Journal of Education and Health Promotion

Abstract BACKGROUND: Coronavirus (COVID‑19) a worldwide pandemic has significantly affected
life of people around the globe. It has also caused various psychological issues among public
such as uncertainty, fear, anxiety, and of course stress. Globalization has facilitated it and has
added greater complexity to the containment of infection leading to urgent call for public health
challenge. Consequently, a multilevel stress coping adjustment process is going on. Hence, it is
imperative to explore how people are affected psychologically and how they are coping with it.
People are adopting different strategies for coping up from this challenging situation. In this sense,
the present study intended to: explore which coping strategies were of relevance for people for
adjusting in COVID‑19 crises and were sociodemographic factors influencing the coping strategies.
MATERIALS AND METHODS: The research is descriptive study. For the present study, a sample
of 475 participants was asked for coping strategies used by them using valid and reliable scales.
RESULTS: Results revealed that positive attitude and trust in God were the most used adaptive
coping strategies and sociodemographic variables were playing a significant role in adaptive coping
strategies.
CONCLUSION: Hence, understanding and identification of coping strategies and their relationship
with demographic variables can help health professionals to direct interventions to control stressors
related to the pandemics.

Abstract BACKGROUND: Considering that the quality of personal life and the quality of sexual life of working
women interact with each other and considering that job as one of the dimensions that can play
a direct role in the quality of life and also due to increasing women’s participation in professional
activities in today’s society, this study was designed and conducted to explain the experiences of
working women considering sexual health challenges.
MATERIALS AND METHODS: This research was a qualitative study that the information of which
was obtained through face‑to‑face interviews with semi‑structured and open‑ended questionnaires.
Interviews were conducted with 32 working women working in public and private offices in Tehran,
Iran, to explore their experiences of the role of jobs in sexual challenges. The sampling method
was purposive. Data analysis was performed using a qualitative content analysis method with a
conventional approach by MAXQDA software version 10, and to establish the reliability and validity
of findings, Graneheim and Lundman criteria were considered.
RESULTS: Data analysis from 32 interviews resulted in the formation of 223 primary inferential
codes and 1 main category and 4 subcategories. The results of data analysis were presented in
one main category, including sexual health challenges among working women. This main category
consisted of four subcategories such as sexual problems due to employment, job harassment, the
essential needs for sexual relationship, need for the better job management, and married sex life.
CONCLUSIONS: Explaining the experiences of working women showed that sexual problems due
to employment and job harassment are among the factors that cause sexual health challenges in
working women. It also seems that meeting the essential needs for sexual relationship and the better
management of job and married sex life can interact with the sex lives of working women.

Abstract BACKGROUND: Health literacy (HL) is an important role‑play in health risk behaviors such as
alcohol drinking and smoking. Inadequate HL in substance use (HLSU) is a barrier to reduce the
risk of alcohol and tobacco use. This study aims to investigate the association of HLSU with alcohol
consumption and tobacco use among Thai adolescents. Hence, the strengthening of HL program
intervention may applied to reduce substance abuse among Thai adolescents.
MATERIALS AND METHODS: This was a cross‑sectional study conducted on 1087 university
students studying in three universities located in northeastern area with multistage sampling methods
by geographical areas. The data were collected by self‑administered questionnaire. Multiple logistic
regression was applied to determine the effect of HLSU of alcohol consumption and tobacco use.
RESULTS: Most adolescents were drinkers (60.7%) and about 20.7% were smokers. Approximately
40% of them reported as inadequate HLSU. Adolescents with inadequate HLSU and a high level of
positive alcohol expectancies and smoking outcome expectancies (SOE) were more likely to drink
alcohol and smoke. Conversely, those who had a high level of negative alcohol drinking and SOE
were less likely to consume alcohol and tobacco.
CONCLUSION: Adolescents’ alcohol consumption and tobacco use were influenced by HL, hence
improving adolescents’ HLSU could help prevent or reduce the risk of drinking and smoking behaviors.

Abstract BACKGROUND: Breast cancer is the most common type of cancer among women. Mammography
is the most sensitive and important method for screening and early diagnosis of breast cancer.
Considering the importance of using mammography in breast cancer screening, this study was
performed to evaluate mammographic determinants.
MATERIALS AND METHODS: In the cross‑sectional study, we surveyed 985 women over 40 years in
Tehran concerning demographic characteristics: age, socioeconomic status, a problem in the breast,
alcohol use, drug use, and health belief model. Logistic regression was used to identify determinant
factors associated with mammography performance.
RESULTS: The results of this study showed that 42.1% (95% confidence interval [CI]: 38, 45)
participant performed mammography at least once during their lifetime. Age (odds ratio [OR] = 4.252;
95% CI = 2.041–8.857); housing situation (OR = 1.706; 95% CI = 1.178–2.469); having breast
problems (OR = 5.224; 95% CI = 3.501–7.795); socioeconomic status (OR = 1.855; 95%
CI = 1.035–3.325); family income level (OR = 1.998; 95% CI = 1.028–3.884); alcohol
consumption (OR = 2.676; 95% CI = 1.344–5.328); smoking (OR = 2.824; 95% CI = 1.418–5.623);
self‑efficacy (OR = 1.935; 95% CI = 1.242–3.015); perceived barriers (OR = 2.017; 95%
CI = 1.348–3.019); self‑care (OR = 4.901; 95% CI = 3.152–7.620); perceived susceptibility (OR = 1.971;
95% CI = 1.271–3.057) and perceived severity (OR = 1.830; 95% CI = 1.170–2.860) were
mammography behaviors determinants.
CONCLUSION: The findings indicated that the rate of mammography screening among Tehranian
women is low and highlights the need for developing a comprehensive national breast cancer control
program, which should be considered as the priority for health‑care providers. Furthermore, the
identification of these factors can help to design an appropriate educational intervention that focuses
on the benefits of mammography screening.

Abstract BACKGROUND: Neonatal seizure (NS) reflects serious underlying brain injury, requiring immediate
evaluation and early treatment. In neonates, phenobarbitone and phenytoin are used primarily to
control the seizures. If uncontrolled, widespread off‑label use of midazolam and levetiracetam was
practiced. These drugs gained popularity though there are no such studies available on literature
search comparing them. The present study was designed to explore these lacunae using these two
drugs in refractory cases. To study the efficacy and adverse drug reactions (ADRs) of midazolam
and levetiracetam not responding to usual line of therapy.
MATERIALS AND METHODS: This was a prospective cross-sectional study conducted on 69
neonates in the NICU and Department of Pharmacology in Burdwan Medical College and Hospital,
West Bengal. Patients receiving midazolam or levetiracetam when uncontrolled with first line
antiepileptics, namely, phenobarbitone and phenytoin, were considered eligible. The study variables
were time to control seizure, seizure recurrence and frequency, and treatment-related adverse events.
analysis used Mann–Whitney U-test were applied Comparison with respect to time to control and
Chi-square test were applied to detect difference in proportion for ADRs. The SPSS Statistics 17.0
was used for analysis.
RESULTS: We compared the time periods to control neonatal seizure for effectiveness between
levetiracetam and midazolam showing no significant difference (P = 0.190). Comparing the portion
of recurrences in two groups gives statistically nonsignificant (P = 0.878) result. Only respiratory
depression was seen in the levetiracetam group (12.90%) and midazolam group (18.42%). All
adverse events were ‘probable’ as per the WHO‑UMC criteria, and there was no statistically significant
difference between the two drugs (P = 0.533).
CONCLUSIONS: Both midazolam and levetiracetam are equally effective and safe in NS not
responding to usual line of treatment.

