Journal of Education and Health Promotion

Abstract

Abstract

Abstract BACKGROUND: Organizational health (OH) is an organizational aspect in which staff is encouraged
to be clearly involved and participate in decision‑making, problem solving, and collaborating to improve
organizational climate and culture. Multilevel staff involvement facilitates strengthened relationships,
open communication, trust, and organizational commitment. The purpose of this study was to find
components of OH for small‑sized health‑care organizations.
METHODS: A systematic review across three key databases by using an extensive list of keywords
components and interventions was conducted. This survey included studies that explored various
OH elements, components and interventions.
RESULTS: It comprises 34 full‑text studies from 221 received studies. Afterward, the OH elements
were classified into three main categories (OH elements, organizational health literacy, and
organizational health interventions). Then, according to the reviewed data, 23 dimensions were
defined similarly for all groups of studies and relevant explanations related to them were reported.
CONCLUSION: The OH encompasses multiple dimensions. Empirical research is required for
designing a questionnaire according to the final extracted components and measuring its validation
in small‑sized health organizations.

Abstract BACKGROUND: Since the outbreak of the pandemic, the release of the COVID (Corona Virus
Disease)‑19 vaccine was highly anticipated. Nevertheless, vaccine availability does not symbolize the
end of pandemic due to ongoing vaccine hesitancy and anti‑vaccination movements. The objective
of this study is to evaluate COVID‑19 vaccine acceptance among pregnant and lactating individuals
in Maharashtra state, India.
MATERIALS AND METHODS: A descriptive cross‑sectional study was conducted via a hybrid
approach using various digital portals such as Whatsapp, telegram, and physical distribution to those
who did not have access to smartphone devices. A probability proportional sampling strategy was
deployed. A pre‑validated structured self‑administered questionnaire tool designed by Freeman et al.
2020 (Oxford COVID‑19 vaccine hesitancy scale) was used, which consisted of seven close‑ended
targeted and focused questions. Analysis of several survey items and vaccine acceptance was
conducted using the Chi‑square test.
RESULTS: Analysis revealed that 58% of individuals were willing to take vaccines after government
approval and 26% of individuals showed hesitancy toward vaccination. When compared, lactating
individuals showed less vaccine hesitancy (22%) than pregnant individuals (27%). The maximum
vaccine hesitancy was observed in the third trimester of pregnancy (29.5%).
CONCLUSIONS: Trust in vaccines is a crucial factor and is dependent on the ability of the government
in promoting vaccines through effective communication; this can be one of the reasons for the high
level of acceptance and awareness toward COVID‑19 vaccination in this study.

Abstract BACKGROUND: The immense comorbidity among disorders could be ascribed to common
trans‑diagnostic processes. The term trans‑diagnostic has been of interest in both pathology
and psychology. Trans‑diagnostic treatments were created as opposed to treatments based on
single‑diagnosis treatments. It addresses the common underlying mechanisms in a range of comorbid
disorders. Trans‑diagnostic treatment is one of the new psychological treatments, and its efficacy has
been proven on many psychological variables. The main focus of the current study is on designing
unified trans‑diagnostic interventions and their efficacy on the shared mechanisms of comorbid
obsessive personality disorder with anxiety, depression, and obsessive‑compulsive disorder.
MATERIALS AND METHODS: the sequential transformative strategy has two stages; qualitative
and quantitative. In The first and qualitative section of the research, explanatory research will be
carried out to investigate the trans‑diagnostic intervention using a systematic review. To validate
the trans‑diagnostic intervention, and simultaneously with the trans‑diagnostic intervention, a
questionnaire has been prepared and given to 10 psychology experts and professionals in the
treatment field concerning content validity by evaluators.
Quasi‑experimental research will be assessed with a pre‑test, post‑test, and a two‑month follow‑up
after confirming the validity and reliability of the intervention in the quantitative section.
CONCLUSION: Designing unified trans‑diagnosis interventions and their efficacy on the common
mechanisms of comorbid obsessive personality disorder with anxiety, depression, and obsessive‑compulsive
disorder is an effective treatment method for helping those suffering from a personality disorder. Clinical
psychologists, psychology experts, psychiatrists, and mental health experts are all the immediate
beneficiaries of this study. Moreover, clients could benefit from this intervention with less money and time.

