identify the prevalence of musculoskeletal problems and their related physical and
psychosocial factors of surgeons who are involved in such work.
METHODOLOGY: Forty‑three surgeons were enrolled in this study. To evaluate the musculoskeletal
disorders, the participants were assessed through Standardized Nordic Questionnaire, Quick
Exposure Check for the work pattern, and Work style Short Form for screening purpose.
RESULTS: Out of 43 participants, 30 were male and 13 were female. Their mean age was
42.07 ± 12.35 years, and the mean working years ± standard deviation of the group was
15.14 years ± 9.017. On an average, they worked a total of about 8.58 h ± 1.96 per day. The
prevalence of work‑related musculoskeletal symptoms was found in 36 participants (83.70%), while
only seven surgeons (16.30%) were symptom free.
CONCLUSION: The present study indicates a high prevalence of musculoskeletal symptoms in
surgeons. The results also indicated that surgeons had a high sense of commitment and self‑imposed
pressure.

Abstract BACKGROUND AND OBJECTIVE: Applying the Best Evidence Medical Education (BEME)
in real educational arena is a necessity in medical education. As to the literature, there are
enough evidence; however, their application by educators and policymakers has been still failed.
Therefore, this study conducted to explore the experience of educators about applying BEME in
Iranian context.
MATERIALS AND METHODS: Qualitative approach using content analysis method was utilized for
exploring 25 participants involved with medical education in different levels, introduced the study using
purposeful sampling. Data were collected through a semi‑structured interview by which they answered
to researcher’s questions in around 45 min about how they apply evidence in their educational setting.
To make more clarification, probing questions were used. Interviews were recorded and transcribed
and then analyzed by coding paradigm immediately.
RESULTS: Three categories were emerged as: applying different levels of evidence, substitution
of evidence‑based medicine for BEME, and variation of understanding BEME. The first category
includes subcategories of using personal experience, textbooks, and filtered papers. The second
contains lack of knowledge about BEME elements, time and motivation as well as no priority for
applying available medical education evidence; and third, using different terminology and having
some problems in applying process, based on individual understanding and using papers with or
without modification.
DISCUSSION: For effective evidence application, it is necessary to operationalize BEME terminology
and overcome any ambiguity surrounded it. It is also important to suggest educators to apply the
appraised evidence as well as teach them how they search and appraise evidence independently.
Certainly, in the first steps, supervision and providing a proper context for BEME applications are
crucial.

Abstract INTRODUCTION: Cancer is the second cause of mortality among children. The aim of this study
is to identify the health information needs of families in childhood cancer as main source of support
and care for these children.
MATERIALS AND METHODS: The qualitative content analysis approach was used in this study.
The study population comprised parents of childhood cancer patients visiting Omid Hospital among
which 35 were selected using purposive sampling until data saturation was achieved. The study tool
was semi‑structured interview.
RESULTS: A total of 9 main themes and 24 subthemes were identified. The main themes included:
(1) information about cancer, (2) disease management and self‑care, (3) communication and
information interaction of medical team, (4) consultation services, (5) information sharing and
exchange, (6) access to health services, (7) hospital’s facilities and equipment, (8) access to social
and financial support, and (9) access to health information sources.
CONCLUSION: Health information needs of families in Isfahan are consistent in information needs
of families identified in other studies. Meeting this information needs through plans of health‑care
system can help these families in better control and treatment of their children’s condition.