Abstract Early clinical exposure (ECE) is a teaching‑learning methodology which fosters the exposure of
medical students to the patients as early as the first year of medical college. A worldwide number of
research studies investigated the outcome of ECE and found, ECE sessions motivate the medical
student in various ways making their academic strength, improve clinical skills, and improve
communication skills and making them more confident. In the medical curriculum, ECE makes an
overall impact on student’s performance and confidence. Planning of ECE in real‑time practices
can be done in different settings with the use of appropriate resources such as logbook, textbooks,
notes, instruments, learning material, case record sheets, and computers. Herewith, we reviewed
the scientific base responsible for these outcomes and discussed different ECE settings and their
outcome. The Medical Council of India in new educational reforms made ECE sessions compulsory
from 2019 in undergraduate medical curriculum. In conclusion, the challenge for health professions
education is to look for ways to improve the quality of clinical education by comparing students’
understanding and modifying practices of clinical education in new circumstances. Early clinical
experience will definitely play a crucial role in this context, only if proper strategies are implemented.
This systemic review article highlights ECE settings and scientific basis in a theoretical way helpful
for medical faculties during its implementation in regular teaching.

Abstract BACKGROUND: The COVID‑19 disease has resulted in an almost complete shutdown of all services
worldwide. Hospitals continued to provide emergency services and treatment for COVID‑19 disease.
Teaching hospitals like ours had another responsibility at hand; training of our surgical residents.
Not allowing this pandemic to take away months of training, we resorted to online virtual training
programs, for continuing academic activities. After having conducted thirty such sessions, we took
feedback from the participating students and faculty members to evaluate the usefulness of this new
initiative and identify the lacunae that needed to be addressed.
MATERIALS AND METHODS: The initial twenty classes were held on the GoTo Meeting ® online
platform, whereas the last ten were conducted using the Google Meet application. A 20‑item
questionnaire covering four broad domains of general perception, feasibility, knowledge gained, and
drawbacks was circulated, and 19 responses were registered anonymously. Strength, weakness,
opportunity, and threat analysis was done based on the responses received.
RESULTS: About 89.5% of the participants believed that online classes were the ideal platform for
continuing education and 84.2% of the participants were overall satisfied with the whole exercise. The
Achilles’ heel was the availability of a good Internet connection, and the major lacunae were the poor
quality of video and audio transmission. Seventy‑four percent of the participants wanted to continue
online training in the future too, whereas 26% wanted to revert to the traditional face‑to‑face teaching.
CONCLUSION: Online virtual training classes are an effective and feasible alternative to traditional
teaching in times such as these, which demanded strict social distancing. It naturally lacked the
warmth and personal touch of the traditional teaching classes, but it allowed us to continue teaching
our residents and also prepare them to face the biggest menace of all times.

Abstract BACKGROUND: To prevent the rapid spread of infectious COVID‑19 in India, many steps have been
taken. Adherence to the control measures depends on the knowledge, attitude, and practices (KAPs)
toward COVID‑19 disease in health‑care professionals. The present study was conducted among
health‑care professionals in Jaipur. The objective was to evaluate the KAPs about COVID‑19 among
health‑care professionals.
MATERIALS AND METHODS: A total of 385 participants took part in the study. A self‑designed
questionnaire was filled by the participants online (Google Form). The knowledge of the participants
was assessed using 12 questions. Attitude and practices of the participants were assessed by two
questions for each.
RESULTS: Among the study completers, 52.20% were male, 71.42% of the participants were aged
above 30 years, and 59.22% were nurse. The knowledge score was approximately 90%. The majority
of the participants had a strong conviction that India can overcome this infectious disease in the near
future. Multiple regression analysis found that good knowledge score of COVID‑19 was associated
with lower negative attitudes and less risky practices (P ˂ 0.001).
CONCLUSION: Participants of the study were knowledgeable, held positive attitudes, and had
adequate practices for COVID‑19.

Abstract The objective was to identify the existing links between the conceptual proposal of the movement of
health-promoting universities (HPU) and the activities carried out to increase the health of workers
in higher education institutions. An integrative literature review was conducted in October 2020 in
the following databases: LILACS, Scientific Electronic Library Online, Web of Science, and CINAHL
and with the Boolean phrase citing, University AND “health promotion.” In the initial review, 5351
studies were found, and after removing the repetitions, applying the inclusion criteria, and making the
qualitative analysis, a sample of 9 articles was obtained. For the construction of the flowchart with the
representation of the eligibility and inclusion of the articles, the PRISMA model was use .The findings
were analyzed with the theoretical and conceptual support of the movement of HPU, which made it
possible to establish the construction of three categories, to quote: full provision of social, medical,
and health services; creating a favorable health environment on campus; and development of health
education actions. The movement of HPU is relevant to the contemporary world; however, initiatives
to incorporate these practices are still scarce, creating a gap between expectations and reality.

Abstract There is a lack of conceptual clarity about the role of delivering private hospital services
(DPHS) accompanied by major gaps in evidence. The purpose of this systematic scoping
review was to identify and map the available evidence regarding the developing countries
to scrutinize the participation of DPHS exclusively in the universal health coverage (UHC)
through providing graphical/tabular classifications of the bibliometric information, sources
of the records, frequent location, contribution of the private hospital services in the health
system, and roles of DPHS in UHC. This study was performed following the published
methodological guidance of the Joanna Briggs Institute for the conduct of scoping review,
applying some major databases and search engines. In addition, a narrative-thematic
synthesis integrated with the systematic analysis using the policy framework of the World
Health Organization was employed. The 28 included records in English which met the
inclusion criteria were found between 2014 and January 2020. The chronological trend of
records was progressive until 2019. India was the most frequent location (12%). China and
Sri Lanka on the one end of the spectrum and Somalia along with South Korea from the
other end were, respectively, the least and the most contributed countries in terms of DPHS.
Overall, 90% of the roles were concerned with UHC goals. Although evidence has revealed
inconsistency in the identified roles, a continuous chain of positive or negative effects in the
UHC objectives and goals was observed. Some knowledge gaps about the roles, causes of
the increasing and decreasing DPHS contribution, and its behaviors around the privatization
types and circumstances of the delivery were recommended as prioritized research agendas
for evidence-based policymaking in future.

