Journal of Education and Health Promotion

Abstract BACKGROUND: Domestic violence against women is a global problem that can lead to many
negative consequences on physical, mental, and social health that various sociocultural causes play
a role in its occurrence in different societies. Therefore, this study was conducted to determine the
causes and type of violence against spouses in married men in Kerman.
MATERIALS AND METHODS: This cross‑sectional study was performed in 2018. The study was
conducted on 400 married men who experienced violence against their wives. Sampling was a
multistage cluster sampling method. The data collection tool was a questionnaire on violence against
women. Data were analyzed using descriptive statistics, one‑way analysis of variance (ANOVA),
and two‑variate analysis.
RESULTS: The results of the data showed that the highest rate of violence in the group of housewives
was related to physical violence and in the group of women living in dormitories and pregnant women
was related to verbal violence. The results of data analysis with a one‑way ANOVA test showed
that between the three groups, all dimensions of violence and the overall score of violence had
significant changes (P < 0.05). The results of the two‑variate analysis test showed that there was a
significant relationship between the variables of age, duration of marriage, male education, spouse
education, type of marriage, male job, and spouse job with the overall score of violence in all three
groups (P < 0.05).
CONCLUSION: According to the results of the present study, it seems that the empowerment of
women in all dimensions to improve and promote health to deal with domestic violence is essential.
As a result, the relevant measures should be taken by the support systems taking into account the
circumstances of the individuals.

Abstract BACKGROUND: Increasing in elderly’s population and their individual and social problems especially
mental health problem in this group need special attention. The aim of this study was evaluation
of health promotion behaviors training program efficacy on general health components in elderlies
referring to health centers in Isfahan city.
MATERIALS AND METHODS: This study was a tri phasic field trial in 2014 in which 72 elderlies
allocated randomly in two case and control groups. Case group participated in 9 training sessions on
stress management and interpersonal relationships and the control group participated in 2 sessions
with a neutral discussion content. Data collection tools were demographic information questionnaire
and general health questionnaire 28. Pretest, posttest, and 2‑month follow‑up were performed in
two groups. Data were analyzed by t‑test, analysis of variance with repeated measurement, least
significant difference post hoc test, and SPSS 20 software.
RESULTS: Findings of this study showed that the average of general health score in case and
control groups had not significant difference before the intervention (P > 0.05). However, the mean
difference of general health score after intervention and 2‑month follow‑up was statistically significant
in two groups (P < 0.001).
CONCLUSIONS: This study showed that interpersonal relationship and stress management training
program are effective on promotion of mental health in elderlies. Hence, the findings of this study
can be used in the field of treatment and care of the elderly by other health‑care categories.

Abstract BACKGROUND: Candidiasis vaginitis is an opportunistic and common mucosal infection. Although
Candida albicans is the most common isolated species, other species of Candida such as Candida
glabrata, Candida krusei, Candida parapsilosis, and Candida tropicalis have also increased
significantly in recent years. The aim of this study was to identify Candida species in women with
candidal vaginal infection in order to promote health in women.
MATERIALS AND METHODS: This cross‑sectional descriptive study was performed on nonpregnant
women of childbearing age who referred to health centers in Neyshabur in 2018. At the beginning of
the study, 163 people entered the study and the culture results were positive in 68 of them. In vitro,
culture was performed in subduxtrose agar medium containing chloramphenicol and gentamicin.
Species identification was performed using Candida specific culture medium (Saburo dextrose agar
and chloramphenicol). After culture, 15% of the residual wet slide with potash (KOH) was prepared
and observed with a lens. Finally, the data were analyzed with SPSS software version 24.
RESULTS: The participants in the study were women with a mean age of 35.55 ± 5.47 and the
average number of deliveries was 1.38 ± 1.15. In this study, the prevalence of C. albicans was
59.7%, C. tropicalis was 14.8%, C. krusei was 15%, and C. glabrata was 7.61% and also krusei and
tropicalis were 3% simultaneously. Therefore, C. albicans was the most common species isolated
from clinical specimens.
CONCLUSION: In this study, the most common species after albicans were C. tropicalis and
cruciferous. Considering the role of C. glabrata in the development of resistance to antifungal drugs,
the lower prevalence of this species in the present study can be associated with improved treatment
outcomes in patients.

Abstract BACKGROUND: Depression prevalence in college students is three to six times higher than US
adults. Counseling utilization increased by 30%–40% despite reports of student unwillingness to
pursue therapy. Pursuance of alternative options, like exercise or meditation, is rarely reported. This
study examined students’ willingness to seek depression treatment through university mental health
services (UMHS) and alternative options (AO).
MATERIALS AND METHODS: This was a cross‑sectional study. Students (n = 780) completed
a survey including validated depression and estimated cardiorespiratory fitness instruments. Yes/
Maybe/No responses regarding willingness to seek UMHS and AO were analyzed for associations
with demographics, depression status, and fitness level. Descriptive and inferential analyses were
employed.
RESULTS: Students were more likely to select “Yes” for AO than UMHS (Χ2 = 104.145,
P < 0.001). Low‑fit students (Χ2 = 8.35, P = 0.02) and those in depression treatment (Χ2 = 15.182,
P < 0.001) selected “Yes” to UMHS more often than expected. Younger (Χ2 = 7.893, P = 0.02),
nondepressed (Χ2 = 7.355, P = 0.03), and fit students (Χ2 = 10.617, P = 0.005) chose “Yes” while
males selected “No” (Χ2 = 8.99, P = 0.01) more often than expected for AO. Approximately 31% of
students reported having moderate‑to‑severe depression, 7.8% were in treatment, and 55% were
classified as having low fitness levels.
CONCLUSIONS: The findings of this study should be considered when developing antidepressant
programming on university campuses.

Abstract BACKGROUND: Critical thinking is one of the important skills required for medical students. It is
considered as a main component in medical education and training competent physicians. The
current study aimed to investigate the trend of critical thinking disposition of medical students and
its association with their academic performance.
MATERIALS AND METHODS: This descriptive cross sectional study was conducted in 2019 on 315
medical students of Ahvaz Jundishapur University of Medical sciences. A two‑section questionnaire
was used for data collection. The first section dealt with demographic characteristics and the second
section included Ricketts critical thinking disposition inventory using t‑test, analysis of variance, and
Pearson correlation coefficient.
RESULTS: Mean and standard deviation of critical thinking disposition of medical students was
121.85 ± 11.32. No significant difference was observed between the mean score of critical thinking
disposition and years of study (P = 0.74, F = 0.590). Pearson correlation test also showed no significant
association between critical thinking disposition and the students’ grade point average (P = 0.89,
r = 0.007).
CONCLUSIONS: The results of the current study showed that medical students’ level of critical
thinking disposition is above average, and there is no significant correlation between critical
thinking disposition and years of study and academic performance of the students. It seems that
the educational process in medical school has not been effective in improving the level of students’
critical thinking disposition.