Abstract CONTEXT: Human immunodeficiency virus (HIV) is a public health problem in India. Dentist plays
an important role in diagnosing since oral lesions are common in HIV‑positive patients and have an
ethical responsibility to provide treatment to them.
AIMS: This study aims to explore educational and promotional opportunities for implementing oral
rapid HIV testing (ORHT) among dentists in Bengaluru, India.
SETTINGS AND DESIGN: A cross‑sectional study was conducted among 300 dentists. Dentists
were included from private practice, dental practice in general hospital, and dental teaching/hospitals.
SUBJECTS AND METHODS: A 43‑item questionnaire was used to assess demographics, educational
knowledge on HIV and ORHT, attitude toward HIV patients, and willingness to promote ORHT and
perceived barriers of performing ORHT.
STATISTICAL ANALYSIS USED: The data were evaluated using SPSS 22. Student’s t‑test,
Chi‑square, Pearson correlation, and binary logistics were used keeping P value at 5%.
RESULTS: Mean age of the participants was 38.97 ± 7.69 years with equal distribution of gender
and practice. Majority were postgraduates (63.0%) and having general practice (56.6%). Although
two‑thirds of the participants belong to high score category, the mean knowledge level is below 50%.
Mean score of knowledge was 10.70 ± 2.5. One hundred and thirty (43.3%) dentists were aware of
ORHT, and 228 (76%) thought that ORHT was needed in the dental clinic. Dentist having specialty
practice felt more accepting of ORHT (odds ratio = 2.455, 95% confidence interval 1.186–5.463).
The lack of knowledge and training was the main barrier (39%) to conduct ORHT.
CONCLUSIONS: The level of knowledge of the dentist about HIV/AIDS was acceptable. Majority
of the dentist thought that ORHT is needed in a dental clinic. Overall, there was positive attitude
toward HIV patients and ORHT.

Abstract AIMS: Improvement of general health literacy is one of the ways to achieve the desired public
health condition. To this end, the first step is to determine the health literacy level and its associated
demographic factors in individuals.
SETTINGS AND DESIGN: This study was a cross‑sectional, descriptive‑analytic survey conducted
on 700 adults (age range: 18–65 years) in Bardaskan, Iran. The required samples were selected
via random cluster sampling method.
SUBJECTS AND METHODS: The demographic questionnaire was used to collect sociodemographic
information. The Health Literacy for Iranian Adults questionnaire was used to determine the level of
health literacy in participants.
STATISTICAL ANALYSIS: Data analysis was conducted using SPSS software version 20 through
descriptive and inferential statistics. Results were considered statistically significant at P ≤ 0.05.
RESULTS: A total of 700 participants with a mean (standard deviation) age of 31.25 (9.32) years
participated in this study. The primary sources of health information were physicians and health
staff (50.9%) followed by the Internet (19.7%). The health literacy level of 18.1% of the participants
was inadequate, 27.7% was marginal, 39.4% was adequate, and 14.7% was excellent. The mean
overall scores of health literacy and its subscales were within the adequate range (66.1–84.0). The
relationships of health literacy level with age, education, marital status, occupational status, and
history of disease were statistically significant (P < 0.001).
CONCLUSION: It seems necessary to design and implement a variety of educational programs to
improve the general health literacy of the citizens of Bardaskan. Educational programs need to focus
on groups with higher priority such as elderly people, individuals with lower educational levels, widows/
widowers and divorced/separated individuals, unemployed and retired individuals, homemakers, and
individuals with a history of disease.

Abstract INTRODUCTION: Protection against financial risks is one of the important goals of the health
system. The present study aims to determine the rate of exposure to catastrophic expenditures in
the insured inpatients.
METHODS: The present study was cross‑sectional one which is conducted in 2016. The statistical
population comprised all the insured patients presenting to a private hospital in Qom who presented
to the hospital within 4 months from December 2015 to March 2016. Random convenience sampling
method was used, and the sample size was estimated at 267 people using Cochran formula.
A questionnaire was employed for data gathering. Data were analyzed using Chi‑square test and
logistic regression using SPSS software version 20.
RESULS: Patients exposed to catastrophic expenditures of treatment accounted for the 54.8% of
the cases. The highest rate of being exposed to the catastrophic expenditures was related to the
insured patients of the Universal Health Insurance Fund (UHIF). People with rural insurance, on
average, paid the highest cost of treatment in the hospital. The surgical ward and critical care unit
accounted for the biggest percentage of the patients who incurred catastrophic expenditures. Being
rural, longer length of stay, lower education of the head of the household, lack of supplementary
insurance coverage, and being in UHIF coverage have a substantial relationship with being exposed
to catastrophic expenditures.
DISCUSSION: The socioeconomic status of the insured people in the UHIF and the Rural Insurance
Fund was worse than other funds in terms of less utilization and higher rate of exposure to catastrophic
expenditures, and this issue requires the adoption of specific targeted policies for these groups in
respect with reducing out‑of‑pocket payments through mechanism such as stepwise copayments,
maximum out‑of‑pocket limit, fee exemptions or waiver and providing supplementary insurance to
reduce the exposure to catastrophic expenditures.

