Journal of Education and Health Promotion

Abstract BACKGROUND: Gestational diabetes is one of the most common metabolic diseases during
pregnancy. The risk of a lifestyle role in the prevention of metabolic syndrome in women with a history
of gestational diabetes has now been identified. The present study was performed to investigate the
relationship between lifestyle and metabolic syndrome in women with a history of gestational diabetes.
MATERIALS AND METHODS: The present study was a retrospective case–control study that was
performed on 90 women (45 women with a history of gestational diabetes and 45 women without a
history of gestational diabetes) in Kerman health centers 5 years after delivery in 2020. Data were
collected using a demographic questionnaire and a standardized Walker lifestyle Health promoting
Lifestyle profile II questionnaire. The reference laboratory was also used to perform the experiments.
SPSS21 software and Spearman’s and Chi‑square tests were used to analyze the data.
RESULTS: The mean age was 35.67 in the case group and 34.27 in the control group (P = 0.230).
Lifestyle did not show any difference between the two groups (P = 0.058). However, metabolic
evaluation was different in the two groups (P = 0.030). Furthermore, the results of Spearman’s test
to examine the relationship between lifestyle and other variables studied showed that in the case
group (P = 0.075) and in the control group (P = 0.819) there was no relationship between lifestyle
and metabolic assessments 5 years after delivery.
CONCLUSIONS: In case group women, it is possible to prevent the progression to type 2 diabetes
and disturb the metabolic assessment by teaching a healthy lifestyle and timely follow‑up after
delivery. A history of gestational diabetes can be one of the causes of type 2 diabetes and metabolic
syndrome. Getting training to change your lifestyle during pregnancy and postpartum can reduce the
incidence of gestational diabetes and type 2 diabetes. Screening pregnant women during childbirth
is a good opportunity to diagnose diabetes early and predict it in the coming years.

Abstract INTRODUCTION: Medical education in India is experiencing a paradigm shift from traditional
curriculum to competency‑based medical education (CBME). It de‑emphasizes time‑based training
and promises greater accountability, flexibility, and learner centeredness. Faculty development is
integral in the context of CBME. Considering faculty perceptions toward the new CBME and addressing
the difficulties will play a vital role in successful implementation.
MATERIALS AND METHODS: A cross‑sectional study was carried out among 297 teaching faculty
in 91 medical colleges across 20 states all over India between February and July 2020. A structured
validated questionnaire on CBME was used to collect the responses through Google forms and was
exported and analyzed in Microsoft Excel.
RESULTS: More than 80% opined that Faculty members in departments are not adequate for
successful CBME implementation. Reflective learning, early clinical exposure, and elective posting
were accepted by 60.2%, 70.4%, and 45.5% of the faculty, respectively. Around 81.8% welcomed
horizontal integration, whereas only 54.2% favored vertical integration during the Phase I MBBS.
CONCLUSION: Few reforms such as curtailing the duration of foundation course, sensitization of
all medical teachers through faculty development programs, better synchronized vertical integration,
increasing the strength of faculty in each department, and adequate infrastructure for skills laboratory
can be undertaken as per faculty suggestions.

Abstract BACKGROUND: Coronavirus (COVID‑19) is an infectious respiratory disease. Quarantine is often
accompanied by unpleasant experiences for those who go through it. The aim of this study was to
determine the mental health status of people during quarantine in northern Iran.
MATERIALS AND METHODS: This cross‑sectional study was conducted during the quarantine
period of coronavirus. Conventional sampling was done from March 6 to April 6. Six hundred and
forty‑two individuals were included. Inclusion criteria were living in Sari and being home quarantined
during the corona outbreak. Exclusion criteria included hospitalization history due to corona and
unwillingness to participate in the study. In this study, the General Health Questionnaire‑28 was used
online to collect the required data. To analyze the data, descriptive and inferential statistics (t‑test,
analysis of variance, and correlation coefficient) were used.
RESULTS: In this study, individuals were included in the investigation with a mean age of
38.74 ± 11.89 (ranged from 15 to 73). Most of the participants were female (72.85%) and
married (71.34%). According to the results, 21.5% of the participants had poor mental health.
Mean mental health scores have a statistically significant relationship with gender, marital status,
education, occupation, quarantine period, patients with corona, and exposure to a patient with
corona (P ≤ 0.05). Furthermore, a negative correlation coefficient was observed between age and
mental health score (correlation coefficient = −0.31, significance >0.001).
CONCLUSION: The average score of mental health has a significant relationship with gender, marital
status, education, occupation, quarantine period, corona, and exposure to a patient with corona.
Given the high prevalence of mental disorders in people during the COVID‑19 epidemic, educating
people and planning to reduce the psychological effects of the epidemic can be helpful.

Abstract BACKGROUND: Participation in a student‑run pro bono clinic (SRPBC) provides opportunities for
students to develop professional skills, engage with the community, and provide an often‑underserved
population with needed care.
MATERIALS AND METHODS: This paper describes the results of a mixed‑method analysis of student
experiences in an SRPBC. A survey with both Likert‑type and write‑in elements was administered
to three cohorts of students enrolled in a doctoral program of physical therapy. Students were
prompted to provide their perspective on the value of the clinic experience with respect to professional
development, academic relevancy, and personal growth.
RESULTS: The analysis discovered that perspective value of the clinic in the areas of personal
growth and academic relevancy differed by cohort. Specifically, 1st‑year students reported that they
benefitted immensely by learning from their peers, especially in the use of outcome measures.
Second‑year students did not report the same benefits.
CONCLUSION: The findings suggest that even though students from different cohorts work together
in the same clinic, they may experience the clinic very differently. This observation provided the basis
for changes to the SRPBC to enhance leadership and conflict management skills of the 2nd‑year
students.

Abstract BACKGROUND: Globally, depression is one of the leading causes of illness and disability among
adolescents, and suicide is the third leading cause of death among the young and adolescents.
Since we have limited data on the prevalence of psychological distress among the youth of India,
our aim was to estimate the prevalence of psychological distress, anxiety, and depression among
students of professional colleges.
MATERIALS AND METHODS: This study was conducted in Visakhapatnam, Andhra Pradesh (India).
A total of 502 apparently healthy students have participated in this study. Data were collected from
243 medical students, 119 engineering students, 103 dental students, and 36 nursing students.
A pretested, prevalidated, and structured Kessler’s Psychological Distress Scale (K10) was used for
the assessment of mental health among students. This is a self‑administered questionnaire‑based
cross‑sectional study. Microsoft Office Excel was used for data storage and tabulation. Mean,
standard deviation, Chi‑square test, Mann–Whitney U‑test, and Kruskal–Wallis test were used to
find the association difference between various parameters using SPSS 22 software.
RESULTS: Out of 502 students, 34.7% of students were found to have normal mental health, 135
students were having mild mental problems, and 116 and 77 had moderate and severe mental illness,
respectively. Out of 197 males, 66 were normal, 61, 46, and 24 had mild, moderate, and severe
mental problems, respectively. Out of 305 females, only 108 were found to be normal.
CONCLUSION: Male students were found to have higher prevalence of mental abnormalities.
A significant higher prevalence of depression is seen in day‑scholars compared to hostellers. Nursing
students are having significantly higher prevalence of depression and nonpsychotic mental illness
as compared to dental, engineering, and medical students. Medical students are having the lowest
rate of depression than other nonmedical professional subjects.