Abstract BACKGROUND: Media news emerged reporting that double masking can increase protection
against COVID‑19. This led to differential published reports, fueling debate among the public and
creating controversy and confusion. In this paper, we present a lesson plan for health communication
students to enhance their critical thinking ability and equip them with the necessary tools to analyze
various media texts and products.
MATERIALS AND METHODS: The lesson plan included a set of activities on three different news
pieces related to double masking, each published through a different media outlet: A newspaper,
a television channel, and an online magazine/podcast. The lesson was designed for 120 min,
over 2 days. It required a digital device and Internet access. Students were tasked to compare
between the news based on set criteria and asked to provide their opinions accordingly. They were
also assigned to fill out an inverted pyramid for further analysis and interpretation.
RESULTS: Students were assessed through a rubric that evaluated gained competencies after
lesson completion. The rubric is composed of five elements to assess the students’ performances.
Elements included filling assigned cells and diagrams, usage of proper English, validation of news
sources and reported facts, critical analysis of findings, and finishing the lesson on time.
CONCLUSION: This lesson plan enhanced the ability of students to understand and analyze various
media texts and validate the content and perspectives published through the different platforms.

Abstract BACKGROUND: This study was designed to assess the clinical judgment of medical students in
surgery clinical decision‑making by a standard examination after lecture‑based learning (LBL) or
problem‑based learning (PBL).
MATERIALS AND METHODS: A prospective randomized trial study on 175 medical students
whom were randomly allocated to three groups was performed during November 2017 and January
2018. LBL group (n = 103), PBL group led by an attending (n = 39), and PBL group (n = 33) led by
an intern. Chi‑squared test and independent student t‑test were used to compare between the two
groups. All the analyses were performed by the two‑sided method using the Statistical Package for
the Social Sciences software (SPSS version 22; SPSS, Inc., Chicago, IL, USA), and a P < 0.05 set
as statistically significant.
RESULTS: The students in the PBL group scored significantly higher on the posttraining multiple‑choice
examination, compared to the LBL group (P = 0.048). However, there was no significant difference
between the PBL group led by an attending and the PBL group led by an intern (P = 0.892).
CONCLUSION: We concluded that PBL remarkably increased the students’ scores in the
problem‑solving examination, as compared to the conventional method. We found no significant
differences in PBL facilitated by an attending or an intern.

Abstract Front‑line clinicians and health‑care workers need to be educated to provide care in critical situations
such as large‑scale catastrophes and pandemics. This narrative review is focused on investigating
educational strategies in confrontation with coronavirus disease 2019 (COVID‑19) pandemic. We
conducted a literature search in December 2020 through LitCovid, PubMed, ERIC, and Cochrane
Library in order to retrieve relevant studies regarding the role of education in prevention, diagnosis,
and treatment of COVID‑19. There were 12 reviewed studies related to this specific subject. The
articles selected for this study demonstrated that education and training had a positive impact on the
knowledge and attitude of the participants and also the educational interventions, whether they were
simulation‑based or other formats of training, would be deemed crucial for enhancing participants’ level
of perceptions and confidence. Therefore, it is highly recommended that public health policymakers
consider this important issue.

Abstract BACKGROUND: Identification of frailty syndrome in patients with heart failure can affect the process
of the disease and their ability to self‑care. Considering the lack of a study on the relationship
between frailty syndrome and self‑care ability in the elderly with heart failure in the Guilan province,
the North of Iran, this study was conducted to determine the relationship between fertility syndrome
and self‑care ability in these patients.
MATERIALS AND METHODS: The present cross‑sectional correlational study was conducted in
2020. Research settings were the CCU and post CCU wards in the East Guilan public hospitals.
The sample size was 125 people who were selected by the convenience sampling method. The
research tools include; Self‑Care Heart Failure Index and Tilburg Frailty Index Questionnaires. Data
were analyzed using SPSS software version 20 using descriptive and inferential statistics with a
significance level of 0.05.
RESULTS: The results showed that the mean score of frailty syndrome in the elderly with heart
failure was 5.44 ± 2.47. In addition, the mean score of self‑care in the elderly with heart failure was
67.16 ± 10.96. There was a significant and negative correlation between frailty syndrome and the
ability to care in the elderly with heart failure (P < 0.001, r = −0.358).
CONCLUSIONS: According to the results, the elderly with fragility syndrome cannot take good
care of themselves. This indicates that in the management of heart failure, the assessment of frailty
syndrome as a care/treatment goal in the care programs of these patients should be considered.

Abstract BACKGROUND AND AIM: Marital satisfaction is a multidimensional phenomenon, which refers to
the quality of marital relationship, or the general view of marriage status and reflection of happiness
and marital performance. Repetition of certain positive behaviors can make a huge difference in
the success of continued married life, and that awareness of such behaviors seems to be critical to
recognizing certain warnings. Therefore, this study with qualitative approach conducted to promoting
long‑term marital satisfaction by exploring couple’s experiences.
MATERIALS AND METHODS: This study was conducted using descriptive phenomenology method.
The participants were 12 person (six couples) with a history of 20–30 years of married life expectancy
and a marital satisfaction score of above 65. The data were collected by purposeful sampling and
semi‑structured interviews, analyzed using Colaizzi method. By categorizing the codes, subcategories,
and main categories were extracted.
RESULTS: An analysis of the experiences of the participants resulted in emergence of eight
subcategories, and three main categories: “Strong Foundation For Living Together,” “Mutual
Commitment To Protecting Marital Cohesion,” and “Striving To Improve Sexual Relations.”
CONCLUSIONS: A long‑term marriage associated with a variety of variables, including a strong
foundation for living together, a mutual commitment to protect marital cohesion, and an effort to
improve sexuality. And the results showed that the type of relationship will change during the years
after marriage in a way that takes on certain meanings and concepts and can be interpreted in
physiological, cultural and other specific contexts.

Abstract BACKGROUND: Severe acute respiratory syndrome coronavirus 2, the virus that causes COVID‑19,
mainly spreads through respiratory droplets. The dental profession is particularly at risk. Routine
dental care was suspended after the announcement of the first lockdown in India. This makes the
group vulnerable to psychosocial consequences. The present study aims to evaluate the psychosocial
issues among dental professionals during COVID‑19 pandemic.
MATERIALS AND METHODS: Across‑sectional study was conducted among 627 dental professionals
of India, using online Google Forms from April 23, 2020, through April 30, 2020. Participants were
evaluated using self‑constructed and self‑administered personal and professional hardship and fear
checklist specifically developed for this study. The 9‑item Patient Health Questionnaire (PHQ‑9)
Depression Scale and 7‑item Generalized Anxiety Disorder Scale and PHQ‑15 were used to assess
the depression, anxiety, and somatic symptoms.
RESULTS: Fear had a remarkable impact on 80.7% of responders. Among the participants, 40.5%,
24.5%, and 30.6% reported symptoms of depression, anxiety, and somatic symptoms, respectively.
Somatic symptoms were significantly associated with gender (P = 0.000). Work setting was significantly
associated with depression (P = 0.011) and anxiety symptoms (P = 0.001). Concern, worry, and fear
due to COVID‑19 were significantly associated with depression (P = 0.000), anxiety (P = 0.033), and
somatic symptoms (P = 0.009). There was a positive correlation between depression and anxiety
symptoms (P = 0.01) and between age and somatic symptoms (P = 0.5).
CONCLUSIONS: This group reported a high level of depression, anxiety, and somatic symptoms.
Female dental professionals and private practitioners had more depression, anxiety, and somatic
symptoms. Immediate and special intervention is needed for this group. Further exploration into the
nature and its effects of the psychological symptoms may be required.