Abstract INTRODUCTION: Mental health is very important during pregnancy, and perfectionism, body image,
and eating disorder are three important factors in mental health. Given that eating disorders are very
dangerous in pregnancy, the aim of this study was to determine the relationship between perfectionism
and body image with eating disorder in pregnancy.
METHODS: This descriptive study was performed on 200 pregnant women referred to Isfahan Health
Centers in 2017. The research units, if met the inclusion criteria, completed the Eating Attitudes
Questionnaire, Multidimensional Relationships of their Body Questionnaire, and Perfectionism
Questionnaire. Finally, the data were analyzed by SPSS software version 22, with a significance
level of 0.05.
RESULTS: The results showed that there was a significant negative relationship between positive
perfectionism with symptoms of eating disorder, anorexia nervosa, and nervous longing to eat.
There was a significant positive correlation between negative perfectionism with symptoms of eating
disorder, anorexia nervosa, and nervous longing to eat. The results also showed a significant negative
relationship between body image and its dimensions with symptoms of eating disorder, anorexia
nervosa, and neurasthenia.
CONCLUSION: Perfectionism and body image and its dimensions are psychological problems related
to eating disorder in pregnancy. For this reason, it seems that taking classes for pregnant women
and their spouses can reduce the incidence of this disorder.

Abstract

Abstract INTRODUCTION: Overweight and obesity as a major public health issue can lead to adverse
health consequences during the life span. This study aimed to measure socioeconomic inequality
in unhealthy weight among school students in Kermanshah, west of Iran.
METHODS: The cross‑sectional study measured the socioeconomic‑related inequalities in unhealthy
weight among 1404 secondary school students aged 11–16 years in Kermanshah in 2018. Unhealthy
weight is defined as body mass index of >25 kg/m2
 in the study. Socioeconomic‑related inequality
in unhealthy weight was calculated using the concentration index (Cn
). A logistic regression model
was used to estimate the marginal effect of independent variables.
RESULTS: The prevalence of unhealthy weight for the total sample was 0.13 (95% confidence
interval [CI]: 0.11–0.14). Of these, the prevalence of unhealthy weight for girls and boys was
0.11 (95% CI: 0.09–0.14) and 0.15 (95% CI: 0.12–0.18), respectively. The value of Cn
 for the
total sample was 0.12 (95% CI: 0.03–0.2), which indicates a higher concentration of unhealthy
weight among the high socioeconomic status (SES) students. Two factors of SES (49.11%) and
gender (40.08%) had the largest contribution to socioeconomic inequality in unhealthy weight among
the study students.
CONCLUSIONS: Socioeconomic‑related inequality in unhealthy weight was concentered among
high‑SES students in the study. Thus, public health policies need to be formulated to change sedentary
lifestyles and unhealthy dietary patterns among students with higher SES.

Abstract

Abstract INTRODUCTION: Various programs are implemented internationally to promote the mental and social
health of the students in schools. This study systematically reviewed and categorized all resources,
indicators, and criteria for evaluating mental and social programs of schools.
MATERIALS AND METHODS: This systematic review was conducted by collecting data
from the PubMed, Google Scholar, Scopus, ProQuest, and Web of Science databases
using the keywords of “evaluation, mental health program, social health program, behavioral
and emotional program.” In the initial review, 4295 studies were found, which reduced to 75 after
removing the repetitions and evaluating the studies’ quality. The articles were selected using the
PRISMA chart.
RESULTS: The findings resulted in three main categories of structure, process, and
outcome; 16 subcategories; and 166 codes. The category of structure included the subcategories of
human resources, physical space, facilities, training, needed committees and teams, financing, and
implementing mental and social programs. The subcategories of process category were functional
indicators, guidelines and protocols, communication, documentation, planning/coordination, time
management, and monitoring. The subcategories of behavioral‑therapeutic, satisfaction, and
educational outcomes were associated with the outcome category.
CONCLUSION: Application of the structure, process, and outcome indicators, derived from the
findings of this study, will greatly improve evaluation of the international mental health programs in
schools.