Abstract BACKGROUND: The World Health Organization (WHO) states that vaccine hesitancy is one of
the top 10 threats to global public health. Evidence shows that vaccine hesitancy studies in India
are limited and targeted toward individual vaccines. The study aimed to fill this gap by exploring the
relationship between demographics and SAGE factors toward vaccine hesitancy.
MATERIALS AND METHODS: A hospital‑based, cross‑sectional, analytical study was conducted
in a non‑governmental organization (NGO) hospital with 330 beds, located in Bathalapalli,
Andhra Pradesh, India. Mothers of under‑five children who attended outpatient departments of
pediatrics or obstetrics and gynecology were included. A total of 574 mothers were enrolled and
vaccine hesitancy was determined by reviewing the mother–child protection card for the presence
of delay or refusal of the recommended vaccine. A face‑to‑face interview was conducted to obtain
demographics and WHO–SAGE variables from the participants. Binary logistic regression analysis
was performed to associate independent variables (demographics and SAGE variables) with the
dependent variable (vaccine hesitancy).
RESULTS: Out of 574 respondents, 161 mother’s children were noted as vaccine‑hesitant (refusal = 7;
delay = 154); and the prevalence of vaccine hesitancy was 28.05%. The delay was observed in all
recommended vaccines, but the refusal or reluctance was seen in only four vaccines (hepatitis B
birth dose = 1; IPV 1 and 2 = 2; Measles 1 and 2 = 3; and Rota 1, 2, and 3 = 1). The respondents’
demographics like no or lower parent education (OR = 3.17; 95%CI = 1.50–6.72) and fewer antenatal
visits (OR = 2.30; 95%CI = 1.45–3.36) showed higher odds, whereas the upper socioeconomic
status showed lower odds (OR = 0.09; 95%CI = 0.02–0.36) toward vaccine hesitancy. The WHO–
SAGE dimensions like awareness (OR = 0.14; 95%CI = 0.03–0.53), poor access (OR = 7.76;
95%CI = 3.65–16.51), and low acceptability of the individual (OR = 07.15; 95%CI = 1.87–27.29),
community (OR = 6.21; 95%CI = 1.58–24.33) were significantly associated with vaccine hesitancy.
CONCLUSION: The study concludes that the prevalence of vaccine hesitancy was high. Vaccine
safety and children’s health are primary concerns for parents’ refusal/reluctance. To achieve 100%
immunization coverage, policymakers need to reduce vaccine hesitancy by developing strategies
based on demographic and WHO–SAGE working group predictors.

Abstract BACKGROUND: Biomedical research is not given adequate attention during undergraduation
due to the failure of the medical curriculum to motivate the students to take up research, teach the
research methodology, and emphasize the scope of research in the future. Our objective was to
study the perceptions of medical undergraduate students toward biomedical research and to explore
the facilitators and barriers to biomedical research.
MATERIALS AND METHODS: This was an explanatory, sequential, mixed‑method study. Consenting
medical undergraduate students, irrespective of their previous contribution to research, were
interviewed by a pretested questionnaire concerning biomedical research, its barriers, and facilitators.
For the qualitative component, two focused group discussions (FGDs) were conducted among
students in the nonclinical and clinical phases. Data were analyzed and expressed as percentages.
Thematic manual content analysis of the transcribed manuscripts was performed.
RESULTS: This study included 553 participants. Only 5.52% had previous experience undertaking
research. Self‑interest and acquiring deeper knowledge were identified as drivers. Lack of motivation,
proper guidance, and training in research methodology was found to be the barrier among 90% of
the subjects. The FGD reflected the perceptions of students and variations in their ideologies toward
taking up research.
CONCLUSION: It becomes important to analyze the factors that promote or avert a student from
taking up research. A thorough investigation in this regard will be helpful for future cohorts of
medical students and will impact their decisions on taking up research and in seeking a career in
research‑based fields.