Abstract BACKGROUND: Quality of working life (QWL) refers to aspects of life quality, which are related to
work settings. This study was designed to evaluate the QWL and its effective factors among nurses
of Tehran University of Medical Sciences Hospitals.
MATERIALS AND METHODS: In this cross‑sectional descriptive–analytical study, the demographic
questionnaire and work‑related quality of life questionnaire were used to collect data among 435
nurses working in hospitals, affiliated to Tehran University of Medical Sciences. This article has been
adapted from the approved project of Medical Ethics Committee of Tehran University of Medical
Sciences (with the identification code 8911215132).
RESULTS: The average QWL of nurses in the study was 50.56. There was a significant statistical
relationship between gender, frequency of overtime, and working ward with QWL (P < 0.05). In a
multivariate analysis, working ward had the only meaningful relationship.
CONCLUSION: Due to low QWL of nurses in the emergency department, the need of interventions
to improve conditions and ultimately to increase QWL of nurses working in the emergency room is
being reminded.

Abstract BACKGROUND: Limited research has been conducted in the field of diabetes educator’s competency.
However, no comprehensive and integrated explanations of educator’s competence requirements
in treatment centers exist in Iran. The aim of this study is to explain the components of diabetes
educator’s competence in diabetes self‑management education in Iran.
MATERIALS AND METHODS: This was a qualitative descriptive‑exploratory study. The data were
collected through semi‑structured and in‑depth interviews and using purposeful sampling method
in Isfahan University of medical science from April to October 2018. Sampling continued until data
saturation. Participants included 20 people who were selected by purposive and snowball sampling
method. The interviews were analyzed using content analysis method of Graneheim, Lundman.
RESULTS: Data analysis resulted in the emergence of three main categories including (1) Patient and
family centered education, (2) process‑based education, and (3) continuous progress in profession
and also seven subcategories (patient and family activation, empower), facilitating educational
process, comprehensive education assessment, development, implementation and evaluation of
educational plans, developing educators’ educational knowledge and skills, development of creativity
and innovation, promote inter‑professional cooperation in education.
CONCLUSION: The evaluation of facilitation factors for participation and empowerment patient and
family along with creativity and interprofessional collaboration for comprehensive evaluation of patients
in designing, implementation of educational programs were mentioned as important competencies
of diabetes educators, which can have a significant impact on patients’ recovery, treatment, and the
promotion of society’s health.

Abstract BACKGROUND: During the 2nd week of July 2020, the coronavirus disease 2019 (COVID 19)
infection spreading in the community. Now more than 15 lakhs peoples have been infected in India,
out of the 26816 patients were deceased. COVID 19 outbreaks become an additional hazard to the
health‑care workers (HCWs), leading to fatigue, anxiety, depression and fear of death. The objective
of this questionnaire‑based study is to know about the knowledge of HCWs about COVID 19, their
experiences while dealing with the disease, and the protective measures taken to prevent the infection.
MATERIALS AND METHODS: A cross‑sectional, questionnaire‑based study was conducted for
1 month starting from the 2nd week of June 2020 after getting institutional ethical clearance. This
study included 240 HCWs posted in the medical and surgical Departments of All India Institute of
Medical Sciences, Jodhpur, Rajasthan. This questionnaire was prepared in online Google forms and
required 2 min to complete. Mean, median, range, and standard deviation were used to describe the
continuous variables, and percentages were used to describe the categorical data.
RESULTS: Among 240 HCWs, 79.16% (n = 190) participants have good knowledge and adapted
good precautions (score 15–23) for COVID 19 infection. Rest 20% (n = 48) and 0.8% (n = 2)
participants has average (score 8–14) or poor knowledge (score <8) with adaptation of average or
poor precautionary measures against COVID 19, respectively.
CONCLUSION: This study concluded that we have the requirement of more educational training
programs for awareness of HCWs and precautionary measures against COVID 19. Thereby, HCWs
can improve their knowledge and participate in this fight against COVID 19 with more efficiency and
confidence.

Abstract BACKGROUND: A novel innovation in medical education was initiated by the Medical Council of
India after 21 years. Competency‑based medical education (CBME) is an effective outcome‑based
strategy, which requires integration of knowledge, attitude, skills, values, and responsiveness. The
aim was to assess the students’ perspectives on competency‑based medical curriculum.
MATERIALS AND METHODS: This cross‑sectional descriptive study was conducted among 1st year
MBBS students (2019–2020 batch). A validated questionnaire was administered through Google link
among phase I medical students of various medical colleges across India by multistage sampling.
RESULTS: A total of 987 students from 74 medical colleges in India responded. Nearly three‑fourths
opined that foundation course (FC), attitude ethics communication module, and early clinical exposure
were necessary. Horizontal integration was more appreciated to vertical integration. Maintaining log
books was perceived as time‑consuming and cumbersome.
CONCLUSION: The CBME when meticulously adopted will inspire student enthusiasm for learning.
Few reforms such as curtailing the duration of FC, diffuse sessions on stress and time management,
better synchronized vertical integration, and an exemplary implementation of adult learning techniques
can be undertaken.

Abstract BACKGROUND: Paying attention to students’ opinions and suggestions on existing evaluation
methods and new methods of evaluation is an essential and important part of clinical education, so
this study aimed at determining the effectiveness of two evaluation techniques satisfaction among
undergraduate nursing students.
MATERIALS AND METHODS: This was a quasi‑experimental study conducted on 60 undergraduate
nursing students of Isfahan University of Medical Sciences in 2019. There were 30 samples in each
group (logbook and e‑logbook) that were selected by convenience sampling method. the Android
application (e‑logbook) was used in the intervention group to evaluate the clinical skills of students.
The User Satisfaction Questionnaire was conducted by undergraduate nursing students. Data were
analyzed using SPSS software version 14 and descriptive statistical tests.
RESULTS: The results showed that the mean (standard deviation) overall score of satisfaction
from both evaluation methods including logbook and e‑logbook was 39.7 (9.4) and 47.7 (12.2),
respectively. Also satisfaction score of the evaluation method was significantly different between
the two groups (P = 0.03).
CONCLUSION: According to the results of the present study, the use of new and active methods of
evaluation, including the application of e‑logbook, can be useful in evaluating nursing students and
cause student satisfaction, so using the application is useful.