Abstract BACKGROUND: A large proportion of noncommunicable diseases (NCDs) can be prevented by
reducing unhealthy nutrition, inadequate physical activity, smoking, and alcohol consumption. The high
burden of NCDs underlines the need for a greater understanding of the causes of these risk factors.
This paper aims to identify factors affecting smoking, alcohol consumption, unhealthy nutrition, and
inadequate physical activity in current and future times.
MATERIALS AND METHODS: A scoping review was conducted in Iran University of Medical
Sciences, Tehran, Iran, in 2020 to identify factors affecting smoking, alcohol consumption, unhealthy
nutrition, and inadequate physical activity. The review was guided by the five‑step Arksey and O’Malley
model. A deductive qualitative content analysis was employed to identify the factors synthesized
through descriptive and narrative synthesis. The search was conducted in English without date
restrictions up to January 2020.
RESULTS: We identified 1437 studies through database search and other sources and finally included
72 studies in the review. The content analysis of the data led to the identification of 27 factors affecting
smoking, alcohol consumption, nutrition, and physical activity. The factors categorized into social,
technological, environmental, economic, political, and values factors.
CONCLUSION: Political and economic factors have a significant effect on all risk factors, and it is
necessary to take comprehensive measures to improve these factors. Technological factors have a
greater impact on healthy nutrition. Physical activity is more affected by environmental factors than
other risk factors. However, smoking and alcohol consumption are more influenced by social factors
and individual attitudes.

Abstract BACKGROUND: Evaluating clinical performance is a challenge in nursing education. On the other
hand, a single evaluation method cannot be used to judge different areas of interpersonal skills.
Therefore, this study was conducted to compare the evaluation of teachers’, peer, and self‑evaluation
of nursing students in the psychiatric ward of Baharan Hospital affiliated to Zahedan University of
Medical Sciences.
MATERIALS AND METHODS: In this analytical cross‑sectional study, forty trainee students were
selected by a census method in a time period and they were evaluated by three methods including
self‑, peer, and teachers’ evaluation. Their clinical skills were assessed using a school‑based
clinical evaluation questionnaire containing 15 questions in the areas of taking history, examination
of psychiatric health, and the ability to communicate with the patient. The analyses were performed
by SPSS‑22 software.
RESULTS: The mean and standard deviation of the evaluation scores of clinical teachers as well
as peer and self‑evaluation in the areas of taking patient’s history were 13.82 ± 2.74, 14.46 ± 2.68,
and 15.75 ± 2.56, respectively. In addition, the outcomes in the areas of psychiatric examination
were 8.11 ± 1.54, 9.25 ± 2.70, and 10.43 ± 2.65 and in the areas of clinical communication were
8.93 ± 2.03, 9.04 ± 2.25, and 10.21 ± 1.98, respectively. There was a significant correlation between
the mean of teachers’ evaluation and self‑evaluation scores (P = 0.003) as well as comparing peer
and self‑evaluation (P = 0.048). However, no significant correlation was observed between teachers’
and peer evaluation (P = 0.062).
CONCLUSION: Due to the difference in scores of different methods of evaluation, self‑ and peer
evaluation can be used as a complementary method with teachers’ evaluation in measuring the
clinical performance of clinical students.

Abstract BACKGROUND: This study aims to use the artificial neural network as a novel approach to explore
factors that determine and predict successful performance of nursing interns in Saudi Arabia on the
Saudi Nursing Licensure Examination (SNLE).
MATERIALS AND METHODS: The study employed a cross‑sectional, analytic approach. A total of
62 nursing interns were recruited by convenience sampling from the University of Hail to participate.
Data collection was conducted from September to December 2019. Descriptive statistics were used
to describe the demographic characteristics of the nursing interns and their responses regarding
examination determinants. Neural network analysis was used to identify factors that are highly
predictive of the success of the nursing interns on the SNLE.
RESULTS: Overall, the nursing interns were undecided (3.94 ± 0.14) about the influential factors
determining their success. Their study hours (100%) and grade point average (GPA) (96.9%) were
identified as strong determinants reflective of the tenacity and vigor of the nursing interns, based on
the predictive power of the model. Meanwhile, age (45.7%), marital status (21.3%), gender (15.2%),
and the type of academic program (5.9%) were considered the least important of the sociodemographic
variables.
CONCLUSION: Exam preparation activities such as preparation programs, review classes, and
exam simulations must be promoted and enhanced to increase the passing tendencies of the nursing
interns in the SNLE. The GPA and increased study hours make the most significant contributions to
success on the SNLE as compared to other variables such as age, gender, marital status, and the
academic program. This study serves as a springboard for nursing educators and administrators in
laying tailored strategies to strengthen the nurse interns’ GPA and time management.

Abstract The coronavirus disease 2019 (COVID‑19) is a serious global pandemic that has extremely affected
health‑care systems. This article aimed to review the perspectives of general surgical practice during
the COVID‑19 pandemic. A systematic review of the literature addressing modification to general
surgical practice during the COVID‑19 pandemic indexed in PubMed, Scopus, Google, and Google
scholar was carried out on June 19–20, 2020. The literature review yielded 577 articles. The exclusion
of duplication, articles not in English, and specialized ones in various surgical disciplines precluded
398 articles. Finally, following checking for relevance and publication status, 114 papers were included.
Recommendations for surgical practice during the COVID‑19 pandemic revolved around mitigation
of the risk of virus transmission to patients and health‑care workers. The emerging themes of safety
precautions were related to patient prioritization and testing, mindful consideration of the operative
strategy, optimum use of personal protective equipment, operative room setup, and departmental
organization. However, those recommendations were often diverging and bore on a dearth of
evidence and personal opinions. Multidisciplinary work and cooperation among surgical specialties
are required to establish and validate the protocols for safe surgical practice during the pandemic
and perhaps similar crises in future. The COVID‑19 pandemic has brought several challenges to
the field of medicine, including the surgical specialty. The centrality of safety precautions emerging
in this crisis requires surgeons to adopt the new roles and work standards and translate them into
practice during the pandemic and perhaps longer.

Abstract Despite the importance and position of evidence‑based policymaking in the proper management of
the health system, studies show that the lack or improper and untimely use of evidence are still one
of the main challenges of health systems. Knowledge translation as a solution to this challenge is a
process that includes a period of time that starts of decision to choose the research topic and continue
to publish of research results, in which the interaction of the researchers and stakeholders is the key
factor and the main axis of the process. Since the recognition and promotion of knowledge translation
processes resulting from research in health system policy‑making will lead to the improvement of the
health system, this review protocol was designed to identify factors affecting knowledge translation
implementation, including barriers and facilitators of this process. Identifying these factors can be
used as a guide for health system decision‑makers and research managers in planning to select
appropriate policies for deployment of the knowledge translation process to increase the use of
research results in the health system.