Abstract BACKGROUND: With more than 12 million new cases of cancers and nearly 7.6 million deaths
worldwide in 2020, cancer is currently the third leading cause of mortality in the world. The costs
spent on treating patients with cancer account for a significant amount of healthcare costs. Healthcare
expenditures for cancer treatment have also increased significantly and are projected to skyrocket
further over the next decade. This study was conducted to determine medical and non‑medical direct
costs for the prevention of cancer in patients hospitalized in 10 selected educational hospitals in Iran.
MATERIALS AND METHODS: The study employed a cross‑sectional design and was conducted in
10 selected educational hospitals in Tabriz, Tehran, Isfahan, Mashhad, and Shiraz in 2020. Using
a researcher‑made questionnaire, we assessed direct medical costs and direct non-medical costs
of cancer in patients over 20 years old with kinds of breast, prostate, leukemia, lymphatic, stomach,
liver, lung, bladder, uterine, and intestine cancers who undertook oncology treatments (n = 2410).
Data were analyzed using descriptive statistics including mean and standard deviation and analytic
statistics such as Kolmogorov–Smirnov, analysis of variance, and t‑test, using SPSS 18 and P ≤0.05.
RESULT: The mean direct non-medical cost paid out of pocket per month was $99.6 ± $10.81 USD,
and the mean direct medical cost per month was $1029.4 ± $68.5 USD. The total cost paid by the
patients was $889.4 ± 69.81 USD per month.
CONCLUSION: Given the increasing number of patients with cancer, it is necessary to increase the
number of special centers for the prevention and treatment of cancers. Dissemination of information
about the costs of illnesses and their complications enables decision‑makers to make a proper
comparison between different uses of resources. Moreover, to support the patients, the health system
must implement plans to decrease out‑of‑pocket payments by patients.

Abstract BACKGROUND AND AIM: Given the complexities of the health care system and the importance
of the subject and effects of health literacy in all aspects of care, defining specific health literacy in
this context seems necessary. The purpose of this research was to explain the concept of hospital
health literacy (HHL), its definition, and the related dimensions using the qualitative research method.
MATERIALS AND METHODS: An exploratory qualitative design was used. Exploratory, open‑ended,
and face‑to‑face interviews based on the interview guide were used to elicit participants’ perspectives
between July 2021 and January 2022. By using the content analysis method, researchers coded
transcripts and collated these codes into sub‑categories and then merged them into the main category
and explored the dimensions of the concept.
RESULTS: A total of 23 service providers and 25 service recipients were included in the study.
Analysis of qualitative data led to the identification of 6 categories and 25 sub‑categories including
cognitive literacy, functional (basic) literacy, communicative literacy, behavioral literacy, media
literacy, and emotional literacy.
CONCLUSION: The findings of the present study provide a deep understanding of the concept
of HHL that could be applied to develop valid and reliable measurement tools for assessing HHL
among a variety of populations. Also, it is hoped that the present attempt can be useful to guide
future research and interventions as well as to provide a clear base for planning, implementing, and
evaluating interventions aimed at promoting individuals’ health literacy in health settings.