Abstract BACKGROUND: Entrepreneurship is the engine of economic growth and a main symbol of innovation
in any country. The health system of the country needs entrepreneur managers to eradicate the
problems and provide better services. The purpose of this study was to identify factors affecting the
nurturing of entrepreneurial managers in the Iran’s health system.
MATERIALS AND METHODS: This study was carried out qualitatively with the grounded
theory method and through semi‑structured interviews with six questions. The data sources
were 22 key informants who were purposefully selected from healthcare organizations and other
entrepreneurship‑related institutions. Data were analyzed and interpreted using the framework
analysis. Data were managed and analyzed using MAXQDA software.
RESULTS: Findings of this study indicated 6 main themes and 46 subthemes. The six factors
affecting the development of entrepreneurial managers in the Iran’s health system were determined
as individual, family, social, economic, organizational, and educational.
CONCLUSION: Iranian health organizations need to nurture entrepreneurial managers to tackle the
challenges of the health system, compete internationally, and have successful performance. Hence,
delivering the health industry to entrepreneurial managers in the long run will bring back positive
results of growth and development to the body of the health system. Therefore, paying attention
to the identified themes and subthemes and the solutions presented in this study can help nurture
entrepreneurial managers’ and successful performance of the Iran’s health sector.

Abstract BACKGROUND: Diagnosing cancer, as a life‑threatening event, in children and adolescents stops
the normal course of life for all family members. Spirituality, which plays an essential role in coping
with illness and death, can increase resistance against psychological crises induced by cancer
diagnosis and treatment. This study aims to discover the spiritual needs of mothers having children
with cancer aged 1–12 years old.
MATERIALS AND METHODS: In this qualitative study, the conventional content analysis approach
was used. The research environment was three pediatric oncology wards of Amir Hospital in Shiraz,
Iran. Data were collected from September 2019 to March 2020 through face‑to‑face semi‑structured
in‑depth interviews. Fifteen participants including 12 mothers and 3 nurses were interviewed through
purposive method considering maximal variation. The interviews were recorded, transcribed, and
subjected to a qualitative analysis. Credibility, dependability, confirmability, and transferability of
data were confirmed.
RESULTS: The mean (± standard deviation) age of the mothers was 35.76 (±5.96) years old. The
spiritual needs of the mothers were classified into three categories, including religious well‑being,
existential well‑being, and growth and excellence as well as seven subcategories. Religious well‑being
included subcategories of direct and indirect connection with God, existential well‑being included
subcategories of need for hope, multifaceted support, and rethinking, growth, and excellence consisted
of subcategories of devoting yourself and surrender.
CONCLUSION: Mothers of children with cancer face important spiritual needs. Therefore, it is
necessary for the treatment team to identify these needs and use them to provide appropriate
spiritual care.

Abstract BACKGROUND: Osteoporosis is considered a health problem that can be simply prevented by
lifestyle modifications in adolescence. Therefore, this study was conducted to investigate the effects
of protection motivation theory (PMT)‑based training on osteoporosis‑preventive behaviors in female
high school students in Zahedan, Iran.
MATERIALS AND METHODS: The present quasi‑experimental study was performed on 240 female
high school students who were selected by a multistage sampling technique in Zahedan in
2019–2020. To collect the data, a multipart questionnaire was distributed among the participants
in three stages, namely at the baseline, immediately, and 2 months after the intervention. This
instrument consisted of demographic information, socioeconomic status, knowledge, PMT constructs,
and preventive behaviors. The intervention group was subjected to educational content. The
collected data were analyzed in SPSS software (version 22) by descriptive and analytical tests
(i.e., Chi‑square, independent t‑test, and ANOVA).
RESULTS: Based on the results, the intervention and control groups showed no significant
difference in terms of the mean score of knowledge, theoretical constructs, and preventive behaviors
at the baseline (P > 0.05). However, the two groups were significantly different in terms of the
mentioned variables immediately and 2 months after the intervention (P = 0.001). Mean score of
preventive behaviors, the two groups also demonstrated a significant difference (i.e., calcium intake,
physical activity, and sunlight exposure) 2 months after the intervention, compared to before the
intervention. (P = 0.001).
CONCLUSION: The findings of the present study were indicative of the PMT effectiveness, which
can, therefore, be used as a framework for designing educational programs regarding osteoporosis
prevention.

Abstract BACKGROUND: An Indian medical graduate needs to be competent in the diagnosis and
management of human immunodeficiency virus (HIV) patients. This is crucial in terms of occupational
safety. A participatory learning approach could be a possible way to change behavior and improve
HIV risk assessment skills among medical students for better occupational safety and health care. The
present study was planned to identify the need, provide different learning experiences for acquiring
competency, and compare the effectiveness of participatory learning over traditional in developing
HIV risk assessment skills.
MATERIALS AND METHODS: An educational interventional (randomized controlled trial) was
carried out at GEMS and Hospital. Needs assessment survey was conducted, which identified HIV
risk assessment as a key competency. For which the outcome‑specific learning objectives were
defined, two different learning experiences were employed. A pretest was conducted to assess the
baseline knowledge and attitude (n = 92); they were then divided into two equal groups (A and B).
“A” group was taught by participatory approach, whereas “B” by traditional techniques followed by
posttest and objective structured clinical examination (OSCE) to assess their HIV risk assessment
skills. Statistical analysis: Paired t‑test for assessing knowledge and attitude within the same group
and unpaired t‑test for assessing skills between the two groups were used in this study.
RESULTS: Statistically significant improvement (P < 0.001) in knowledge and attitude scores was
noticed that OSCE scores were significantly higher in the intervention group “A” (P < 0.001) as
compared to “B” taught by traditional techniques.
CONCLUSION: Participatory learning effectively builds upon existing knowledge and attitude to
develop better HIV risk assessment skills.

Abstract BACKGROUND: M‑learning is “learning across multiple contexts, through social and content
interactions, using simple hand‑held technologies, wireless and mobile network. This personal
electronic device is a way to facilitate the transfer of learning and improve teaching. Hence, the
researchers decided to design a mobile‑based learning application to teach surgical instruments
comprehensively and compare students’ learning and satisfaction in both mobile‑based learning
and flashcards methods.
MATERIALS AND METHODS: An interventional study was conducted on surgical technologist
students in Alborz University of medical science (2019). Students were divided into two groups:
flashcards (n = 21) and mobile application learning group (n = 21). The difference of pre‑ and post‑test
scores was considered for the evaluation of learning level in two groups. Data were entered into SPSS
20.0 software and analyzed by statistics tests.Data were analyzed by a paired t‑test, independent
t‑test, and Pearson’s correlation coefficient.
RESULTS: There was no significant difference in students’ knowledge level between two groups
before intervention (P = 0.87) but there was significant difference between groups after the
intervention (P = 0.003). In the evaluation of student’s satisfaction, the mobile application was
preferred by 84.28% of students.
CONCLUSION: Given the effectiveness of using both methods (flashcards and mobile application),
it is recommended that these methods especially mobile application be used for surgical instruments
education.