Abstract BACKGROUND: As nonnative speakers of English, Iranian health researchers/authors often need
to publish in English; however, published manuscripts may reflect a need for language editing. The
study is aimed to investigate the language accuracy of Persian authors’ articles published in Iranian
health journals, and to explore whether these journals take steps towards an acceptable level of
Standard written English.
MATERIALS AND METHODS: In this descriptive study, fifty original articles were selected from
five health journals (from April 2017 to April 2018) with nonnative editors/proofreaders based on
convenience sampling in 2019. The articles were carefully read several times; errors were identified
according to Gass and Selinker’s model and classified into four categories and further expanded
into 22 subcategories.
RESULTS: The results showed 4322 errors in the 50 articles, where the “grammatical errors” obtained
the highest frequency, with punctuation errors (n = 989) ranking first, and errors in using auxiliary
verbs (n = 19) the last in frequency. The descending order of the errors emerged as follows: the
grammatical, mechanical, lexical, and discoursal errors.
CONCLUSION: All categories of errors contributed to textual unintelligibility, attributable to either the
authors’ inadequate English proficiency or their native language interference. Most errors could have
been corrected by the journal editors. Professional development courses and hands‑on workshops
are advised for both nonnative authors and journal editors/proofreaders in Iran to help authors keep
to the conventions of scientific writing.

Abstract BACKGROUND: One of the main goals of hospital management is to attract, maintain, and increase
the number of qualified and efficient human resources, and one of the key and most important factors
in achieving this goal is to design and implement a fair and efficient payment system. The purpose
of this project is to determine the challenges of the performance‑based payment system and provide
solutions to overcome its obstacles in the city of Tehran.
MATERIALS AND METHODS: This qualitative research sought to perform content analysis so as
to explore the experiences and perceptions of a purposeful group of specialists and managers of
Tehran’s educational and medical centers (n = 10). Data were collected using in‑depth semi‑structured
interviews and were ongoing until the point of saturation.
RESULTS: On analysis of data by Specialists and managers of Tehran’s educational and medical
centers, three main themes including behavior, organization, rules and regulation were defined
alongside seven subthemes includes scheduling, platform, education, quantity‑oriented, motivation,
implementation, and payment system.
CONCLUSION: In general, it can be concluded that for the successful implementation of any project,
the necessary infrastructure must be provided for implementation. In this plan, despite the challenges
in the field of behavior, organization, and rules and regulations, the need for necessary training
before implementing the plan, special attention to quality instead of quantity, motivating employees
to cooperate in implementing the plan as successfully as possible, creating a platform Appropriate
before the implementation of the plan and most importantly, the pilot implementation of the plan
before its widespread implementation seems necessary.

Abstract BACKGROUND: Stress and low psychological well‑being among students in higher education impact
their academic performance. The purpose of this study was to determine the relationship between
SOC, SDLR, and academic performance in year 3, 4, and 5 undergraduate dental students.
MATERIALS AND METHODS: Two hundred and ten students completed a validated questionnaire on
SOC and SDLR. The percentage of marks obtained by these students in their year‑end examination
was used as their academic performance. The SOC scores were further divided into three hierarchical
clusters using cluster analysis. The data were analyzed to determine the difference in the SDLR
scores and academic performance among the three clusters. Furthermore, the relationship between
SOC scores, SDLR scores, and academic performance was assessed.
RESULTS: The SDLR scores significantly increased from the low SOC cluster to the high SOC
cluster (P = 0.026). However, there was no significant change in academic performance. A positive
relationship was found between the SOC and the academic performance(R = +0.025; P > 0.05). The SDLR
had a significant positive relationship with both SOC and academic performance (R = +0.27; P < 0.001).
CONCLUSION: Although SOC may not have a direct influence on academic performance, SDLR
can play an intermediary role. Early identification and timely intervention in students with a weak
SOC and low SDLR can have a beneficial influence on their academic life.

Abstract BACKGROUND: Today, hospitals need managers who, in addition to having the necessary skills for
management and leadership, are accountable to stakeholders, especially the community. Accordingly,
the purpose of this study was to evaluate the social accountability of managers of public and private
hospitals in Tehran.
MATERIALS AND METHODS: The present study is descriptive‑analytical and cross‑sectional and
was performed on 155 managers of selected public and private hospitals in Tehran. The research
tools included a demographic characteristic questionnaire and a researcher‑made social accountability
questionnaire for managers. Data analysis was performed using descriptive and inferential statistics
in SPSS 22 software.
RESULTS: The situation of social accountability in the managers of public hospitals was at a
weak level and in the managers of private hospitals in Tehran was at a good level. In comparing
the status of social accountability and its dimensions in the managers of public hospitals with the
managers of private hospitals, the status of social accountability in the dimensions of human resource
management, quality improvement, executive management, and overall social accountability were
significantly different from each other (P ≤ 0.05). However, in terms of governance, the status
of social accountability of public hospital managers was not significantly different from private
hospitals (P ≥ 0.05). Overall, the results of social accountability in private hospitals were better
than in public hospitals.
CONCLUSION: The social response status of managers in private hospitals was better than public
ones. Lack of attention of managers to social accountability affects the quality of other educational,
health, and medical services. This fact raises the need for managers to pay more attention to the
issue of social accountability.

Abstract BACKGROUND: The prevalence of diabetes makes considerable costs for health‑care organizations.
The increase of patient’s self‑care abilities by use of personalizing health information prescription
can reduce these costs. This study was conducted to explore the benefits and challenges related to
personalizing health information prescription in diabetes clinical settings.
MATERIALS AND METHODS: The samples included diabetes education officials working in
specialized diabetes clinics and Diabetes Research Centre managers of Iran and Tehran Universities
of Medical Sciences. They were 21 cases and selected through purposeful sampling method.
Semi‑structured interview and focus discussion groups were used to collect the viewpoints of
specialists. Interview guide, based on literature review and the documents of diabetes, was used
in interviews and focus groups. Their validity was affirmed by specialists. The interview texts were
coded in MAXQDA10 software and analyzed through content analysis method.
RESULTS: The most important benefits of personalizing health information prescription were
classified into five themes as follows: medical services improvement, facilitation of consumers to
information resources, improvement in patients’ knowledge and awareness, increase in self‑care
ability and disease management, reinforcing the relation between physician and patient and keeping
physician in the information prescription cycle. The challenges of personalizing of health information
prescription were revealed as follows: Recognition of patients’ personal characteristics at the turn
of entering the system, systems’ functional modifiers especially bilateral interaction and relation to
patient’s health file, content recognition, and creating suitable protocol.
CONCLUSION: This study showed that diabetes clinical settings face different organizational and
process challenges for establishing the personalization of health information prescription. The most
important challenges which should be considered in designing information prescription in diabetes
clinical environments are as follows: reinforcing physicians’ recognition of information prescription
benefits, lack of integrative electronic health information system, and patient primary assessment
in the first stage of entering the patient into the system in respect of clinical and personal aspects
in information needs of consumer.