Abstract BACKGROUND: The angiotensin‑converting enzyme 2 (ACE2) receptor, a membrane receptor
present in the respiratory system, the gastrointestinal tracts, the heart, and the kidney is the entry
point for SARS‑CoV‑2 to enter human cells. Concerns were raised about the influence of using
antihypertensive drugs like angiotensin‑converting enzyme inhibitors (ACEIs) or angiotensin receptor
blockers (ARBs) in individuals with COVID‑19 due to its tight relationship with the ACE2 receptor. The
aim of this study was to investigate the impact of being on an Angiotensin Receptor Blockers (ARB)
on mortality in patients consecutively diagnosed with COVID‑19.
MATERIAL AND METHODS: This is the retrospective observational study done in all patients
consecutively diagnosed with COVID‑19 from January 2021 to June 2021. All related patient
information and clinical data was retrieved from the hospitals electronic medical record system.
RESULTS: In this study, out of 500 patients, 51 died, having mean age of 66.92 ± 10.85 years.
144 (28.8%) patients were on angiotensin receptor blockers as antihypertensive treatment,
142 (28.4%) having other antihypertensive and 214 (42.8%) were not on any treatment. Out of 51
Death 7 (4.9) patients were on ARBs, 15 ± 10.6 were on other medication [OR 2.31 (0.94–6.22,
P = 0.077) univariable; OR 2.57 (1.00–7.23, P = 0.058) multivariable] and 29 ± 13.6 had no treatment
at all [OR 3.07 (1.38–7.80, P = 0.010) univariable; OR 3.36 (1.41–9.08, P = 0.010) multivariable].
CONCLUSION: Use of ARB medications for the hypertensive patients who acquire COVID‑19
infection has shown protective effects of such medications on COVID‑19 disease severity in the
term of mortality and the mortality rate among hypertensive patients on COVID‑19 with ARBs/ACE
inhibitors showed significant differences as compared to other antihypertensives.

Abstract AIM AND BACKGROUND: Multiple sclerosis (MS) is a long‑course incurable disease as well as an
unknown prognosis causing patients to experience a variety of psychological outcomes. Meanwhile,
inability to control the disease‑related uncertainty leads to the use of maladaptive coping strategies,
causing more psychological distress. This study investigated the effectiveness of intervention focused
on the intolerance of uncertainty on psychological distress and quality of life in MS patients.
MATERIALS AND METHODS: This research adopted a true experimental design. All phases of the
study were conducted online due to the COVID‑19 pandemic during 2021 in Tehran. The statistical
population of the study was purposefully selected from among MS patients and was randomly assigned
to three groups of 20: IU intervention and two control groups (cognitive behavioral therapy (CBT)
and treatment as usual (TAU) groups). The study included pre‑test, post‑test, and follow‑up stages.
The outcome measures of the study included the Depression Anxiety Stress Scale (DASS‑21) as
well as Multiple Sclerosis Quality of Life‑54 (MSQoL‑54). Mixed analysis of variance was used to
analyze the data.
RESULTS: The results showed that IU intervention compared to CBT, is more effective on
psychological distress (depression P = 0.006, anxiety P = 0.01, and stress P = 0.01) and quality of
life (P = 0.001) in MS patients. Nonetheless, IU‑focused intervention is more effective than TAU on
psychological distress (depression P = 0.0001, anxiety P = 0.0001, stress P = 0.0001) as well as
quality of life (P = 0.0001) in these patients.
CONCLUSIONS: IU‑based intervention can reduce psychological distress and improve quality of
life of MS patients. Accepting uncertainty can reduce the anxiety and stress of MS patients which
can increase the quality of life of these patients.

Abstract BACKGROUND: Globally, one in ten pregnant women have diabetes; out of which, 90% contribute
to gestational diabetes mellitus (GDM). Medical Nutrition Therapy (MNT) is the cornerstone for GDM
treatment yet adherence to MNT among the masses is not adequately monitored as part of the routine
antenatal services. The study aimed to estimate the proportion of adherence to MNT and determine
the factors related toadherence among antenatal women with GDM. This study also explores the
facilitators, barriers, and possible suggestions for improving adherence.
MATERIALS AND METHODS: This facility‑based sequential explanatory mixed‑method study was
conducted among 341 antenatal women with GDM at, Puducherry. The study was conducted in 2021.
Dietary adherence was evaluated using Perceived Dietary Adherence Questionnaire and based on
the scores obtained they were selected for in‑depth interviews to explore the facilitators and barriers.
Collected data wereanalysed by Chi‑square test using STATA version 16.
RESULTS: Out of 341 participants, the proportion of participants adherent to MNT was 135 (39.6%)
with 95% CI of 34%–44%.Thepredictors for poor adherence were unemployment (PR: 0.65; 95%CI:
0.48–0.88) and good adherence was antenatal women in the 2nd trimester (PR: 1.541; 95%CI:
1.18–2.025).Barrierstonon‑adherence were financial crisis, lack of awareness ofthe need for MNT,
and joint family pressure.
CONCLUSIONS: About two‑thirds of antenatal women with GDM are non-adherent to MNT.
Unemployment and period of gestation were found to be theirdeterminants. Appropriate action has
to be implemented for improving the adherence rate.