Abstract BACKGROUND: This study aimed to investigate the effect of educational intervention based on the
Pender’s health promotion model (HPM) on lifestyle and self‑efficacy of the patients with diabetic
foot ulcer.
MATERIALS AND METHODS: In this clinical trial conducted in 2019, 74 patients based on
inclusion criteria were selected through convenience sampling and allocated to two groups of
intervention (n = 37) and control (n = 37) using the randomized permuted block method. In this
study, Demographic characteristics and localized Diabetes Foot Care Self‑Efficacy Scale and
Health‑Promoting Lifestyle Profile Questionnaire for diabetic foot care were completed by two groups.
The obtained data were analyzed using SPSS 16 and through descriptive and comparative statistics,
independent t‑test, paired t‑test, and ANCOVA.
RESULTS: After the intervention, the mean score of the intervention group significantly increased
in all lifestyle dimensions (P < 0.001). Furthermore, the mean score of self‑effcacy increased in the
intervention group after the intervention (P < 0.001). Comparing the change in the mean scores of
lifestyle and self‑efficacy in both the groups 50 days after the intervention, an increase was observed
in the mean scores of self‑efficacy (P < 0.001) as well as those of lifestyle and its dimensions in the
intervention group compared to those in the control group (P < 0.001).
CONCLUSION: Educational intervention based on the Pender’s HPM can promote the self‑efficacy,
lifestyle, and its dimensions in the patients with diabetic foot ulcers. The results of this study can be
used in educational interventions aiming at patients with diabetic foot ulcers to change their lifestyle
and improve their self‑efficacy.

Abstract BACKGROUND: Women play a pivotal role in managing crises and diminishing their serious
consequences both in the family and society. In the first place, the spread of coronavirus disease
2019 (COVID‑19) is one of the most severe crises in the world. Accordingly, many precautionary
measures have been taken in many countries, including Saudi Arabia, such as border closures, lack
of movement, and quarantine procedures, leading to an unprecedented impact on the daily lifestyle,
and contributing significantly to increasing pressures on women because of her multiroles in family and
work. This study aims at identifying the role of women in managing family crises during COVID‑19.
MATERIALS AND METHODS: This was a descriptive, cross‑sectional study. An online survey was
conducted using self‑designed electronic questionnaire consisting knowledge about the role of Saudi
women in managing family during COVID‑19 crises. The questionnaire was applied to 324 Saudi
working women in Riyadh and Najran, with an average age of 33 years.
RESULTS: The results indicate that the role of Saudi women during the COVID‑19 crisis was
approximately 82%. Moreover, results showed that the prevalence of the social, psychological, and
professional role of Saudi women during crisis was 82.24%, 83.40%, and 78.80%, respectively, which
indicates the importance of the role of Saudi women in managing family crises during COVID‑19.
CONCLUSION: Based on these results, the study emphasizes the importance of urging responsible
persons to provide a package of rescue and stimulus, including social protection measures.
Furthermore, it empowers Saudi women in all sectors of society and provides them with all means of
support to help them achieve their mandated role in society generally and in their families particularly.

Abstract BACKGROUND: Evidence‑based performance competence has a significant impact on the
performance of care measures. The higher the qualifications of nurses, the more effective and
desirable their performance. Evidence‑based practice demonstrates the competencies and abilities
of nurses. There is a need for valid and reliable tools for evaluating and promoting evidence‑based
competence in nursing students, and there are few tools in reviewing studies, but they have not
considered the cultural dimension. The purpose of this study is to validate cultural competence in
evidence‑based practice for nursing students.
MATERIALS AND METHODS: A methodological and validation study was conducted in the School
of Nursing and Midwifery of Kermanshah and Ilam University of Medical Sciences in 2018. The
Evidence‑Based Performance Competency Questionnaire (  EBP‑COQ) is one of the most valid tools
used in various studies by Ruzafa‑Martinez et al. Initially, the original version of the competence in
evidence‑based practice questionnaire was translated into Persian after securing a permission from
the designer of the tool. Totally 300 nursing students were selected through simple sampling method
and entered into the study. The validity of the tool was evaluated using face validity and performing
factor analysis. The reliability of the questionnaire was evaluated using Cronbach’s alpha and internal
consistency. Statistical works were carried out in SPSS and AMOS.
RESULTS: To determine the content validity of the tool, comparative fit index of the statements
was obtained equal to 0.88. Factor analysis of the items yielded acceptable and statistically
significant results (P < 0.001). The reliability of the tool was determined using internal consistency
method (Cronbach’s alpha) for the whole tool, which was equal to 0.7. The reliability of the
questionnaire was investigated at two stages, and pretest/posttest correlation coefficients were
obtained (P < 0.05).
CONCLUSION: The questionnaire had an acceptable validity and reliability. It can be used to
evaluate evidence‑based practice. Among advantages of the tool is that it is easy to administer in
health‑care fields.

Abstract Today, as age increases, the demand for independent living has increased. Since driving is one
of the safest and preferred ways for the elderly to travel, paying close attention to the accurate
assessment of the elderly’s driving ability can prevent traffic accidents in this age group. The purpose
of this study was to identify and introduce practical tools for drive assessment fitness of the elderly.
This systematic review was conducted according to Cochrane methodology and reported findings
according to PRISMA. The following databases were searched from PubMed, ISI web of knowledge,
Scopus, ProQuest, Medlib, SID, Magiran, Iran doc, and Iran Medex based on the population
intervention comparison outcome method. The total records involving 12 main tools were assessed
from 26 selected records in the final evaluation. The research findings indicated the selection of
seven tools in the psycho‑cognitive function domain such as TMT‑B, Clock Drawing Test, MAZE,
Montreal Cognitive Assessment, GDS‑15, MMSE, and ACE‑R, three tools in the sensory function
domain such as Snellen, Confrontation Visual field, and Whispered Voice Test, and also two tools
in motor function domain such as Rapid pace walk, and Manual test of the range of motion. The
findings led to selecting practical, accurate, and fast tools for widespread use for the assessment of
driving competencies of the elderly. Therefore, it is recommended that the selected tools be used in
practical batteries to assess the driving skills of the elderly.