Abstract BACKGROUND: Adolescents experience many physical and psychological changes during
adolescence. Not paying attention to the issue of girls’ puberty may have a negative impact on their
mental health and self‑efficacy in future. The aim of this study was to compare the two methods of
motivational interviews and peers on puberty health of female high school students.
MATERIALS AND METHODS: This study was performed semi‑experimental intervention on 334
high school students in 2019 through multi‑stage randomization. Data using two demographic
questionnaires and Scherrer self‑efficacy questionnaire in three stages (pre‑test, immediately after
the test and one month after the test). It was collected that in the motivational interview group, 5
training sessions were presented, and in the peer group, only one training session was taught to the
peers and the control group was not trained in any intervention.
RESULTS: Immediately after, and 1 month after the intervention, the two intervention groups had
significantly better scores in self‑efficacy compared to the control group (P = 0.001). The mean score
of self‑efficacy in the control group in the three time periods before, immediately, and one month
after the intervention, respectively (50.75 ± 5.322, 50.45 ± 5.34, 50.45 ± 5.37), in the motivational
interview group (50.56 ± 5.95, 53.63 ± 5.83, 56.03 ± 6.49) and in the peer group (50.10 ± 5.62,
54.40 ± 4.28, 59.19 ± 4.43) was. Moreover, there were significant differences in self‑efficacy scores
within and between the groups by time (P < 0.001) in intervention groups.
CONCLUSION: This study showed that puberty health education increases students’ self‑efficacy,
that correct information should be conveyed by peers and motivational interview, and motivational
interview is more effective.

Abstract BACKGROUND: Coronavirus disease rapidly spreads across the entire world in < 2 months and
gravely jeopardizes the regular human routine. The medical fraternity recommends a vaccine as one
of the best solutions to save the universe. However, to be effective, the population should reflect an
encouraging attitude to accept it. The study aimed to measure vaccine acceptability and reason for
hesitancy among the public.
MATERIALS AND METHODS: Eight hundred and forty one adults visiting a tertiary care hospital
responded to a pretested validated questionnaire on vaccine acceptability and hesitancy. The Chi‑square
test and independent t‑test, followed by multinomial logistic regression, were used to analyze the findings.
RESULTS: Overall, 53.4% (n = 445) of participants interested to take vaccine, 27.2% (n = 229)
were not sure, and the remaining 19.4% (n = 163) did not intent to vaccinate. Gender (P = 0.013),
information on the vaccine (P = 0.022), chances to get coronavirus disease in the next 6
months (P < 0.001), awareness on India COVID‑19 vaccine (P < 0.001), Indian manufacturing
company of vaccine (P < 0.001), family history of the laboratory‑confirmed case (P < 0.001), and
health status (P = 0.011) found a significant association with intention to vaccination (a response
“yes” vs. “no” and “not sure”). Reasons for vaccine hesitancy included specific antivaccine attitudes
and beliefs, a concern of fear and phobia, lack of information, and safety issues on the vaccine.
CONCLUSIONS: This institute‑specific survey revealed that approximately every 4 in 8 people were
not sure to take the vaccine, and one in five people refused to be vaccinated. The study recommends
using target‑based health education to understand and address vaccine‑specific concerns to enhance
vaccine coverage, and boost confidence among the population.

Abstract BACKGROUND: Considering the role of sexual quality of life in public satisfaction, improving
interpersonal relationships, promoting the general quality of life, especially in women, and ultimately
maintaining, consolidating, and promoting family and community health, the need to explain the factors
affecting it, such as sexual health literacy, is felt from the perspective of women. This study aimed
to determine the relationship of sexual health literacy on the sexual life quality of women referring
to health‑care centers in Qazvin.
MATERIALS AND METHODS: This research was a descriptive cross‑sectional study. The population
of this study was 420 women of Qazvin in 2020 who were selected by multistage sampling. The
data collection tool was a demographic questionnaire and the standard questionnaire sexual health
literacy for adults and Sexual Quality of Life‑Female questionnaire. Data were analyzed using SPSS
software version 22 and descriptive statistics and logistic regression.
RESULTS: The mean (standard deviation) of the sexual health literacy score was 78.47 (17.85) and
sexual quality of life was 59.71 (19.21). The results of logistic regression test showed that the variables
of sexual health literacy, education level, age of marriage, and number of sexual intercourses per
week were effective factors on the sexual quality of life (P < 0.05).
CONCLUSION: Women with lower sexual health literacy, lower education level, higher marriage age,
and women who had sex less per week had a lower sexual quality of life. Therefore, it is necessary to pay
more attention to these women in designing educational programs to improve the quality of sexual life.

Abstract BACKGROUND AND AIM: Parasitology course is one of the basic science courses in the educational
curriculum for medical students. Since the integration of basic and clinical sciences has helped
students better understand the basic science course content, the aim of the present study was to
determine the effect of integration of basic and clinical aspects of a specific topic in a parasitology
course on medical students learning.
MATERIALS AND METHODS: A randomized controlled trial was conducted on 110 undergraduate
fifth‑semester medical students from April to July 2018. The students were randomly divided into two
groups, based on student identification number: Intervention and control groups. The topic selected
for this study from the parasitology course was “cutaneous leishmaniasis.” At the beginning of the
program, a dermatologist presented the clinical aspects of the topic to the intervention group. Then,
a parasitologist delivered a traditional lecture about the basic aspects of the topic to both groups.
The students’ scores on questions related to cutaneous leishmaniasis in the final exam were used
as a measure of learning and teaching outcomes. A questionnaire that consisted of seven items and
three open‑ended questions was used based on the objectives of the randomized controlled trial.
Statistical analysis was performed by SPSS software.
RESULTS: Based on the result of the final examination, there was no significant difference in
the learning rate of students between the intervention and control groups (P ≥ 0.05). According
to students’ comments, the teaching of clinical science alongside basic science increased the
importance of the topic and the students’ interest in basic science. Most students agreed that this
method prepares them for their clinical years.
CONCLUSION: Many medical students believe that the content of many basic science courses are
forgotten in the future. Therefore, basic science education alongside clinical science presentations
are suggested.

Abstract BACKGROUND: The growth in the elderly population is predicted to expand exponentially and
developing countries like Pakistan have about two‑third of the global elderly population. It is vital to
maintain the health of the elderly aged population to reduce disabilities and health‑care cost.
AIM: This study aimed to determine the health promotion practices among the older aged population
in Pakistan and to explore the factors associate with adopting healthy lifestyle practices.
MATERIALS AND METHODS: This was a cross‑sectional study spanning from 2019 to 2020
conducted on 317 participants of age more than 60 years in Pakistan. The participants included
healthy attendants of patients visiting the outpatient clinics of different disciplines in the Liaquat
National Hospital Karachi through purposive sampling technique. The health‑promoting practices
were assessed using Health‑Promoting Lifestyle Profile II Questionnaire. The factors that determined
the healthy practices among the elderly population were identified using independent t‑test and
analysis of variance and Tukey test, with a significance level of P < 0.05. IBM SPSS Statistics 22
was used for data entry and analysis.
RESULTS: The highest subscale was detected from interpersonal relationships and spiritual growth.
The lowest score was detected from physical activity. The scores differed significantly by occupation,
education, and the marital status of the participants. Females, unmarried people, those who were
less educated, and participants relying on others for financial support had lower health‑promoting
lifestyle scores.
CONCLUSION: The overall health‑promoting practices were good among the old‑aged population of
Pakistan. These practices differed particularly for physical activity, spiritual growth, and interpersonal
relationships.