Abstract BACKGROUND: One of the most important goals of sexual intercourse is to arouse the psychological
effects of intercourse and to increase sexual self‑concept, which changes following sexual behaviors
such as the use of contraception methods. This study was performed to investigate the relationship
between sexual self‑concept and contraception sexual behavior in 15–49‑year‑old women covered
by community health centers.
MATERIALS AND METHODS: The present descriptive correlational study was performed on 297
married women referring to Isfahan community health centers in 2020 who were selected as cluster
that randomly classified. The tools included demographic information and the Snell’s Multidimensional
Sexual Self‑Concept Questionnaire, the data of which were analyzed via SPSS version 22 software
by Mann–Whitney U test and Pearson correlation.
RESULTS: Among a total of 297 women, 5.4% of the samples used hormonal methods and 94.6%
used non‑hormonal methods, which was the most common intermittent method. The results also
showed that the mean score of negative sexual self‑concept in women using the hormonal level
method was significantly higher (P = 0.012). Positive and positive sexual self‑concept score was
significantly higher in women using non‑hormonal methods (P = 0.048 and P = 0.002). Therefore,
there was a significant relationship between sexual self‑concept and contraception method.
CONCLUSION: Due to the relationship between contraception and sexual self‑concept, it is
recommended to pay attention to the aspects of sexual self‑concept and contraception during
reproductive health counselling sessions so that if there is a disorder, useful advice can be provided
or referred, if necessary.

Abstract BACKGROUND: Metamemory can be described as an intentional endeavor to guide or control
one’s memory processes. In other words, awareness and knowledge of one’s own memory process
and strategies for using the memories effectively. Planning, allocating cognitive resources, selecting
strategies, assessing understanding, and evaluating performance all rely heavily on metamemorial
information. For efficient learning, good memory abilities are necessary. This study aimed to
understand metamemory functioning and to see if there were any gender differences in metamemory
functioning among medical students.
MATERIALS AND METHODS: This cross‑sectional study was conducted by collecting data from
350 medical students using the Memory Functioning Questionnaire in 2021. The sample group was
selected from medical colleges in South India such as Kerala, Karnataka, Tamil Nadu, Telangana,
and Andhra Pradesh using a purposive sampling technique. This questionnaire focused on the
seriousness of forgetting, the rate at which people recalled things over time, and frequency of use
of mnemonics and techniques that assist memory. Descriptive statistics, independent sample t‑test,
correlation, and regression were used for analysis.
RESULTS: There was a significant difference based on gender among medical students in general
memory functioning and frequency of forgetting (P < 0.001). Similarly, it was also found that gender
was a major predictor of general memory functioning and frequency of forgetting among medical
students (P < 0.001).
CONCLUSION: Most medical students believe they have a minor memory issue. Even if the majority
of medical students forget information, the vast majority of them believe they have an exceptional
memory. Gender acts as a significant predictor of general memory performance and forgetfulness.