Abstract BACKGROUND: Breast cancer is a preventable disease, using three secondary preventive methods
of mammography, clinical breast examination (CBE), and breast self‑examination (BSE) that can
lead to early detection of breast cancer. This study was designed to assess breast cancer screening
behavior and its associated factors in females employed in South Khorasan.
MATERIALS AND METHODS: In this analytic‑descriptive study, 2256 female personnel of
governmental organizations were investigated in Birjand city in 2016–2017. The data collection tool
was a three‑part questionnaire: sociodemographic characteristics, knowledge about breast cancer
screening methods plus women’s performance, and stage of change regarding screening behaviors
of mammography, CBE, and BSE. The data were analyzed by SPSS 16 and one‑way analysis
variance, Tukey’s post hoc, and multiple logistic regression model statistical tests.
RESULTS: The mean ± standard deviation score of knowledge of the women was 3.45 ± 1.5. There
was a significant difference of the mean score of knowledge between the single and married (P = 0.03)
and age group (P = 0.04). The stage action of mammography, CBE, and BSE was 6.8%, 12.3%,
and 16.8%, respectively. Logistic regression model showed that variables such as age and family
history of breast cancer were highly significant related to mammography and also CBE. Knowledge
was also highly significant in mammography, CBE, and BSE. Education level in CBE, marital status
in BSE and mammography, and job in BSE were also significant (P < 0.001).
CONCLUSIONS: This study reveals insufficient knowledge of female workers about breast cancer
and the negative influence of low knowledge on the practice of breast cancer screening behavior.
Therefore, the establishment and maintenance of regular educational courses for female employees
is essential.

Abstract BACKGROUND: Caring for brain dead patients is the heaviest of duties for nurses, and despite
tremendous stress, there are no theories/models to support nurses in this situation. This study
designed a supportive model for nurses to provide care for potential organ donors.
MATERIALS AND METHODS: This qualitative study was conducted in two stages. In the first
stage, semi‑structured interviews with 31 nurses and other stakeholders, observation and field
notes continued until data saturation, (on 2018), were analyzed using continuous and comparative
analysis through Corbin–Strauss method. In the second stage, theory synthesis of Walker and Avant’s
strategies for theory construction (2011) was used to design a supportive model/theory. The theory
synthesis includes three stages: (i) selection of focal concept (the concept of “moral obligation to
provide holistic care until the last minute” was selected); (ii) review of studies to identify the factors
related to focal concept relevant studies (42 articles were reviewed, statements and concepts
related to focal concept were then extracted and classified, and their relations were specified);
and (iii) organization of concepts and statements within a relevant general and effective manifestation
of the phenomenon under study which led to developing of a model.
RESULTS: In this supportive model/theory, “improving psychological security and empowerment”
was conceptualized within the conceptual framework. This supportive model entails three main
components, including (i) informational and educational support, (ii) systematically support,
and (iii) management support.
CONCLUSIONS: According to the results, nurses with moral obligation to provide holistic care
were faced with several challenges. Therefore, it is recommended that the healthcare system take
supportive proceedings for nurses in various fields of the care for brain dead patients to resolve
educational, moral, and legal challenges. This supportive model is essential for maintaining the
nurses’ health, increasing the quality of nursing care and the health of potential transplant organs.

Abstract BACKGROUND: COVID‑19 pandemic has forced medical colleges around the world to shift to
online teaching. There is hardly any evidence regarding such rapid transitions to online teaching,
especially from resource‑poor settings. We share our experience of developing an online teaching
program based on teachers’ and students’ feedback.
MATERIALS AND METHODS: A mixed methods study was conducted during the COVID‑19
lockdown period in a public‑funded medical institute of India. Online feedback was obtained 3 weeks
after the beginning of emergency remote teaching. The responses by the students and teachers
shaped the final online teaching program which reinforced the perceived strengths and addressed
the weaknesses. Observations were made for the proportion of scheduled lectures delivered through
digital platform and students’ attendance in the 1st week and last week of the study period.
RESULTS: Feedback was obtained from 367 students and 56 teachers. Around three‑fourths of the
students (76.7%) and teachers (73.2%) were satisfied with online teaching. The themes generated for
benefits of online teaching were similar for both students and teachers, but the perceived challenges
differed. Students found online teaching more stressful, and teachers were apprehensive of the new
technology and lack of a controlled environment.
CONCLUSIONS: A rapid transition to development and implementation of an online teaching program
was found to be feasible and acceptable to the primary stakeholders. Not only the content but student
engagement and supportive environment for both students and teachers are essential requirements
in the context of an online undergraduate teaching program.

Abstract BACKGROUND: In recent years, to achieve the fundamental goal of educating meta‑competent
future medical doctors, varieties of educational methods have been proposed in all medical schools.
In Shiraz Medical School, we implemented an extracurricular theme focusing mostly on medical
education’s psychosocial aspect. This study aims to discuss the implementation and evaluation of
this extracurricular theme.
MATERIALS AND METHODS: The present study is a descriptive‑analytic one; we included all
undergraduate medical students in basic sciences courses who started medical education in 2014
and 2015 in Shiraz Medical School. The evaluation tools were questionnaires designed in different
formats and handed out to medical students before and after the workshops. Data were analyzed
by paired sample t‑test in SPSS Software Version 23.
RESULTS: Students’ satisfaction was more than 60% in all items of all workshops, except in some
items of studying and learning methods and research methods workshops, which were lower than
60%. Students’ knowledge about all aspects of communication skills, stress management, critical
thinking, studying and learning methods, and research methods workshops improved significantly
after participation in these workshops.
CONCLUSIONS: Medical students can become meta‑competent future medical doctors. They can
reach all of the learning outcomes described in the three‑circle model of learning. This goal cannot
be achieved by implementing a medical curriculum which only contains medical literature. Some
extracurricular issues based on students’ and societies’ requirements must be added to the main
curriculum. The whole curriculum must be evaluated continuously, and required changes must be
applied.

Abstract BACKGROUND : Cancer is one of the major health problems across the world that poses a great
threat to human health and active life in all age groups, causing numerous personal, familial, and
social damages in physical, mental and spiritual dimensions. The aim of the present study was
to investigate the effect of positive psychotherapy on happiness, character strengths, pleasure,
commitment, and semantic measures in the lives of people with cancer.
MATERIALS AND METHODS: Within the framework of a quasi‑experimental design, 58 patients
suffering from cancer meeting the inclusion criteria (disease history and married) were selected via
purposeful sampling method. However, only 30 of the patients met the required criteria to participate
in all psychotherapy sessions. The participants were then randomly assigned to two intervention
and control groups (15 participants per group). The intervention group received eight 120‑min
sessions of positive psychotherapy on a weekly basis while the control group was put on the waiting
list. Data collection tools included the Oxford Happiness‑Depression Questionnaire and Values in
Action‑Inventory of Strengths. The participants completed the questionnaires before and after the
intervention. Data analysis was conducted by analysis of covariance.
RESULTS: The results of covariance analysis suggested that the use of positive psychotherapy has
been effective on increasing happiness (F = 0.129, P = 0.005), increasing character strength (F = 27.55,
P = 0.001), increasing the semantic measures (F = 15.23, P = 0.002), increasing pleasure (F = 8.51,
P = 0.005), and commitment (F = 64.19, P = 0.001) among patients with cancer.
CONCLUSIONS: The results of the present study indicated that positive psychotherapy has been
effective on happiness, strengths, pleasure, commitment, and semantic measures of the life among
people with cancer. Positive psychotherapy can be used to minimize the effects of cancer on patients.