Abstract BACKGROUND: Osteoporosis is a common disease in women over age 45 years.
Calcium intake is among the factors that help prevent osteoporosis. Identifying the social‑cognitive
determinants of calcium intake can have a major role in the development of osteoporosis prevention
programs.
MATERIALS AND METHODS: This cross‑sectional study was conducted on 400 women
aged <50 years from 10 health centers by cluster sampling in Isfahan in 2016. A hypothetical
social‑cognitive model was assessed using path analysis, and the fit indices and explanatory power
of the model were assessed. The constructs, including self‑efficacy, outcome expectations, social
support, and self‑regulation, were taken as the explanatory variables and calcium intake as the
criterion variable.
RESULTS: The mean age of the participating women was 34.07 years (standard deviation = 7.99)
(range = 19–50), and their mean calcium intake was reported as 909.94 (12. 6) mg/day. The
conceptual model was able to explain 73% of the variance in calcium intake and had good fit indices.
Self‑regulation was identified as the strongest predictor of calcium intake, and outcome expectation
was eliminated from the model since it was the weakest explanatory factor of calcium intake.
CONCLUSIONS: The theoretical model of this study is recommended as a suitable framework for
the development of targeted osteoporosis prevention interventions.

Abstract BACKGROUND: Health‑care workers (HCWs) are highly vulnerable to depression during an
epidemic outbreak. Protecting the mental well‑being of HCWs is a priority while battling with
COVID‑19. However, documentation on COVID‑19‑related depression among HCWs is scarce
due to the limited availability of measuring scales. Hence, this study was purposed to develop
a scale to measure depression relating to COVID-19 and evaluate its psychometric properties
among HCWs.
MATERIALS AND METHODS: A validation study was carried out among 320 HCWs including
physicians of various medical specialties, dental specialists, and nurses in the year 2020. Exploratory
factor analysis using Promax rotation with Kaiser normalization for the determination of factor structure
was employed in data analysis using SPSS version 16 software.
RESULTS: COVID-19 Depression Scale for HCWs (CDS‑HW) demonstrated a two-component
structure identified as “work‑related anxiety” and “psychological distress.” The mean CDS‑HW score
of the study participants was observed to be 23.67 ± 2.82, and the scale demonstrated good internal
consistency reliability (Cronbach’s alpha: 0.741).
CONCLUSION: CDS‑HW is a rapidly administrable, valid, and reliable tool that can be used to
measure COVID-19-related depression among HCWs.

Abstract BACKGROUND: COVID‑19 pandemic has spread all over the world. However, information regarding
clinical characteristics and prognostic factors is scarce. The aim of this study was to explore the
impact of preexistent chronic comorbid conditions and multimorbidity on risk of mortality in patients
with COVID‑19.
MATERIALS AND METHODS: We designed a retrospective, cross‑sectional, observational,
single‑center study. Data were analyzed from all consecutive patients diagnosed with COVID‑19 who
admitted in a pandemic hospital affiliated with Tabriz University of Medical Sciences, Tabriz, Iran,
from February 20, 2020, to September 25, 2020. The independent effects of preexistent conditions
were evaluated using multivariate logistic regression model.
RESULTS: A total of 2597 hospitalized patients with COVID‑19 were included. At least one preexistent
condition was observed in 36.5% of study population. Multivariate logistic regression analysis showed
that older age, male sex, diabetes, cardiovascular disease, hypertension, cancer, chronic kidney
diseases, liver diseases, and chronic obstructive pulmonary disease were associated with increased
risk of mortality. In addition, the number of comorbidities was significantly associated with increased
odds of mortality compared to no‑comorbidity.
CONCLUSION: The results of this study suggest that patients with comorbidities have an increased
risk of in‑hospital mortality following COVID‑19 infection.

Abstract BACKGROUND: Many accidents in industries occur due to unsafe practices and unsafe conditions.
Occupational accidents endanger the health of workers and impose excessive costs on the employers.
This study was designed and conducted to evaluate and implement a behavior‑based safety approach
in an industrial workplace based on the theory of planned behavior.
MATERIALS AND METHODS: The present study was a quasi‑experimental study performed on 90
supervisors of an industrial workplace. Behavior‑based safety interventions were performed based
on the components of the theory of planned behavior using nine strategies of health education and
health promotion, including skills training, participation, and social support. The data collection tool
consisted of a researcher‑made questionnaire that was answered by the supervisors before and
6 months after the intervention. The collected data were evaluated using SPSS 22 software. The
significance level was considered 0.05.
RESULTS: The results showed that the constructs of subjective norms, attitude, and perceived
control of behavior predict the safe behavior of supervisors. After behavior‑based safety interventions,
significant changes were observed in subjective norms, intention, attitude, and perceived control of
behavior (P < 0.001) compared to before the intervention.
CONCLUSION: The results of this study showed the improvement of safe behavior of supervisors
in the workplace due to behavioral‑based safety interventions using the theory of planned behavior.
Accordingly, this theory can be used as a suitable theoretical framework for designing and
implementing interventions to promote safe behaviors of employees in the workplace.

Abstract BACKGROUND: One way to reduce the burden of early detection of COVID‑19 disease is in
vulnerable and high‑risk groups. The aim of this study was to diagnose and evaluate the disease in
the homeless in Southern Iran Bandar Abbas.
MATERIALS AND METHODS: The target group of this study was 234 homeless people. Census
sampling included all homeless residents of Isin camp Bandar Abbas. People were individually
examined, and their information was recorded. COVID‑19 sampling was done for all as outpatients
this year.
RESULTS: Eight percent of people were able to answer the questions of awareness about symptoms,
ways of transmission, and ways of prevention of COVID‑19 disease. Nine percent of the homeless
people in the target group stated that they used to wash their hands before settling in the camp. Six
percent of homeless people stated that they used face masks before settling in the camp. Fifteen
participants showed similar symptoms to COVID‑19, yet their test result was negative. However, six
people who were asymptomatic ended up afflicted. The mean duration of time (since the emergence
of symptoms to the sampling date) was 3 days. The minimum duration of time from the emergence
of symptoms to the sampling date was 3 h, and the maximum time was 7 days.
CONCLUSION: Considering the spread of the disease, certain social measures need to be taken in
society to help take care of these people and transfer them from streets to safe places and provide for
their essentials. Diagnostic tests should be done periodically among these people at regular intervals.

Abstract BACKGROUND: Nowadays, the use of Internet with e‑learning resources anytime and anywhere
leads to interaction possibilities among teachers and students from different parts of the world. It
is becoming increasingly pertinent that we exploit the Internet technologies to achieve the most
benefits in the education.
MATERIALS AND METHODS: This study compares the difference between traditional classroom
and e‑learning in the educational environment. Medical undergraduate students of our institution were
enrolled to compare between the online versus traditional method of teaching through questionnaire.
RESULTS: Forty percent of students found the online lecture material difficult to understand. 42.6%
of respondents found it difficult to clear the doubts in online teaching; 64.4% of the participants
believed that they have learned more in a face‑to‑face learning.
CONCLUSION: In this study, we concluded that online mode offers flexibility on timing and delivery.
Students can even download the content, notes, and assignment. Despite all the advantages
offered, there is a general consensus that no technology can replace face‑to‑face teaching in real
because in this, there will be visual as well as verbal discussion. Looking at the uncertainty of the
current scenario, it is difficult to predict how long online classes will have to continue. Hence, it is of
paramount importance that we assess the effectiveness of online classes and consequently take
measures to ensure proper delivery of content to students, especially in a skilled field like medicine,
so we concluded that face‑to‑face learning is of utmost importance in medical institutions.