Abstract BACKGROUND: Competence in providing spiritual care to patients has become an increasingly
important aspect of nursing care delivery. However, studies on nurses’ competence in spiritual care
delivery and the factors affecting it are very limited. The present study was conducted to evaluate
Iranian nurses’ competence in providing spiritual care and its relationship with their Spiritual
Well‑Being.
MATERIALS AND METHODS: The present study is descriptive‑analytical research conducted in Bam
in the south of Iran between 2016 and 2017. All nurses working in the teaching hospitals affiliated
with Bam University of Medical Sciences were invited to participate in the study. For data collection,
the Spiritual Care Competence Scale (SCCS) and the Spiritual Well‑Being Scale (SWBS) were used.
Collected data were then analyzed using descriptive statistics (mean and standard deviation), Pearson
correlation coefficient, independent t‑test, and one‑way ANOVA with SPSS software.
RESULTS: In this study, 158 nurses were participated. The result showed that the mean score
SCCS and SWBS were 101 ± 12.6, 76.92 ± 13.4, respectively. Pearson correlation test showed a
significant and direct relationship between the mean score of SCCS and SWBS (P = 0.001, r = 0.264).
The results of this test also showed a significant relationship between all the dimensions of SCCS
and SWBS (P < 0.05).
CONCLUSIONS: In this study, the nurses had a relatively appropriate competence in providing
spiritual care to patients. There was also a significant relationship between the nurses’ spiritual
care competency and their spiritual well‑being. Given the lack of adequate studies in spiritual care
delivery competencies, it is recommended that similar studies are conducted among nurses in other
parts of the country and worldwide.

Abstract BACKGROUND: Simulation‑based training is an important strategy for skill development in a
competency‑based curriculum, especially so for laparoscopic surgery given its unique learning curve,
need for practice, and patient safety concerns. The study was conducted for postgraduates in two
surgical disciplines in a medical college tertiary care center. The study evaluates the acceptability and
utility of structured simulation‑based training for laparoscopic skills. Simulations provide deliberate
practice in the leaner supportive environment.
MATERIALS AND METHODS: The educational intervention was carried out among the 16
postgraduates from year 2 and year 3 of general surgery and obstetrics and gynecology. A structured
training and assessment module was designed and validated, and a 12‑week structured training
on laparoscopic box trainers was given to postgraduates under faculty guidance. Feedback
from postgraduates and faculty was obtained using separate validated questionnaires. The
pre‑ and post‑training assessment scores were compared applying the Wilcoxon matched‑pairs
signed‑rank (2‑tailed) test using the SPSS Windows Version 20.0 (IBM Corporation).
RESULTS: Sixteen postgraduates participated in the study. The median satisfaction score of the
postgraduates was 4 (range 3–5), a scale of a maximum of 5. The group identified faculty feedback,
stepwise skills learning, supportive learning environment, and trainers’ motivation as enabling factors
in the training. The faculty observed that the trainees were effectively engaged. The group mean
improvement scores in percentage were 40.08 for task 1, 42.08 for task 2, 43.13 for task 3, and
45.63 for task 4.
CONCLUSIONS: It is feasible to incorporate faculty‑guided sessions of simulation training in basic
laparoscopy skills for postgraduates in our setup. It is well accepted by the key stakeholders, and
we recommend it to be incorporated in the formal training program.

Abstract BACKGROUND: Kane’s validity framework examines the validity of the interpretation of a test at the
four levels of scoring, generalization, extrapolation, and implications. No model has been yet proposed
to use this framework particularly for a system of assessment. This study provided a model for the
validation of the internal medicine residents’ assessment system, based on the Kane’s framework.
MATERIALS AND METHODS: Through a five stages study, first, by reviewing the literature, the
methods used, and the study challenges, in using Kane’s framework, were extracted. Then, possible
assumptions about the design and implementation of residents’ tests and the proposed methods for
their validation at each of their four inferences of Kane’s validity were made in the form of two tables.
Subsequently, in a focus group session, the assumptions and proposed validation methods were
reviewed. In the fourth stage, the opinions of seven internal medicine professors were asked about
the results of the focus group. Finally, the assumptions and the final validation model were prepared.
RESULTS: The proposed tables were modified in the focus group. The validation table was developed
consisting of tests, used at each Miller’s pyramid level. The results were approved by five professors
of the internal medicine. The final table has five rows, respectively, as the levels of Knows and Knows
How, Shows How, Shows, Does, and the fifth one for the final scores of residents. The columns
of the table demonstrate the necessary measures for validation at the four levels of inferences of
Kane’s framework.
CONCLUSION: The proposed model ensures the validity of the internal medicine specialty residency
assessment system based on Kane’s framework, especially at the implication level.

Abstract BACKGROUND: Women who experience stillbirth and preterm delivery are likely to be associated
with an increased risk of posttraumatic stress disorder (PTSD) compared to women with live births
and dose religious attitude related to posttraumatic stress? The aim of the study was promotion PTSD
following traumatic birth experiences and the influence of maternity religious Attitude.
MATERIALS AND METHODS: A cross‑sectional analytical study was conducted at selected hospitals
of Shiraz University of Medical Sciences on 82 subjects in 2018. The instruments were demographic
questionnaire, Religious Attitude questionnaire, and Mississippi PTSD Scale which were completed
after delivery. Data were analyzed using SPSS software, version 22, using the Pearson correlation test.
RESULTS: About 75% stillbirth group and 65% of the preterm delivery group had a high level of
religious attitude. In the stillbirth group, 90% had high levels of PTSD and in the preterm delivery
group, 90% had moderate stress, and 10% had high PTSD levels. The correlation between religious
attitude and PTSD after stillbirth was 0.373 with a significance level of 0.018. Therefore, there was
a significant positive relationship between religious attitude and PTSD. However, the relationship
between religious attitude and PTSD after preterm delivery was not statistically significant (P = 0.158).
CONCLUSION: PTSD was significantly higher in mothers with stillbirth and had a significant
relationship with religious attitude. However, in mothers of preterm infants, the level of stress was
moderate and did not have a significant relationship with religious attitude. The findings indicate the
need of mothers for interventions to cope better with the physical and psychological problems of
stillbirth and preterm delivery.

Abstract BACKGROUND: The beginning of a marital relationship is very important as a part of a family
relationship, and it satisfies many mental and physical necessities in a safe environment and has
a great impact on people’s health. The aims of this study were to investigate the effectiveness of
sexual health counseling based on cognitive behavioral approach on satisfaction and excitability of
newly married women.
MATERIALS AND METHODS: A randomized clinical trial study was conducted in 50 newly married
women who referred to the health center of Jiroft City. They randomly divided into the intervention
and the control groups. All of the participants completed Linda Berg’s Sexual Satisfaction Scale
before intervention, 8 weeks after intervention and 4 weeks later (follow‑up). The interventional
group participated in CBT (8 sessions, 90 min), but the control group received routine counseling.
In all tests, a significance level of 0.05 was considered. Data were analyzed by SPSS version 20.
Descriptive test, t‑test, and repeated measure test used to analyze data.
RESULTS: In intervention group, sexual satisfaction was obtained 51.88 ± 12.27, 57.2 ± 12.88
and 62.76 ± 11.35 (P < 0.05) and in the control group was gotten 47.12 ± 9.6, 45.8 ± 8.07 and
43.48 ± 7.39 (P > 0.05) before intervention, 8 weeks after intervention and 4 weeks later (follow‑up),
respectively. In intervention group, sexual excitability was obtained 82.80 ± 17.24, 91.72 ± 13.07,
and 99.28 ± 11.2 (P < 0.05) and in the control group was gotten 87.04 ± 12.99, 87.48 ± 11.64, and
81.96 ± 12.83 (P > 0.05).
CONCLUSION: It can be concluded that cognitive‑behavioral counseling can help to improve the
sexual satisfaction and excitability of the newly married and can be used to improve and promote
women’s sexual health.