Abstract BACKGROUND: Cardiovascular diseases are the most common causes of death in the world.
Because of the rate of emergencies and disasters in the country, this study was conducted to
investigate the challenges of providing health services to cardiovascular patients in emergencies
and disasters in Iran.
MATERIALS AND METHODS: This conventional content analysis study was conducted in 2020.
Subjects were selected from among 16 Iranian experts) epidemiologists, cardiologists, PhD in Disaster
Health, and PhD in Nursing (using purposeful and snowball sampling methods. Data were collected
using semi‑structured interviews and were analyzed by the content analysis.
RESULTS: The results were obtained after analyzing the data in the pre‑emergency phase (lack
of training on medication and nutrition, lack of training vulnerable groups, lack of databases of
cardiovascular patients, and lack of identification of patients before disasters), the emergency
response phase (lack of sleep and rest patterns, lack of health forces, lack of blood pressure control,
lack of proper nutrition, increased medication needs, and lack of mental health interventions), and
the post‑emergency phase (lack of planning, lack of management of patients’ mental problems).
CONCLUSION: Developing strategies for planning, training, providing resources, and mental
health during the three phases of the emergency management cycle for specific groups such as
cardiovascular patients together with empowering these patients in the event of disasters is one of
the key strategies which can be used after curbed emergencies and disasters to reduce the rate of
mortality.

Abstract BACKGROUND: The teacher must conduct educational responsibilities in the best way by observing
the ethical principles to meet students’ educational needs. The aim of the study was to investigate the
main factors of professionalism among faculty members from the viewpoints of various stakeholders
including learners, peers, and educational officials, as well as the components were assessed from
the viewpoints of the stakeholders.
MATERIALS AND METHODS: This was a descriptive analytical study conducted in two phases. In
the first phase, a questionnaire was developed and validated to assess the professional behavior
of faculty members. In the second phase, the evaluation of the teachers’ professional behavior was
done from the viewpoint of various stakeholders, including learners, middle and senior education
managers and peers. The participants were faculty members from 10 schools enrolled in the study
by census (n = 427). To extract the factors that constitute professional behavior in faculty members,
exploratory factor analysis was used. Data were summarized using descriptive indices (mean,
standard deviation, and percent). Exploratory factor analysis (EFA) was used to extract the factors
that constitute professional behavior in faculty members. Data was analyzed by using SPSS
software (version 23.0).
RESULTS: In the first phase, the questionnaire with 11 items was developed. The validity and reliability
of the tool was confirmed. The mean (SD) of the faculty members’ scores was 4.54(±0.34), with a
minimum score of 2.33 and a maximum score of 5.00. The highest scores of faculty members were
reported in the items of “altruism to colleagues and students” and the lowest scores were related
to “feedback seeking and feedback acceptance”. Professional behavior was categorized under two
domains: accountability to professional duties and adherence to professional values. Fifty percent
of the participants followed the adherence to professional values (P = 0.22), but less than 50% of
the individuals followed the adherence to professional duties significantly (P = 0.002).
CONCLUSION: The results of the present study showed that adherence to professional duties was low
in faculty members. Assessment of individuals’ adherence in these two domains showed that faculty
members’ compliance in the domain of accountability to professional duties was significantly lower.

Abstract During the COVID‑19 pandemic, people are using social media more than usual routine because they
rely on online sources to seek health information for themselves and their loved ones. The spread of
inaccurate and misleading information via social media has a number of detrimental psychological
effects on members of society. The aim of this systematic review was to describe the impact of social
media on the mental health of the general population. An extensive systematic search was done till the
last month of 2021 for collecting the evidence using the PRISMA technique. The search was mainly
focused on the article leading with keywords and search engines used during the course of the study
were Pubmed, Semantic Scholar, Mendeley, and Science direct. Articles for this study were selected
based on the predetermined eligibility criteria and performed quality assessment by using the NHLBI
quality assessment tool. Most of the studies included in this review are found fair (score between
9 and 12) quality. Out of 866 publications, 533 articles were included in the initial screening, after
duplication removal 46 full‑text articles were assessed for eligibility and 14 studies were selected for
systematic review. In most of the studies, maximum participants used social media as a primary source
of information. Relatively high rates of symptoms of depression (14.14% to 48.3%), anxiety (7.4% to
47.82%), and prevalence of stress increased to 37.67% are reported after exposure to social media
for coverage of COVID‑19 news in the general population. Risk factors of psychological distress are
associated with female gender, younger age group, marital status, staying alone, and duration of
exposure to mass media. Increased exposure to COVID‑19 information through mass/social media
is associated with highly significant levels of psychological health issues; mitigating the hazardous
effect of social media exposure during the COVID‑19 pandemic on the psychological health of the
general population is an international public health priority.