Abstract Renal disease is the most prevalent disease. Kidney failure can cause physical problems. Hence,
patients need to use dialysis therapy or kidney transplantation, and actually, people are in the
waiting list for a transplant. This research aimed to extract the prognostic models that evaluate the
preparation of kidney donors diagnosed with brain death (DBD).This research was a systematic
review of PubMed, Science Direct, and general explorers up until 2020. It followed the Preferred
Reporting Items for Systematic Reviews and Meta‑Analyses‑P protocol. The assessment of the
articles was done by the authors. This evaluation was supposed to be in the form of scoring,
prioritizing, and ranking the donors in terms of their preparation. Eleven sources of information
included 9 academic articles along with 2 Grey Sources from 7 different countries. 9 algorithms
and models were extracted which included, overall 10 factors. All the models were comprised of
4 factors and about 90% of these models considered 4 or 5 factors to evaluate the preparation of
kidney donors DBD. Over 60% of the models had taken into account age, blood pressure history,
and creatinine factors. Disease prognosis facilitates a doctor’s decision‑making on the emergence
of the disease. Prognostic models of renal diseases can be a great help to patients. A review of
the related literature revealed that all the models received a high score in terms of the two factors
they included, age and history of blood pressure.

Abstract BACKGROUND: Hospitals are a significant part of the health system, so their performance is always
measured based on some factors such as patient satisfaction and their safety level.
AIM: The present study was aimed to examine the relationship between patient safety culture with
patient satisfaction and hospital performance.
MATERIALS AND METHODS: This descriptive–analytical, cross‑sectional study was performed on
240 patients, 240 staff and 20 hospital managers in Shafa hospital of Kerman, Iran, in 2020. To collect
data, the patient safety culture, the patient satisfaction, and the hospital performance questionnaires
were used. The data were analyzed by SPSS and PLS software; to measure the research model,
structural equation models and confirmatory factor analysis were used.
RESULTS: The variable “patient satisfaction” and its components had a high mean, with the
component “the treating physician” having the highest mean. The variables “patient safety culture
and hospital performance” had a medium mean. There was a significant positive relationship between
patient safety culture–hospital performance, patient safety culture–patient satisfaction, and patient
satisfaction–hospital performance.
CONCLUSION: The patient satisfaction level was appropriate in the studied center, and a positive
and significant relationship was found between patient safety culture and patient satisfaction and
hospital performance.

Abstract BACKGROUND: COVID‑19 pandemic poses unique physical and emotional challenges in providing
clinical education. Failure to identify the challenges and problems that students face in the clinical
learning environment hinders their effective learning and growth. Consequently, the progress of
their skills is affected. The aim of this study was to develop a challenge in the clinical education
environment of medical students during the outbreak of COVID‑19 questionnaire and to test its
psychometric properties.
MATERIALS AND METHODS: This study is part of a larger study that was conducted using a
combined consecutive method in Qazvin. In the first stage, a phenomenological study was performed
with van Manen’s method by interviewing 12 students at Qazvin University. To extract the items of
the tool in the second stage, the concept was defined. Ultimately, the psychometric properties of
the questionnaire were evaluated with face validity, content validity (quantitative and qualitative),
construct validity (exploratory factor analysis), internal consistency (Cronbach’s alpha), and test–retest
reliability (intraclass correlation coefficient).
RESULTS: The initial tool had 70 questions. After validation, 53 items remained in the final
questionnaire. Four extracted dimensions were as follows: “Inadequate professional competency,”
“Inefficient clinical planning” and “outcomes of learning‑teaching activities,” and “the challenges
related to the stigma of medical staff.” Cronbach’s alpha for the whole questionnaire was
0.98 (range: 0.87–0.98). The test–retest (intraclass correlation coefficient) reliability was
0.98 (P < 0.001).
CONCLUSIONS: According to the obtained results, if the items of “Inadequate professional
competency,” “Inefficient clinical planning” and “outcomes of learning‑teaching activities,” and “the
challenges related to the stigma of medical staff,” the challenges of students’ clinical education can
be reduced during the COVID‑19 outbreak.

Abstract BACKGROUND: Utilizing the successful experiences of countries and local regions can be useful in
the management and control of coronavirus disease‑2019 (COVID‑19), so the research team aims
to determine and extract the strengths, weaknesses, opportunities, and threats of the health system
in the risk management of COVID‑19 using strengths, weaknesses, opportunities, threats (SWOT)
analytical approach.
MATERIALS AND METHODS: This study was performed by a qualitative multimethod approach.
In addition to reviewing the minutes of meetings and approvals of the Provincial Anti‑Corona
Headquarters, focused group meetings and in‑depth semi‑structured individual interviews were
conducted. The results were extracted based on the SWOT analytical approach in the form of
strengths, weaknesses, opportunities, and threats of the health system and then based on the SWOT
matrix, the necessary strategies were identified.
RESULTS: In the necessary strategies, based on SWOT matrix in SO strategies: SO1, formation
of regional health assessment teams; SO2, promotion of preparedness, resilience, and effective
response; SO3, activation of research and training centers; SO4, integrated management,
supervision, and coordination; in WO strategies: WO1, analysis and COVID‑19 risk monitoring;
WO2, communication and risk information management; WO3, people‑based management; and
WO4, activation of local economic institutions and manufacturing centers; in ST: ST1, comprehensive
care system strategies; and ST2, enhancing social trust with a transparency approach; and finally
in WT strategies; WT1, stress management; and WT2, specific financial system design for disaster
management were identified.
CONCLUSION: Now, for the prevention and control of this disease, the need of empathy and
participation of all human societies is felt more than anything else. These experience and analysis
are based on the SWOT approach for the health system to be able to provide solutions and practical
points that can be used by stakeholders.

Abstract BACKGROUND: The acceptability of hospital staff in the use of hospital information management
system (HIMS) is an emerging research area it can explain the fate of any HIMS development and
implementation project in hospitals. The aim of this study was to observe the level of acceptance of
HMIS among nursing officials working at a teaching hospital.
MATERIALS AND METHODS: This cross‑sectional study was conducted for 1 year in a teaching
hospital of northern India by using a pretested questionnaire. Our study participants were nursing
officers who were not under the probation period and we used a purposive sampling (10% nurses
from each ward). Our sample size was 256.
RESULTS: We have observed that majority of 174 (67.96%) participants had good acceptability
to the HIMS system. Our study revealed that most of the participants were aware of HIMS. Among
all participants, nearly half of them had good acceptability to the HIMS system. This is may be due
to their job profiles, distribution of their working places, and their past experiences with HMIS. The
bottlenecks such as connectivity problem, error prevention, and lack of training can be addressed
by the hospital management by proper measures.
CONCLUSION: The acceptance level of HIMS among the nursing officials working in a teaching
hospital was good.