Abstract BACKGROUND: Motivation and desire are the main psychological factors associated with regular
breakfast consumption among elementary students. The purpose of this study was to assess the
readiness of students to regular breakfast consumption.
MATERIALS AND METHODS: This research was cross‑sectional study; 300 students participated
who were selected based on cluster sampling from elementary schools in different parts of Ardabil
and were interviewed using a motivational questionnaire according to SOC model. The acquired
data was then analyzed by ANOVA and linear regression.
RESULTS: Cognitive processes of change such as social liberation (β = 0.31, α = 0.001) and
self‑reevaluation (β = 0.13, α = 0.04) and self‑efficacy (β = 0.44, α = 0.001) played a significant role
in motivating students to move from the inactive stage to preparation stage.
CONCLUSION: By understanding the motivational factors of regular breakfast consumption, a regular
program can be implemented to increase breakfast consumption and ensure the health of students
and help them to grow in learning ability and abstract thinking.

Abstract BACKGROUND: It has been realized by senior researchers that interest in biostatistics is very poor
among medical professionals. Knowledge of biostatistics plays an important role in medical research.
Studies conducted about knowledge, attitude toward biostatistics by many researchers, but there were
no works about factors in relation to it. Considering this gap, we tried to develop a new instrument.
MATERIALS AND METHODS: Item generation and questionnaire formation were done using focus
group discussion involving seven experts from different departments of medical colleges. Face validity
and content validity and pilot testing were carried out step by step. In estimating reliability, internal
consistency measured after collecting data from 66 study participants. Data were collected through
self‑administered paper‑based questionnaire where response in each item was in five‑point Likert
scale. Cronbach’s alpha for reliability analysis was used.
RESULTS: In first stage, item generation through FGD, then face validity was assessed by senior
faculties. Content validity was checked by Aiken’s V index. In initial stages, with six items, Cronbach’s
alpha was 0.805. Scale mean and variance were 24.24 and 27.26. After final reliability testing, it
became 0.866 with four items where scale mean and variance came to 15.85 and 16.38.
CONCLUSION: All the six items were important factors. Reliability improved when knowledge in
statistics in higher secondary level and biostatistics classes in PG course were eliminated as factors.
More qualitative research is needed for better understanding of this concept.

Abstract BACKGROUND: Todays, human lifestyle has faced significant changes, and this lifestyle has
caused health problems. The increase of smoking, among young people, is one of the risk factors
and incorrect lifestyle factors. The present study will design an educational campaign intervention
based on the protection motivation theory (PMT) on smoking preventive behaviors in students.
MATERIALS AND METHODS: In designing this study, five phases are considered. (1) needs
assessment and determination of the current situation are considered. In this phase, the required
communication is established to form a planning team with key and influential people and experts, (2)
tool design, (3) educational intervention (educational campaign) is designed. Some individuals will
be selected and trained as facilitators to start entering the target population, have a better access
to the target group, and implement the interventions in the target group. (4) the implementation of
the educational plan, in which the designed educational intervention (educational campaign) will
be implemented on the students of the studied universities. (5) the educational evaluation, which
will be conducted 2 months after the intervention of the educational campaign. The posttest will be
based on before and after the implementation of the educational campaign. In the prevention of the
second type in smoking students, the salivary cotinine levels of smoking students will be measured
and comparisons will be made before and after educational using appropriate statistical tests.
RESULTS: The present study addresses the needs and strategies for smoking prevention using a
training campaign based on the PMT and web .
CONCLUSION: Designing a campaign which will lead to smoking preventive behaviors causes
lifestyle changes, prevent health problems such as cancer, cardiovascular diseases, and other
chronic diseases, reduce treatment costs, and increase life expectancy.

Abstract BACKGROUND: Patient‑centered care (PCC) is a cornerstone for health‑care professionals to
improve the quality of care they provide to patients with cardiac disease. However, implementation
of PCC programs has always accompanied with unpredictable challenges and obstacles. Therefore,
the present study was conducted to determine effective strategies for the implementation of PCC
from the perspective of patients and healthcare providers.
MATERIALS AND METHODS: The present research was a qualitative study using conventional content
analysis method in one of the university hospitals of Abadan University of Medical Sciences during
2019–2020. Purposive sampling was performed until data saturation was achieved. Data were collected
through four focused group discussions and 24 in‑depth semi‑structured interviews with 22 health‑care
providers and seven cardiac patients. Depending on the interview process and the responses of each
individual, the sequencing of questions was different from one participant to another. Data analysis was
performed continuously and concurrently with data collection, using a comparative method.
RESULTS: After data analysis, seven subcategories and three main categories were extracted. The
main categories included structural, process, and outcome strategies. The category of structural
strategies included subcategories of nursing care organization, application of appropriate motivational
mechanisms, and expansion of team coordination. Process strategies included three subcategories,
namely, promoting communication, respectful and compassionate care, and the development of
holistic care. Finally, the outcome strategy consisted of the subcategory of patient empowerment.
CONCLUSION: The practical strategies for the implementation of PCC in coronary care unit revealed
in this study were at structural, process, and outcome levels. Health‑care managers and administrators
can avail themselves of the findings of the present study to promote the quality care for cardiac care
unit patients and improve patient satisfaction.

Abstract BACKGROUND: Pain is a common health issue and acute pain is the main problem for patients
after surgery and injury. Inadequate and inappropriate management of pain is dangerous and costly
for patients and leads to undesirable health effects. To overcome this problem, empowerment of
the health‑care team, especially nurses, is essential. Today, to improve the quality of health‑care
provision, various methods are used that e‑learning is one of them.
MATERIALS AND METHODS: Based on the studies on pain management, existing parameters
were extracted, and according to them, the educational content of the software was approved by
nursing professors and anesthesiologists. The Unified Modeling Language diagrams were designed
to provide a better understanding of the entities and the order in which the software operates. The
software was implemented in the google android studio environment using Photoshop and JQuery
mobile. Finally, the software was evaluated by using Questionnaire for User Interface Satisfaction.
The software was evaluated by experts and students in two stages. The first stage was evaluated
by eight anesthesiologists and nursing professors, and the second stage was evaluated with the
participation of 55 undergraduate students and 28 M.Sc. nursing students.
RESULTS: The software was developed with two main modules of training and testing, and sections
of the report, about us and exit, and four scenarios for the test section. In the initial evaluation of
software by experts with an average of 91.85%, and in the second assessment of students, with a
mean of 78.15%, application software was evaluated at a good level.
CONCLUSIONS: In order to teach academic and practical (clinical) materials to students, the use of
digital teaching aids and e‑learning, along with traditional methods such as lectures, increases the
students’ eagerness, and motivation to learn more and thereby enhance the level of learning and
improving the quality of education.

Abstract BACKGROUND: The relationship between willingness to mobile learning (m‑learning) and educational
achievement was examined in health‑care professional students.
MATERIALS AND METHODS: This is a descriptive correlative study that was conducted from
January 2020 to February 2020. A total of 295 students in Saveh University of Medical Sciences in
Iran were selected through census method. The data were collected using the standard willingness to
m‑learning questionnaire. The data collected were analyzed statistically using Pearson’s correlation
coefficient and concurrent regression analysis.
RESULTS: The mean score of willingness to m‑learning was 165.55 ± 13.4, which is an indicative
of a higher willingness level in the health‑care professional students for m‑learning. There was a
positive and significant relationship between willingness for m‑learning and educational achievement
(r = 0.77, P < 0.01). The predictive variable, i.e., willingness to m‑learning, predicted 53.8% of the
variance of educational achievement (F = 58.801, P = 0.00). Among the variables of willingness to
m‑learning, the regression coefficients of perceived ease, attitude, self‑management in learning,
educational use, and efficiency of m‑learning were significant (P < 0.05). This means that these
variables are direct predictors of educational achievement.
CONCLUSIONS: Willingness to m‑learning had a positive and significant relationship with educational
achievement. Although this study was performed just before the corona outbreak, paying attention
to the results of this study can be helpful for students, faculty members, and policymakers in filling
the educational gap during the coronavirus disease 2019 outbreak.