Abstract BACKGROUND: Educational managers at universities of medical sciences are the suppliers of
human resources to the healthcare system. Thus, attention to their professional empowerment can
play a prominent role in improving the quality of medical science education.
MATERIALS AND METHODS: The present study was implemented through the method of modeling
and in the three stages of conceptual, modeling, and validation. The research environment was the
medical science universities of Iran and the sampling method was purposive. The two qualitative
approaches of literature review and semi‑structured interview were used to develop the components
of the model. The results were then integrated, the relationships between the components were
investigated, and the model was eventually finalized. The resulting scores were analyzed using
MicMac software.
RESULTS: Twelve categories and 20 subcategories were identified in the first micro‑study (desk
research). Qualitative analysis of the interviews in the second stage led to the identification of 21
subcategories and seven categories. Components of the conceptual model were extracted from
the results of the two first stages, both of which were aimed at the extraction of concepts relevant
to dynamic empowerment of medical science educational managers, and the conceptual model for
dynamic empowerment of medical science education managers was designed in the six categories
of education, decision‑making, organization, belief, dynamic capabilities, and environment after the
interactions between the components were studied.
CONCLUSIONS: Results of the present study revealed that dynamic empowerment of the managers
is a multifaceted and multidimensional concept, and all of the factors incorporated in the conceptual
model for dynamic empowerment of managers must receive special attention.

Abstract BACKGROUND: Human survival requires the ability to communicate. Today’s students’ use of
social media has opened up a slew of new possibilities; nevertheless, it is hard to say how many
more may emerge in the future. As the years have gone by, the use of social networking sites has
grown in popularity among teenagers. This research investigates both the ways in which social
media draws in users and the ways in which it hooks users by revealing the gimmicky worlds that
they inhabit. Depending more on social media than on oneself causes a tremendous problem. It is
quite challenging to separate human beings from their many electronic devices in today’s world. The
use of devices gradually began to take over the world.
MATERIALS AND METHODS: Qualitative research approaches were used in this research. The
qualitative study’s findings were gathered from a variety of secondary sources, including media
articles, academic journal articles, and past theses. Throughout the course of this study, a discourse
analysis method was employed, and several case studies were gathered from news articles and
journals.
RESULTS: According to the results of the research, addiction to the Internet has been defined as
a decrease in an individual’s ability to exercise self‑control within the context of the social‑cognitive
framework. The research is based on true events that occurred in and around India. This research
article focuses on the various positive and negative effects that social media may have on education
and students. It is critical to figure out how to tackle this issue.
CONCLUSION: One effective strategy is to restrict their access to social media. The bulk of the
disadvantages may be mitigated by reducing the amount of time spent on social media sites. Keeping
track of their academic progress and dealing with any problems early on can help them avoid the
negative effects of social media on their education.

Abstract BACKGROUND: This study sought to understand whether the theoretical components of the
curriculum prepared students for clinical practice training in the Bachelor of Health Sciences (BHSc)
in Clinical Technology program at the Durban University of Technology.
MATERIALS AND METHODS: Two samples were recruited, namely, academics and students
using non‑probability sampling methods. The first sample comprised 13 students, and the second
sample included four academics, involved in teaching and supervising the placement of students at
healthcare institutions. At least one student from each of the 13 units where clinical practice training
was undertaken was invited to participate. Data was gathered using in‑depth, semi‑structured
interviews on an adapted version of Gibbs’ cycle of reflection.
RESULTS: Three broad themes emerged, namely, curriculum structure, factors that enabled graduate
attribute development in the clinical environment, and the transition to online teaching.
CONCLUSION: While it appears that the curriculum had in many ways prepared students for clinical
practice, the study highlights key issues that may guide curriculum developers when seeking to
improve preparedness of students for clinical practice. Furthermore, it underscores the need for
continuous review of current curricula so that these are responsive to student and societal needs.