Abstract BACKGROUND: Previous studies have reported that medical students show high rates of depression,
anxiety, and stress levels, but mixed findings were found regarding possible differences between
gender and different years of medical training. This study evaluated depression, anxiety, and stress
levels and psychiatric drug use in students in an Italian medical school and investigated the differences
between gender and year of study.
MATERIALS AND METHODS: This cross‑sectional study included 694 medical students in their
1st (n = 286), 4th (n = 209), and 6th (n = 199) year of study. The questionnaire included demographic
information, self‑report questionnaires regarding depression, anxiety, and stress, and questions
about psychiatric drug use. Data analysis was performed using SPSS/Ver 22 through descriptive and
analytic statistics, including Mann–Whitney U‑test, Fisher’s exact test, and GLM two‑way ANOVA.
RESULTS: Depression, anxiety, and stress symptoms were reported by 365 (52.6%), 428 (61.7%),
and 545 (78.5%) medical students, respectively. Female students in their 4th year of study reported
higher depression levels than males of the same year (P = 0.004), whereas levels of anxiety were
higher in 6th‑year female students compared with those in their 1st and 4th years (P = 0.001; P = 0.025).
Stress levels were consistently higher in females than in males for all 3 years (1st year: P = 0.041;
4th year: P < 0.001; 6th year: P = 0.004). No gender differences were found in the use of psychiatric
and stimulant drugs.
CONCLUSION: This study provides preliminary evidence suggesting the importance of planning
interventions aimed at reducing emotional distress among medical students that should be targeted
on gender and year of the study.

Abstract BACKGROUND: Over the last few centuries, the overspecialization of various sciences under the
pretext of benefiting from pure disciplinary knowledge led to alienation among and competition
between different fields of science. Such competition has deviated knowledge from its main objective
which is to understand and explain the phenomena. The remedy to this dilemma is to address a new
approach, introduced to higher education in the late 1950s as “interdisciplinarity.” Accordingly, the
main purpose of this article is to propose the strategic instances of operationalizing interdisciplinarity
as the key requirements to provide a guideline for designing interdisciplinarity activities.
MATERIALS AND METHODS: The present survey was carried out through the framework synthesis
method. To codify the instances of operationalizing interdisciplinarity, the main elements and structures
of the model were set as the basis of the query for each element and structure; an independent
query was carried out in the literature of the study. The correspondence of the discovered instances
was once more compared with the conceptual boxes of the primary theoretical model. Ultimately,
the taxonomy was concluded through the operational instances based on the primary framework.
RESULTS: A total of 152 strategies were identified as implications of operationalization of 13 layers
and 38 sublayers of the multilayer interdisciplinary model.
CONCLUSION: The development of interdisciplinarity in the national higher education system requires
several measures to be taken at different levels of a discipline or scientific field of study. Relying on
this, which is the main basis of entering into interdisciplinarity activities, the present study suggests
and presents strategic instances of interdisciplinarity operationalization.

Abstract BACKGROUND: The quality of life (QOL) is essential in all different stages of life; however, It is
more important for older people as it can be effective in promoting their health. Therefore, the present
study aimed to review the literature on the QOL in the Iranian elderly population.
MATERIALS AND METHODS: The study was carried out as a systematic review. For this purpose,
all databases were searched in March 2021. The keywords used for the search were “quality of life,
elderly, older adults, aging, seniors, and Iran” along with the Persian equivalents. PRISMA protocol
was used to screen articles. After removing duplicate and irrelevant items, two evaluators appraised
the articles separately based on a researcher‑made checklist derived from the SBEM and STROBE
Statement standard checklists.
RESULTS: The initial search yielded 3734 studies on the QOL in the Iranian elderly population. After
screening and assessing the studies based on inclusion and exclusion criteria, 22 articles remained in
the study. Most of the studies (cross‑sectional) were conducted in Tehran using a 36‑item Short‑Form
Health Survey to assess the QOL. The studies investigated sociodemographic determinants, physical
and health‑related behaviors, and spirituality and psychological determinants of the QOL. The
sociodemographic determinants were the most common factors under study. The results showed
that the role of gender and socioeconomic status was the strongest among the sociodemographic
characteristics. A significant association was found between the QOL in the Iranian elderly population
and factors such as depression and religious confrontation.
CONCLUSION: In addition to chronic diseases, diseases of the oral and dental, as well as an
unhealthy diet, should be considered in the elderly. Therefore, attention should be paid to all social,
physical, and psychological variables that affect the QOL of older people.

Abstract BACKGROUND: Patient education is a key factor in promoting the health of people with acute
coronary syndrome (ACS), and the effective use of technology can play an important role in this
regard. This study aimed to determine the effectiveness of education using media messages on the
lifestyle of patients with ACS.
MATERIALS AND METHODS: The present clinical trial was conducted on 91 cases with ACS
admitted to the cardiac ward of Afshar Hospital in Yazd, Iran, during 2018–2019, who were randomly
assigned to control and intervention groups. The former only was provided with routine training before
discharge, while the latter, in addition to routine training before discharge, received education on
social networking and sending text/visual messages. At baseline and 3 months after the intervention,
the Walker’s Lifestyle Questionnaire was completed. The independent t‑test, paired t‑test, and
Chi‑square test were employed for data analysis.
RESULTS: The average lifestyle value of the intervention group was significantly higher compared
with the control group after the intervention (P ˂ 0.001). Moreover, the lifestyle score was significantly
different pre‑ and post‑intervention in the intervention group (P ˂ 0.001).
CONCLUSIONS: Education using media messages is useful to promote the lifestyle in cases with
ACS, which seems effective in planning the follow‑up for these patients.

Abstract BACKGROUND: Following the global emergency of coronavirus disease 2019 (COVID‑19),
health‑care workers, especially nurses were encountered with an increasing workload. Therefore, due
to the importance of this issue, the present study aimed to examine stress, anxiety, and depression
levels among nurses during the COVID‑19 pandemic in Iran.
MATERIALS AND METHODS: This cross‑sectional study was conducted in four educational hospitals
affiliated to Kerman University of Medical Sciences in 2020. The standard Depression, Anxiety and
Stress Scale‑21 questionnaire was applied to assess the levels of stress, anxiety, and depression
in nurse personnel with a census method (n = 403). Data were analyzed using descriptive statistics
and analytic statistics such as Kolmogorov–Smirnov, Mann–Whitney, Kruskal–Wallis, and multiple
linear regression tests through the version 20, SPSS Inc., Chicago, IL, USA, Software at the level
of P < 0.05.
RESULTS: The results of the study showed that the mean scores of depressions (9.18 ± 4.45),
stress (9.62 ± 4.94), and anxiety (10.32 ± 4.85) in nurses were at moderate level. A significant
relationship was observed between stressed, anxious, and depressed participants in the gender,
marital status, level of education, and working hours per month. No statistically significant relationship
was found between other demographic variables including age, work experience, and employment
status with anxiety, depression, and stress categories.
CONCLUSION: The results of this study can increase the awareness of health system managers,
especially hospitals, about the level of stress, anxiety, and depression and can help in order to provide
psychological support programs for improving the mental health of nurses during the COVID‑19
pandemic.