Abstract BACKGROUND: Global burden of disease (GBD) provides the estimates of mortality and morbidity,
while case fatality rate (CFR) helps in understanding the severity of the disease. People infected
with severe acute respiratory syndrome coronavirus 2 (SARS CoV‑2) with underlying medical
conditions have shown higher levels of unfavorable outcomes including mortality. We assessed the
association of SARS‑CoV‑2 CFR with disability‑adjusted life years (DALY) of various comorbidities
in the low‑middle income countries (LMIC) and high‑income countries (HIC) to study the relationship
of coronavirus disease‑19 (COVID‑19) mortality with GBDs and to understand the linkage between
COVID‑19 mortality and comorbidities.
MATERIALS AND METHODS: This was an ecological study with secondary data analysis comparing
the DALY of various morbidities from GBD with CFR of COVID‑19. Gross domestic product was the
basis of stratifying 177 countries into low‑middle income (LMIC) and high‑income groups (HIC). The
mortality was analyzed using Pearson correlation and linear regression.
RESULTS: The median global CFR of SARS‑CoV‑2 was 2.15. The median CFR among LMIC (n = 60)
and HIC (n = 117) was 2.01 (0.00–28.20) and 2.29 (0.00–17.26), respectively. The regression analysis
found that, in both LMIC and HIC, maternal disorders were associated with higher SARS‑CoV‑2
CFR, while tuberculosis, mental health disorders, and were associated with lower CFR. Further, in
LMIC, musculoskeletal disorders and nutritional deficiencies were associated with higher CFR, while
respiratory disorders were associated with lower CFR.
CONCLUSIONS: SARS‑CoV‑2 infection appears to be a systemic disease. Individuals with
comorbidities, such as maternal disorders, neurological diseases, musculoskeletal disorders, and
nutritional deficiencies, have poorer outcomes with COVID‑19, leading to higher mortality.

Abstract BACKGROUND: Colorectal cancer is the third leading to death type of cancer in the world.
The therapeutic guideline varied between different methods. As the main therapeutic guideline
is chemotherapy, recent studies had shown utilization of natural products in combination with
conventional medication, elevate the efficiency of chemotherapeutic methods. Kombucha is a
traditional beverage obtained from the fermentation of green tea as a rich source of flavonoid
medicinal plant. This study aimed to evaluate the natural potential of combination therapy of this
natural product with doxorubicin as a chemotherapeutic agent.
MATERIALS AND METHODS: The study was performed as in vitro evaluation of biological activity
of kombucha on HCT‑116 cell line (human colon cancer cell line). The cytotoxic effect of different
kombucha beverages (fermented green tea) in comparison with green tea extract was evaluated by
dimethylthiazolyl tetrazolium bromide (MTT) assay. In the next step, anticancer activity of doxorubicin
as a general guideline chemotherapeutic agent in combination with kombucha was evaluated by
cell cycle analysis and apoptosis assay flow cytometry. Apoptotic genes expression pattern was
determined using real‑time polymerase chain reaction. The experiments were designed in three
independent replications and statistically analyzed using SPSS software.
RESULTS: The results show that kombucha compared with the green tea extract caused
more (1.2 fold) early apoptosis induction and G0/G1 phase arrest. Moreover, kombucha increased
the expression levels of p21, p53, and B‑cell leukemia/lymphoma 2 (Bcl‑2)‑associated X protein
genes (2, 2.5, and 1.5 fold, respectively) while it decreased Bcl‑2 gene expression level (5–8 fold)
compared with doxorubicin alone. Combination of kombucha with doxorubicin shows 2‑fold increased
G0/G1 phase compared with the doxorubicin treatment.
CONCLUSION: This result indicated that kombucha caused boosted anticancer activity of doxorubicin
agent. These findings suggest that kombucha may be has an assistor and useful role in colorectal
cancer treatment align with chemotherapy.

Abstract BACKGROUND: Coronary artery disease (CAD) is a life‑threatening condition that causes physical
and psychological disorders and decreases patients’ quality of life (QoL). Performing proper
educational self‑care program may lead to higher QoL in these patients. This study was performed
to investigate the effectiveness of a self‑care educational program on QoL in patients with CAD.
MATERIALS AND METHODS: This semi‑experimental study was performed on 60 patients with
CAD referred to the cardiac rehabilitation (CR) center of Vali Asr hospital in Qom, Iran, in 2018–2019.
Patients were divided into control and intervention groups by randomized sampling. The self‑care
educational program was provided through lectures and booklet. Data collection was done using the
“demographic and clinical data questionnaire,” and “Seattle Angina questionnaire.” Questionnaires
were completed in both groups, before and at least 1 month after education. Analysis of the obtained
data was performed using SPSS software (version 25), central indexes, Mann–Whitney test, and
Wilcoxon test.
RESULTS: No significant differences were observed between the two groups for demographics
characteristics and quality of life before the intervention. Before the self‑care program, the mean score
of the QoL in the intervention and control group were 56.14 ± 9.75 and 58.46 ± 11.71, respectively.
After that, the mean score of the QoL in the intervention and control group were 59.25 ± 10.56 and
59.7 ± 13.33, respectively. The statistical analysis showed significant differences in the mean scores
of QoL in the intervention group before and after the intervention (P < 0.05). However, no statistically
significant differences were seen in the control group before and after the study (P > 0.05).
CONCLUSIONS: The self‑care educational program improved the QoL in patients with CAD.
Therefore, lectures and educational booklets should be considered by CR nurses.

Abstract INTRODUCTION: Efficient pain management by nursing staff initially needs accurate knowledge
and proper attitude in this field. The aim of present study was to compare the effects of lecture
and electronic education on the knowledge, attitude, and practice of nursing staff regarding pain
management.
MATERIALS AND METHODS: The present superiority randomized controlled trial with two parallel
arms was conducted on 78 occupied nurses of surgery wards of X. The participants were recruited
randomly and divided into two groups of lecture and electronic education through random blocking (4
and 6 blocks). For allocation concealment, coded nontransparent pockets numbered 1–78 containing
the type of intervention were used. Educational material was presented using teacher‑centered
method in lecture group, as well as through multimedia program using FLASH software in e‑learning
group through 1‑h sessions for 4 weeks. Data on nurses were collected before and 4 weeks after the
training using demographic questionnaire, Pain Management Principles Assessment Tool, Nurses’
Attitude Survey, and nursing practice checklist. Data were analyzed using SPSS software (version 24)
utilizing descriptive and analytic statistical test such as Chi‑square, Fisher, independent t‑test, and
ANCOVA. P < 0.05 was considered statistically significant.
RESULTS: Mean ± standard deviation of nurses’ knowledge, attitude, and practice regarding
pain management had significant increase in both groups post‑training (P < 0.001). According to
ANCOVA the mean postintervention knowledge score in e‑learning group by controlling baseline
score had significant increase compared to the lecture group (adjusted mean difference [aMD] =
1.8: 95% confidence interval [CI] = 1.5–2.1, P < 0.001). Furthermore, the mean of total scores of
post‑intervention attitude and practice in e‑learning group adjusted for baseline score significantly
increased compared to lecture group (aMD = 1.8: 95% CI = 1.5–2.1, P < 0.001) and (aMD = 3.2:
95% CI = 2.7–3.6, P < 0.001).
CONCLUSION: Electronic education was more efficient than lecture education in increasing of
knowledge, attitude, and practice on pain management among nursing staff.