Abstract BACKGROUND: Healthy nutrition in childhood and adolescence is important for growth and
development. Breakfast is the most important meal during a day, and many studies have linked
eating breakfast to good health. The aim of the present study was to evaluate the subjective norms
and perceived behavioural control of Iranian teenage girls about breakfast consumption and its
related factors in 2018.
MATERIALS AND METHODS: In this descriptive‑analytical study, 320 female students were
enrolled using a multistage sampling method. Data were collected using a questionnaire, the validity
and reliability of which were evaluated. Data analysis was carried out using SPSS16 software and
ANOVA and t independent tests.
RESULTS: There was a significant relationship between students’ sleep duration and the people
with whom they eat breakfast with the Motivation to Comply (P = 0.009), (P = 0.001) and subjective
norms (P = 0.004), (P = 0.001) as well as between the people with whom they eat breakfast and
normative beliefs (P = 0.05). There was a significant relationship between father’s job and control
beliefs (P = 0.03) and perceived behavioural control (P = 0.04), between household size with perceived
behavioural control (P = 0.05), between sleep duration and perceived power (P < 0.001), and
perceived behavioural control (P = 0.03), between the people with whom they eat breakfast with control
beliefs (P < 0.001), perceived power (P < 0.001), and perceived behavioural control (P < 0.001).
CONCLUSION: Considering the importance of sleep duration for adolescent girls as well as eating
breakfast with other family members, health policymakers are recommended to pay special attention
to these two factors while designing educational interventions.

Abstract BACKGROUND: Videoconferencing has been used as a modality of online medical teaching
by various institutes. There is a paucity of studies reporting the perception of medical teachers
toward teaching using teleconferencing platforms. The objective of this survey was to evaluate the
perception of medical teachers toward teaching using videoconferencing platforms such as Zoom
meet, Google meet, and Google classroom during the COVID‑19 pandemic. Our hypothesis was
teaching faculty would have a positive perception and experience toward web‑based teaching
modalities.
MATERIALS AND METHODS: Medical teachers of a medical college were invited to participate
in a prospective observational cross‑sectional online survey. The faculty demographic information,
perception, experience, and satisfaction were noted. Perception data were presented as proportion
and percentage.
RESULTS: 104 out of 160 faculty members participated in the study (response rate = 65%).
61 male (58.7%) and 43 female (41.3%) faculty members participated in the study. The mean age
of the faculty members was 39.3 years ± 13 (range: 27–69 years). Laptop (n = 73 [70.2%]) was the
most commonly used electronic device by the faculty members for conducting e‑teaching sessions
followed by smartphone (n = 25 [24%]). Google meet was the most preferred videoconference tool
for online teaching. Ninety‑six faculties (92.2%) were satisfied with the e‑teaching method adopted
by the institute. Eighty‑three faculty (79.8%) perceived the e‑teaching method to be very useful and
quite useful as a modality for teaching during the lockdown period.
CONCLUSIONS: The teaching faculties had a positive perception toward digital education methods
adopted for teaching of undergraduate medical students at our institute.

Abstract BACKGROUND: Social vitality is one of the most important social indicators to develop a sense
of public satisfaction. The aim of this study was to investigate the effect of educational intervention
based on theory of planned behavior (TPB) and self‑regulatory strategies on the social vitality of
women employee.
MATERIALS AND METHODS: In this randomized controlled field trial study, 66 women employees
of Birjand University of Medical Sciences (Iran) were selected including intervention (n = 31)
and control (n = 35). Data were collected by standard Oxford Happiness Questionnaire and a
researcher‑made questionnaire based on TPB which its the validity and reliability were confirmed.
The educational intervention consisted of 5 sessions based on the constructs of the TPB and
self‑regulatory strategies which were to the interventional group. Data analysis was performed using
the Chi‑square, Fisher’s exact test, independent t‑test, repeated measures ANOVA, and Bonferroni
post hoc test at a significance level of <0.05.
RESULTS: The mean age of women in the intervention and control group was 37.1 ± 9.3 and
36.2 ± 7.6 years (P = 0.67). Model constructs and happiness scores were homogeneous (P > 0.05)
before the intervention, in two group of study, but after attitude (P = 0.016), subjective norm (P = 0.029),
perceived behavior control (P = 0.01), intention (P = 0.006), and happiness score (P < 0.001) had
a significant increase in the intervention group. In the control group, only a significant difference
occurred over time in the happiness rate (P = 0.031).
CONCLUSIONS: The results of the present study showed the effectiveness of educational intervention
on the social vitality of women employees. Therefore, TPB is recommended to use in interventions
to promote social vitality.

Abstract BACKGROUND: During the past decade, the benefits of using portfolios, especially electronic
portfolios, were recognized. Due to the lack of using portfolios and especially electronic portfolio
in the clinical evaluations of internship training in medical schools of Iran, this study has designed,
implemented, and evaluated a comprehensive system for monitoring and evaluating the activities
of interns.
MATERIALS AND METHODS: This study was a software development study in the three phases
of design, implementation, and evaluation. All stages of the project were carried out in the Isfahan
University of Medical Sciences during 2019–2020. The software design phase was performed using
the Rapid Application Development Methodology (RAD model). In the implementation phase, it
was used as a pilot study in the internal department of the medical school. System evaluation was
performed using a combination of quantitative and qualitative methods. Data were analyzed using
the content analysis for qualitative data and descriptive statistical analysis using the SPSS software
for quantitative data.
RESULTS: In the educational standards survey, in 10 items, the percentage of choosing “perfectly
fit” and “fit” was above 90% (high quality). In the technical standards questionnaire, out of 35 items
related to software technical quality, eight items were of acceptable quality and 27 of them were
partially acceptable. In the Student Satisfaction Questionnaire, in 9 items, interns’ satisfaction with the
system was high or very high, and in either case, there was little or no dissatisfaction or satisfaction.
CONCLUSIONS: Positive educational effects can be used in all clinical settings if modification and
improvement of the software continues, with slight modifications.