Abstract BACKGROUND: Worldwide, AIDS is an acute problem. Health Belief Model (HBM) is a model for
prevention and control of diseases. This study examined the predictors of preventive behaviors of
HIV/AIDS based on HBM constructs in participants.
MATERIALS AND METHODS: This cross‑sectional study was performed on 200 women who
were referred to vulnerable women’s centers across Tabriz city between November and December
2018. Participants were selected by census sampling. Inclusion criteria were having a health record,
multiple sexual partners, reading and writing skills, and willingness to participate in the study. To
collect data, questionnaires of sociodemographic characteristics, HIV knowledge, self‑efficacy for
negotiating safe sex, perceived sensitivity, perceived severity, perceived benefits, perceived barriers,
and behavioral prevention (BP) were used. The collected data were analyzed using SPSS version 19
through Pearson’s correlation coefficient, one‑way ANOVA, and multiple linear regression analyses.
The significant level was set at α = 0.05.
RESULTS: Pearson’s correlation test showed a statistically significant correlation between BP
and perceived sensitivity (r = 0.25), perceived benefits (r = 0.32), self‑efficacy (r = 0.33), and HIV
knowledge (r = 0.25) constructs (P < 0.001). According to the multiple linear regression, perceived
sensitivity (P = 0.020), perceived benefits (P = 0.036), and some of the sociodemographic
characteristics were found to be predictors of preventive behaviors that explained in total 50% of
variance of BP (P < 0.05 and R2 = 0.504).
CONCLUSION: It seems that the HBM is useful to predict HIV preventive behaviors among this
vulnerable group. Training programs should be aimed on improving the health belief of HIV preventive
behaviors.

Abstract BACKGROUND : The complex, multifaceted care environment and the threatening situation of caring
for hemodialysis patients cause tension in their family caregivers. Due to the severe tension, family
caregivers are likely to ignore their basic needs and only pay attention to the patient’s needs and
related issues. This study was conducted with the aim of designing and evaluating the Perceived
Care tension Questionnaire for Caregivers of Hemodialysis Patients (PCTQHFC).
MATERIALS AND METHODS: The present study was a sequential exploratory mixed methods
study of scale development variant conducted in two phases: qualitative and quantitative. This study
was conducted in 2019 in Shahrekord. The qualitative phase included item development and scale
development. In the quantitative phase (Item Analysis), the validation characteristics of the tool were
examined using face, content and construct validity, and its reliability by internal consistency and
stability. Findings were performed using software SPSS 18.
RESULTS: Principal components analysis with orthogonal rotation to generate factors, showed that
five factors, namely emotional exhaustion, inadequate social support, care burden, confusion and
ambiguity and lack of adaptability skills had an eigenvalue of higher than 1, so that they explained,
respectively, 75.98%, 61.36%, 72.49%, 76.33%, and 70.31% of the total variance. The internal
consistency was obtained 0.811 and the inter‑class correlation coefficient for the whole instrument
0.832.
CONCLUSION: PCTQHFC is a culturally appropriate measure with strong psychometric properties.
The instrument designed in this study measures the care tension of hemodialysis patients. Therefore,
researchers, health‑care providers, and community health policymakers can plan and implement
interventions to reduce the tension of caregivers of hemodialysis patients by analyzing and identifying
the tensions of caregivers.

Abstract BACKGROUND: COVID‑19 is a contagious disease without any treatment, vaccine, or immunity,
which the only way out is the practice of preventive measures. This article assessed the perception
and factors influencing the practice of preventive measures to COVID‑19 among nurses in Anambra
State, Nigeria. The study objectives include to determine the perception of nurses toward COVID‑19
and to determine factors that influence the practice of preventive measures to COVID‑19 among
nurses in tertiary hospitals in Anambra State.
MATERIALS AND METHODS: The design for the study was descriptive cross‑sectional survey
conducted among 344 nurses in the two tertiary institutions.
RESULTS: Three hundred and three (88.1%) nurses had no formal training on COVID‑19 protocol.
They have a good perception of the disease as, among others, they (165 [48.0%]) see it to be highly
contagious, 207 (60.2%) can recognize symptoms easily, 168 (48.8%) believed that COVID‑19 could
be handled professionally based on their experience, 155 (45.1%) responded that there is no vaccine
yet for the disease, and 200 (58.1%) responded that patients should not hide their symptoms and travel
history to avoid infecting other people. The result on the false benefits has 323 (93.9%) who responded
that COVID‑19 preventive measures will predispose one to the disease, 319 (92.7%) who responded
that the preventive measures will not slow the spread of the disease, 288 (83.7) who responded
that it is independent of normalcy returning to areas affected, and 327 (95.1%) who responded that
COVID‑19 preventive measures are among the effective ways to mitigate the disease and enhance
life sustainability. Some work‑related/institutional and disease‑specific factors influence their practice
of preventive measures to COVID‑19. Such factors include the time to use personal protective
equipment (PPE) in an emergency (170 [49.4%]), remembering to use PPE (158 [45.9%]), insufficient
nursing staff during a shift (158 [43.0%]), and too many responsibilities during a shift (178 [51.7%]).
CONCLUSION: With the increasing death as a result of COVID‑19, of which health workers are not
immune to, it is essential to annihilate all negative factors that may impede the accurate practices
of the preventive measures and also support the nurses with the necessary tools and knowledge to
mitigate their exposure to the disease.

Abstract BACKGROUND: COVID‑19 pandemic has forced medical education to undergo sudden
metamorphosis from the traditional face‑to‑face education to distance online learning. This transition
was dealt with a lot of infrastructure and technical difficulties from both teacher and learner ends,
especially in a developing country like India. This study was conducted with the aim of analyzing
students’ perspective and problems faced in the live online teaching.
MATERIALS AND METHODS: This was a prospective longitudinal study conducted on medical
students enrolled in the 1st, 2nd, and 3rd years of Bachelor of Medicine and Bachelor of Surgery
courses at a government medical college located in hilly state Uttarakhand, India. Clearance from
the institutional ethical committee was obtained. The students were invited to voluntarily participate in
online survey by filling Google Forms which was E‑mailed as well as shared in social media platform.
A total of 237 medical students participated. The first survey was conducted at the time of initiation
of online mode of teaching, during May 1–7, 2020, and second, after completion of 6 months of
regular online teaching, during November 1–7, 2020. The questionnaire comprised initial section
on demographic details and consent followed by 27 and 30 sets of statements pertaining to online
medical education experience in the first and second questionnaires, respectively. A 5‑point Likert
scale was used. Data were analyzed using IBM SPSS version 24.0. Chi‑square test was applied for
association, and P ≤ 0.05 was considered statistically significant.
RESULTS: A total of 237 students participated in the study. The response rate was 52.7%. Majority of
respondents had suitable devices (89.1%) and Internet facilities (62%) for online classes. The students
accepted the new method of teaching very well, but for practical sessions and clinics, traditional
classes were necessary. Long screen time, lack of student–teacher interaction, and interaction with
peers were major concerns of students. However, over the study period, the availability of resources,
friendliness toward technology, and inclination toward virtual classes increased.
CONCLUSIONS: The pandemic has introduced to a new normal where online teaching cannot be
ignored. Despite challenges faced during online learning, 65.5% of students preferred hybrid teaching
in future for delivering medical education. Acceptance for online education by students increased
over time in the study.