Abstract BACKGROUND: The main reason of newborn mortalities in low‑ and middle‑income countries is due
to the lack of skilled caregivers in providing essential care for babies. The aim of the present study
was to evaluate the implementation of helping babies survive (HBS) program to improve newborn
care condition in Isfahan, Iran.
MATERIALS AND METHODS: This quasi‑experimental study was conducted in the labor and
midwifery wards of Shahid Beheshti Hospital in Isfahan. Convenience sampling method was used
for all healthy newborns who weighed >1500 g. First, the samples were selected for the control
group. Then, the Helping Babies Breathe and Essential Care for Every Baby training courses were
held over for ward nurses and midwives. Then, the samples of the intervention group were selected.
The research tools consisted of demographic characteristic questionnaire, caregiver performance
evaluation checklist, and breastfeeding registration checklist. SPSS software version 16 was used
for data analysis.
RESULTS: A total of 130 newborns were divided into control (n = 65) and intervention groups (n = 65).
The average time of umbilical cord clamping increased from 13.85 to 61.48 s, and the average
duration of skin‑to‑skin contact between mother and baby increased from 11.75 to 60.47 min. The
mean of early initiation of breastfeeding improved during the 1st h and the 1st day of the birth. The
rate of neonatal hypothermia in the intervention group decreased sharply.
CONCLUSION: The implementation of the HBS program can positively impact newborn care
condition.

Abstract BACKGROUND: Case‑based learning (CBL) is an established bidirectional active learning approach
where students learn concepts by solving cases or problems under the guidance of a facilitator. In
the present study, the awareness and acceptance level of faculties to implement this method of
teaching were assessed by behavioral analysis.
MATERIALS AND METHODS: This cross‑sectional study was done through two workshops
organized at NDRI Karnal on December 16 and 17, 2019, and BHU Varanasi on March 1, 2020.
Fifty‑four faculties from different applied sciences participated. The participants were given an insight
into this teaching tool through didactic lecture and hands‑on training session about implementation
of this method. Pre and post‑ session responses were compared through a set of questionnaires
and the behavioral change was analyzed by using SPSS version 22. P ≤ 0.05 was considered as
statistically significant.
RESULTS: Only 31.5% faculties were aware of the active learning methods though 83% agreed that
active learning is better than conventional teaching. 96% agreed that CBL is a better way to develop
concepts and nearly 81% agreed that more learning could be done with lesser efforts. The clinical
decision‑making improve significantly. Pre and post‑session mean scores of effectiveness of CBL
as a teaching tool were 2.44 ± 0.63 and 2.72 ± 0.53, respectively.
CONCLUSION: CBL originally is a mode of imparting knowledge in a student‑centric bimodal learning.
Acceptance to the mode is increasing among faculties despite of many deterrents.

Abstract BACKGROUND: In the daily lives of people, the level of anxiety plays a significant role. This applies
to students, who experience anxiety when taking examinations referred to as examination anxiety.
Majority of the current educational institutions have shifted from a traditional evaluation system to one
that is computerized. The present study aim is to identify the computerized examination anxiety (CEA)
among college students in the Faculty of Health and to compare the differences among them based
on study system and gender.
MATERIALS AND METHODS: The research is a descriptive quantitative design. The research
population consists of 138 health college students. CEA scale was used to identify the level of
examination anxiety among students. Data were then exposed to analysis, namely the descriptive
statistics, independent sample t‑test, and Chi‑square tests, to obtain the answers to the research
questions at the level of <0.05.
RESULTS: Based on the findings, the CEA experienced by the health students was of moderate
level. The findings also showed insignificant differences between students’ levels of anxiety based
on gender and study system at <0.05 value.
CONCLUSION: The study contributed to literature by adding a study related to CEA during COVID‑19.
The study enumerated implications and recommendations based on the findings.

Abstract BACKGROUND: Terminally, illnesses such as cancer, AIDS, dementia, and advanced heart disease
will require special supportive and palliative care, although a few numbers of these patients are
provided with these services.The aim of the present study was to perform a comparative study of
supportive‑palliative care provision in selected countries.
MATERIALS AND METHODS: This research was a descriptive comparative study that its research
population was the frameworks of palliative and supportive care provision in Egypt, Turkey, America,
Australia, Canada, the Netherlands, and China. These frameworks were compared across six
dimensions of service receivers, financing, providers, service provider centers, type of services
provided, and training. Data collection tool has included the checklist and information sources,
documents, evidence, articles, books, and journals collected through the Internet and organizations
related to the health information of selected countries and by the library search. Data were investigated
and analyzed using the data collection tool and checklists.
FINDINGS: The findings showed that the developed countries having decentralized trusteeship
structure had a more favorable status in palliative and supportive care provision. The type of services
provided was a combination of mental, psychological, social, spiritual, financial, and physical and
communication services. Provider centers included hospital, the elderly, and cancer and charity
centers.
CONCLUSION: Regarding the investigation and recognition of the status of supportive‑palliative
care provision, it was observed that the provision of these services was a concern of the selected
countries, but they did not have a defined model or pattern to provide these services. Therefore, it
is suggested that each country takes a step to redesign and define frameworks and structures in
the evolution of supportive‑palliative cares in accordance with the particular conditions, indigenous
culture, religion, and other effective cases of that country and pays special attention to the role and
position of supportive‑palliative cares.

Abstract BACKGROUND: Human brucellosis can be a source of problems that affect public health, social, and
economic well‑being of the world’s population. This study was conducted with the aim of determining
the effect of Educational Intervention (EI) based on Health Belief Model (HBM) on preventive behaviors
against brucellosis in Health Volunteers (HVs) in Rafsanjan.
MATERIALS AND METHODS: Randomly, 104 HVs, in the intervention and control group,
participated in a quasi‑randomized, controlled experimental study. Variables were evaluated before
and 1 month after intervention. In the intervention group, the educational program was conducted
with lecture, group discussion, showing movies and related photos, booklets, and pamphlets. The
program included five 45‑min sessions that developed regarding the beliefs and constructs of
HBM about brucellosis and its prevention methods. Data regarding HBM constructs and preventive
behavior were collected using the questionnaire with 100 items by the self‑report method. Finally,
the data were entered into the SPSS software version 16.0, and statistical tests such as Chi‑square,
independent and paired t‑test, Mann–Whitney, and Wilcoxon test were used for the data analysis
at the significant level of 0.05.
RESULTS: Prior to the intervention, the mean score of the HBM constructs and preventive behaviors
between the two groups did not differ significantly, but 1 month later, in the intervention group
increased significantly compared to the control group (P < 0.05).
CONCLUSION: We recommend to health authorities and health‑care providers to use HBM in EIs
to create susceptibility, increase perceived severity and benefits, promote self‑efficacy, uses cue
to action, as well as reduce behavioral barriers, and ultimately adopt health‑promoting behaviors.