Abstract BACKGROUND: Many patients suffer from sexual dysfunction after coronary artery bypass graft
surgery, but they refuse to propose and follow up on the problem due to the cultural structures
prevailing in Iranian society. Untreated sexual dysfunction will disturb the quality of life of these
patients. This study was performed to explain the experiences of male patients from sexual problems
after coronary artery bypass graft surgery.
MATERIALS AND METHODS: This qualitative study was performed with the approach of conventional
content analysis in Tehran in 2020. The data were collected through semi‑structured interviews with
12 men after coronary artery bypass graft surgery at the hospital’s cardiac surgery clinic, as well as
the surgeon’s clinic. Participants were selected by the targeted sampling method. After obtaining
informed consent, the collected data were written word by word, and the content analysis approach
was used to name the data, create analytical codes, and determine subcategories and categories.
The data were analyzed by MAXQDA 10 software.
RESULTS: The findings of this study show that the dimensions of confusion in patients’ sexual
intercourse after coronary artery bypass graft surgery in four subcategories of challenges of the first
intercourse after surgery, ambiguity in how to obtain information, the ambiguity of sexual issues after
surgery, and spouse are concerned about having sexual intercourse.
CONCLUSION: The results of this study show that male patients who have undergone coronary
artery bypass graft surgery have many ambiguities in the process of sexual intercourse, which passes
the beginning of sexual intercourse with fear and avoidance of intercourse. Postoperative patients
do not propose these problems with the medical staff when they suffer from sexual dysfunction or
ambiguity due to the taboo of talking about sexual intercourse. Eventually, the patient and his or her
partner become confused about sexual intercourse after surgery. Therefore, it is recommended that
policymakers in the field of health create the culture and planning for solving the ambiguities created
in the path of sexual intercourse of these patients.

Abstract BACKGROUND: Game‑based education is fast becoming an innovative teaching approach in the field
of medical education. Traditional review sessions (tutorials) are mainly focused on instructor‑based
learning and they help to review concepts previously taught in the lecture class. The primary objective
was to evaluate the cognitive learning of students in game based learning (GBL) as compared to the
conventional review sessions. The secondary objectives were to assess the perception and feedback
of students regarding GBL and conventional review sessions.
MATERIALS AND METHODS: An interventional GBL study was designed for 2nd year MBBS
students. The enrolled students were randomly assigned to either tutorial (Group A) or GBL (Group
B), and informed consent was obtained. Group B students were further divided into smaller groups,
and for Group A, the traditional tutorial method was followed. For both the groups, a multiple choice
question (MCQ) pre‑test and post‑test was conducted on the selected topics. A total of 15 MCQs with
gradually increasing difficulty were used in the GBL. For each group of students, one student would
be on hot seat by answering the questions and then continued the game. Lifelines were provided.
RESULTS: From the pretest and posttest scores, students performed better in Group B (39.53%)
than Group A (18.43%) with respect to the knowledge score, and the difference was statistically
significant. Students’ perception and feedback regarding GBL were very enthusiastic and promising
than the tutorial group. Largely, students commented that GBL was unique, active participation, fun,
and novel learning style.
CONCLUSIONS: GBL is a student‑centered learning and showed more effective than the traditional
tutorials in understanding the topic and was more enjoyable by students.

Abstract BACKGROUND: The widespread occurrence of COVID‑19 has caused people to seek information
from various sources such as virtual social networks, which can positively or negatively affect one’s
mental status. In this article, we present the role of virtual social networks in shaping people’s attitudes
toward COVID‑19 in Iran.
MATERIALS AND METHODS: This is an applied descriptive study, in which 1010 users of virtual
social networks were surveyed through an electronic questionnaire. Data were analyzed with SPSS,
Excel, and Rapid Miner software. The FP‑growth technique was used to investigate the concurrence
of choices in multiple‑choice questions, and the Mann–Whitney and the Kruskal–Wallis tests were
used to determine the correlation of the mean of each dimension with demographic data. Moreover,
the Wilcoxon signed‑rank, the Shapiro–Wilk, and the Kolmogorov–Smirnov tests were used.
RESULTS: Virtual social networks use increased significantly (40%) after the COVID‑19 outbreak.
According to users, the greatest psychological impact of virtual social networks was the induction
of anxiety (46.43%) and the most common use was to learn about COVID‑19 prevention and
treatment (69.3%). Based on the findings, there were no significant differences between the
“awareness,” “behavior intention,” and “attitude and trust” and the users’ marital status, age group,
educational degree, and gender.
CONCLUSION: Although social networks have enriched the public knowledge, they increased the
individuals’ anxiety mostly because of controversial news and disperse of misinformation which in turn
misled the users. The social networks play an important role in directing the behavioral inclinations.
Accordingly, it is recommended that the authorities in healthcare system establish authentic and
formal webpage in these social networks to manage controversial and voluminous information.

Abstract BACKGROUND: Education by smartphone‑based software is a new method among the world’s
educational practices. Due to the lack of studies on the effect of this education on promoting
knowledge and self‑care behaviors of students’ reproductive health this study aimed to determine
the effect of smartphone‑based software education on knowledge and self‑care behaviors in the
field of reproductive health.
MATERIALS AND METHODS: This RCT with 164 married female students (82 in each group)
conducted from October 2019 to January 2020, in Tabriz University and Tabriz medical University.
Participants were randomly allocated to two groups of educational intervention and control.
Smartphone‑based software education designed in four areas of reproductive health. Intervention
group was trained for 4 weeks. The score of knowledge and self‑care behaviors of participants in both
groups were compared at baseline and 8 weeks after intervention. Data were analyzed by SPSS‑23
software using Chi‑square, independent t‑tests, and analysis of covariance tests.
RESULTS: Eight weeks after the intervention, a significant increase was observed in the
mean (standard deviation [SD]) score of overall knowledge for reproductive health and all its
subdomains (P < 0.001), as well as in in the mean (SD) self‑care score of reproductive health and
all subdomains (P < 0.05), except for the family planning in the education group compared to the
control group.
CONCLUSION: The findings indicate a significant effect of smartphone‑based software on increasing
students’ knowledge and self‑care in all areas of reproductive health except for family planning
subdomain of self‑care.

Abstract BACKGROUND: Ethical decision‑making and behavior of nurses are major factors, which can effect
on the quality of nursing care. It seems that there is a correlation between demographic variables
and ethical decision‑making and moral behaviors of nurses. Promoting patients’ health is one of
the issues related to nurses’ ethical behaviors. The aim of this study was to determine the role of
judgment in promoting nurses’ decisions and ethical behavior.
MATERIALS AND METHODS: This was a descriptive, cross‑sectional study in which 260 nurses were
selected based on the inclusion criteria. Sampling method was available. The data collection tool was
the Hospital Ethics Committee Survey Questionnaire. Data were analyzed by SPSS software version 20.
RESULTS: In this study, judgments and ethical behaviors of nurses were evaluated at the moderate
and good level. Gender, marriage status, education level, and nursing position were effective in
judgments and ethical behavior of nurses. Age, job experience, and participation in the ethics
workshop had no significant effect on ethical behavior and moral judgment. The mean score of moral
belief of nurses participating in this study was 181.56 ± 17.60, and their mean moral practice in the
real environment was 168.5 ± 17.77.
CONCLUSION: The judgment competencies in ethical situation of nurses should be promoted to
a higher level. It seems that more advanced educational methods are needed to achieve this goal.
The findings from this study show the necessity of nurses’ ability to improve their behavior and moral
judgment. It also shows that nurses need more reinforcement based on the demographic variables.

Abstract

Abstract BACKGROUND: The scientific Olympiad is an event that creates a competitive environment for
student groups of medical universities across the country to solve problems that can help improve
the health system. This study aims to explain the issues of the scientific Olympiad program of Iranian
medical students.
MATERIALS AND METHODS: This study was conducted using content analysis method, and the
data were collected through 21 semi‑structured, in‑depth interviews with experts from December
2018 to April 2020. Participants were selected using purposive sampling methods. Twenty‑one
students, domain leaders, question designers, Olympiad executive experts, and teachers (11 males
and 10 females) participated in the interviews. Data analysis was performed based on the steps of
Graneheim and Lundman’s method. The interviews were recorded, transcribed, and subjected to a
qualitative analysis by MAXQDA 2018 software.
RESULTS: From the analysis of data, four themes, including inattention to context, inattention to
input, inattention to process, and inattention to output, emerged.
CONCLUSIONS: The scientific Olympiad can lead to interuniversity scientific exchanges and paves
the way for the promotion of education and evaluation of learners in medical universities, but if not
correctly implemented and the problems of previous periods are not solved, it will not help the health
system and can impose considerable costs on the system.

Abstract BACKGROUND: The improvement of the knowledge, skill, and attitude of nurses working at the
intensive care unit (ICU) through implementing training need assessment and holding continuous
in‑service training courses are of main requisites for providing better health services to the community.
Based on this, in the present work, we are looking for the identification and prioritization of the training
need of intensive care nurses in the Zabol University of Medical Sciences’ hospitals.
MATERIALS AND METHODS: As a cross‑sectional, descriptive study, including two phases of
identification and prioritization of training needs of ICU nurses, it was conducted by a close‑ended
researcher‑made questionnaire for collecting the data on training needs from the viewpoint nursing
officials, supervisors, and head nurses of the ICU wards in the first phase and a multiple‑choice
scientific test plus a checklist for measuring the knowledge and skill of the nurses in the ICU in the
second phase. In both phases, census method was used for collecting the data. The validity and
reliability of data‑gathering tools, mentioned above, were tested and verified before gathering data.
Data were analyzed with the descriptive statistics.
RESULTS: The results indicated that ventilator setting according to arterial blood gas sampling
and interpretation (77.81), cardiac monitoring, detecting dysrhythmia and taking immediate
intervention (73.04), ventilator setting according to patient’s respiratory status (68.61), airway
management, oxygenation and intubation (64.39), and adults cardiopulmonary resuscitation (61.77)
were the high‑priority training needs of the nurses successively.
CONCLUSION: To improve the quality of training programs and upgrading the knowledge, skill,
and attitude of nurses working at ICU, the significance and the weight of each training titles should
be determined according to the standards and the continuous in‑service training plan along with
nurses’ training needs and duties.

Abstract BACKGROUND: Providing financial resources for health services is one of the most important issues
in the study of health systems, of which purchasing health services is very essential. The World
Health Organization considers strategic purchasing as a key option for improving the performance
of health systems. The aim of this study was to identify payment methods for service providers and
strategic purchasing strategies in upper middle income countries.
MATERIALS AND METHODS: The present study was conducted in the form of a comparative analysis
involving comprehensive surveys from 2000 to 2019, by searching keywords for the objective of
the study by the search engines through databases including ProQuest, PubMed, Google Scholar,
Irandoc, SID, Magiran, Science Direct, Scopus, ISI Web of Science, EBSCO, and Cochrane.
RESULTS: A total of five upper middle income countries that used strategic purchases entered the
study. Overall, all of them implemented rather similar strategies in terms of strategic purchasing and
paying to the providers of the services.
CONCLUSION: According to the results of this study, per capita payment for primary health‑care and
outpatient services seems to be the best option for controlling the costs of the health sector, while
the appropriate option for the inpatient department is the most common use of diagnosis‑related
group. The payment method is to control the costs of the inpatient department.

Abstract BACKGROUND: The psychological impact of anxiety, stress, and depression among health care
and nonhealth‑care professionals in India contribute significantly to the global burden of mental
illness in the world. Impaired mental health and stress influence the efficiency and productivity of
work. Long‑term professional stress among individuals can lead to chronic illness, increased blood
pressure, and many systemic disorders. The aim of this study was to assess the prevalence of
anxiety, stress, and depression among the health care and nonhealth‑care professionals in India.
MATERIALS AND METHODS: This prospective survey‑based study included 200 study
participants (80 nonhealth care and 120 health‑care workers) who were asked to submit their
feedback and opinion on a questionnaire survey. Depression, stress, and anxiety were scored as
per patient health questionnaire‑4 and UCLA scale. The reliability of questionnaires was assessed
using the Cronbach’s alpha (r = 0.90). The statistical analysis was done using the Chi‑square test.
RESULTS: Higher prevalence ratio of anxiety, depression, and stress was observed among nonhealth
care compared to health‑care professionals.
CONCLUSION: Psychological disturbances were found to be higher among nonmedical when
compared to health‑care workers or professionals. Thus, psychological counseling is required to
manage the stress levels in both health care and nonhealth‑care professionals.

Abstract BACKGROUND: Involving medical undergraduate students in patients’ health education will not only
help in improving students’ learning as well as professional and communication skills but also plays
an important role in achieving better health outcome of patients. The aim of the study was to assess
the impact of students led educational intervention regarding tuberculosis (TB) on their learning and
on the patients’ knowledge and attitude towards the disease.
MATERIALS AND METHODS: One hundred medical undergraduates were included in the study. An
integrated lecture on TB was given to all participants followed by preintervention test on TB. One group
was then subjected to interactive traditional lecture. Whereas the videos reflecting the experiences
of TB patients were shown to the other group and was given an assignment to prepare educational
leaflets for TB patients followed by postintervention test for both groups. The patients’ satisfaction
level with the information given via educational leaflet and the overall perceived benefits of this
activity by the students were assessed. Data analysis done using SPSS version 23.0. Independent
and paired t‑test were used to calculate difference of means for quantitative variables.
RESULTS: Two groups were comparable preintervention however postintervention there was
significant improvement in knowledge in the study group (P0.000). Overall 74.2% of the patients
were satisfied with the information provided through leaflets. Students’ feedback highlighted that
majority of the them felt benefitted from this activity.
CONCLUSION: It can be concluded that such type of educational interventions have dual benefits,
i.e., learning for the students as well as providing health education to patients which in turn will
improve their clinical outcome.