Abstract BACKGROUND: The COVID‑19 epidemic is a global health crisis that, in addition to physical health,
has affected the mental health of all individuals, especially health‑care workers, including nurses
and family members. In this regard, the present study aimed to investigate the effect of COVID‑19
epidemic on mental health of nurses’ family members.
MATERIALS AND METHODS: The present descriptive‑analytic and cross‑sectional study was
conducted in 2020 year on family members of nurses working in Hajar Hospital for admission and
hospitalization of patients with COVID‑19, after obtaining the necessary permits and coordination. To
prevent the spread of COVID‑19 through respiratory or contact droplets, a blog was designed to collect
data using software. Participation in this study was voluntary. Data collection tools included consent,
demographic questionnaire, and mental health questionnaire (Patient Health Questionnaire‑9). Data
were analyzed by SPSS version 22.
RESULTS: Findings of this study showed that out of 208 family members of nurses participating
in this study, 96 were male and 112 were female and their mean age was 35.78 years, and 55.3%
of the participants had university education. Their mean mental health score was 12.91 ± 3.75, so
that 22.6% of people had mild depression, 71.4% of people had moderate depression, and 1.8%
of people had severe depression. Independent t‑test showed that there is a statistically significant
relationship between mental health and gender and marital status (P < 0.001). Furthermore, one‑way
analysis of variance test showed that there is a significant relationship between mental health and
age (P < 0.001); this test also showed that there is no relationship between education and mental
health (P = 0.75).
CONCLUSION: The results indicate that the mental health of nurses’ family members is affected
by the challenges of COVID‑19 epidemic time, so that many of them suffer from some degree of
depression. Therefore, supporting this population requires urgent action.

Abstract BACKGROUND: Self‑regulated learning (SRL) is a critical skill for medical students to reach their
learning goals in the bedside clinical rotations. This study was performed with the aim of comparing
SRL and motivation of 4th year medical students who are in their educational transition between
students with mentors and those without mentors.
MATERIALS AND METHODS: This study was cross‑sectional. A total of 196 medical students
were invited to complete a form consisting the motivation and SRL questionnaire through Google
form during their 1st year of clinical clerkship, while some of them had participated in the mentoring
program beforehand. data correlation and regression analysis were employed.
RESULTS: Comparing SRL and motivational beliefs scores between students with mentors and
without mentors indicated that motivational beliefs mean score in students with mentors (87.5 ± 8.44)
was significantly higher compared to the others (83.49 ± 7.36) (P = 0.005). Among SRL subscales,
planning and examination stress were significantly different between two groups with higher
scores for mentees (P = 0.033 and 0.021). Having a mentor predicted motivational beliefs with
OR = 7.974 (1.391–45.719) and P = 0.020.
CONCLUSION: Considering a significant correlation between mentor possession and the scale of
motivation beliefs, future longitudinal and interventional research besides the customized mentoring
program is required to understand the role of mentoring programs on SRL as a cause‑and‑effect
relationship to recommend the peer mentoring program to enhance SRL skills in the medical students
especially during their transition to the new clinical environment.

Abstract BACKGROUND: With so much content on social media platforms about COVID‑19, determining
which information is reliable can be a daunting task. Hence, this study is aimed to analyze various
posts with regard to COVID‑19 on various social media platforms for their reliability and also examined
various factors that influence information reliability.
MATERIALS AND METHODS: A cross‑sectional study was conducted, with 934 samples related
to coronavirus pandemic published on Twitter, Instagram, and Facebook using systematic random
sampling. We adopted the criteria given by Paul Bradshaw and modified to assess the characteristics
of the samples. Training and calibration of the investigators were carried out for 3 consecutive days
before beginning the study. The data were analyzed using the Chi‑square test and multinomial logistic
regression to estimate the odds ratios.
RESULTS: Out of 934 samples studied, only 570 (61%) were found to be reliable of which
243 (42.6%) were from Twitter, 117 (20.6%) from Instagram, and 210 (36.8%) from Facebook.
We found that the reliability of the information on social media platforms is significantly influenced
by network (odds: 1.32; 95% confidence interval [CI]: 1.16–1.52; P = 0.036), content (odds: 1.83;
95% CI: 1.69–1.92; P = 0.009), contextual update (odds: 1.41; 95% CI: 1.24–1.53) and age of the
account (odds: 1.92; 95% CI: 1.64–2.09; P = 0.002).
CONCLUSION: Our study shows that the reliability of the social media posts significantly depends
on the network, contextual update, and age of the account. Hence, cross verifying the information
from a reliable source is the need of the hour to prevent panic and mental distress.

Abstract Iran is disaster‑prone country in the world. Lack of awareness and failure to have a proper
response to natural disasters cause heavy damages to nations and national assets. Risk
management is essential to prevent, intervene, and fight disasters as it can attenuate the
destructive effects. The present study reviews studies on health in disasters in Iranian schools
with an emphasis on readiness to deal with crises. The study was carried out through a
systematic search using keywords in Persian and English in Iranian and international databases
such as Google Scholar, SID, Magiran, Web of Sciences, PubMed, and Scopus. The time
range of the search included all articles published before September 2020. The reference
lists were also checked to find more articles. Totally, 575 articles were found and full‑text of
32 articles were examined. After omitting repetitious items, the articles were checked by two
independent researchers in terms of inclusion and exclusion criteria so that 15 articles entered
the final analysis phases. The target population consisted of students, teachers, managers,
and experts of disaster resilience. The articles were mostly focused on earthquake, fire, and
structural safety. Implementation of health school models through improving awareness and
crisis management knowledge in school officials plays a key role in improving and preserving
health in school environment and safety of students. Measures like paying more attention to
safety of building and physical space of schools, adding crisis management skills to curriculum
as practical educations, informing parents about such risk, and educating students about safety
and prevention of risks are recommended.

Abstract BACKGROUND: Demanding careers like medicine requires a lot of motivation and the Academic
Motivation Scale (AMS) developed by Vallerand et al. (1992) is an instrument to measure motivation.
This study evaluated the validity and reliability of AMS among medical students in the Middle East.
MATERIALS AND METHODS: This was a methodological research utilizing a convenient sampling
technique. AMS scale comprising 28 items subdivided into seven subscales was administered to 900
students (281 students returned the filled AMS). Data were analyzed using the descriptive statistics,
one‑way ANOVA, and t‑tests. Exploratory factor analysis and Cronbach’s alpha were used to evaluate
the validity and reliability of the scale, respectively.
RESULTS: There was a statistically significant difference between both genders in overall
scores (P = 0.015*), two subscales, namely “Identified Regulation” (P =0.017*) and “Stimulating
Experience” (P = 0.015*), with females showing higher value. Second‑year students (n = 91) had
significantly higher score (10.9 ± 4.1) for “Amotivation” (P =.001*) and first‑year students (n = 48)
had significantly higher score (16.2 ± 3.0) for “Achievement” subscale (P =.014*). P < 0.05
was considered statistically significant with 95% confidence interval. No statistically significant
difference was observed between the groups based on nationality or age. Bartlett’s test of
sphericity was significant (Chi‑square: 2988.010; df = 278; P < 0.001). Kaiser–Meyer–Olkin
was 0.890. Principal component analysis with varimax rotation extracted seven factors
corresponding to the original items of AMS questionnaire. All subscales correlated positively
except “amotivation.” Structural equation modeling revealed the relation between observed
and unobserved variables.
DISCUSSION: This study demonstrated that AMS is valid and reliable for application among Middle
East medical students, without needing any modification. AMS has widespread application in medical
education as it impacts learning outcomes.
CONCLUSION: This study demonstrated that AMS is valid and reliable for application among the
Middle East students without needing any modification.