Abstract BACKGROUND: Cardiovascular disease (CVD) is the number one cause of death in India.
Atherosclerosis begins in the second decade of life; thus, preventive efforts beginning in adolescence
are crucial. Yet, there are no national or regional school‑based educational programs in India for
the prevention of CVD. We aimed to assess the impact of a simple educational intervention on the
awareness regarding CVD among school‑going adolescents in a rural area of Bengaluru.
MATERIALS AND METHODS: This study was conducted using a convenience sample of school‑going
adolescents of classes 8, 9, and 10 in three schools in a rural area of Anekal subdistrict, Bengaluru,
with a sample size of 170. A standardized, validated questionnaire testing CVD awareness was
administered, followed by a simple lecture with audio‑visual aids on key aspects of CVD. Three weeks
later, the same questionnaire was administered to the same students. The results were then analyzed
using appropriate descriptive (mean, percentage) and inferential analyses (Chi‑square, paired t‑test).
RESULTS: The mean (SD) age was 14.5 (1.0) years, and 54% (n = 100) were boys. 75% (139)
belonged to privately funded schools. 23% (43) belonged to class 8, 37% (69) to class 9, and 40% (74)
to class 10. The mean (SD) total score on baseline assessment was 27.4 (9.3) out of 100, with girls
and students of private schools scoring higher. The mean (SD) post‑test total score was 48.5 (15.7),
with significant increases in all domains of awareness, and in all categories of students.
DISCUSSION: Awareness regarding CVD among adolescents from rural Bengaluru was poor,
highlighting the need for educational interventions to aid preventive efforts. A simple educational
intervention resulted in significant improvements in CVD awareness, even after 3 weeks.

Abstract BACKGROUND: Skill Training Intervention Based on the Healthy Lifestyle Counselling Module (5As
model) in the Ira PEN Program.
MATERIALS AND METHODS: This study was a randomized controlled trial in Iran. Participants
were 184 health workers and 184 clients (92 in each study group). The training program entailed
an online training course, educational video, and clip. The behavior related to a healthy lifestyle in
clients was also followed‑up 2 months later. Data were analyzed using SPSS 22 software.
RESULTS: Based on the observations, significant improvement in lifestyle counseling skills
among health workers in the intervention group compared to the control group in terms of healthy
nutrition (P < 0.001), physical activity (P < 0.001), smoking cessation (P = 0.03), and withdrawal of
alcohol consumption (P < 0.001) was observed. Also, lifestyle‑related behaviors among clients in
terms of healthy nutrition (P < 0.001), physical activity (P < 0.001), and withdrawal smoking (P < 0.001)
increased significantly. Furthermore, waist circumference (P < 0.024) and BMI (P < 0.001) among
clients were significantly reduced.
CONCLUSION: The training program for health personnel in healthy lifestyle has a more effective
role in changing people’s behavior and prevention of noncommunicable risk factors. Healthy life
style counselling in primary health cares may lead to control risk factors for Noncommunicable
disease.

Abstract BACKGROUND: Annual influenza vaccine is recommended among health professionals especially,
health science undergraduates; although, studies suggest that there is a low level of vaccine coverage
among health care undergraduates. Thus, the study aimed to investigate students’ knowledge,
attitudes, and practices regarding the seasonal influenza vaccine at King Saud bin Abdulaziz University
for Health Sciences (KSAU‑HS) in Jeddah, Saudi Arabia.
METHODS: A cross‑sectional, unicentral study was carried out during the period of April to November
2021. A total of 341 validated questionnaires that included four sections were distributed in all four
different colleges of KSAU‑HS. Data management and analyses were carried out using Statistical
Software for Social Sciences (SPSS) version 25.
RESULTS: Out of 341 respondents, 336 participants completed the full survey (98.53% completion
rate). The majority of participants were males (67.6% and the most participants were from the college
of medicine (60.4%). The mean knowledge score of students was found to be (11.3 ± 2.0) out of 14
points. The most common barrier to vaccination among healthcare students was not having enough
time to take the vaccine (23.8%), while the second one was the COVID‑19 pandemic (22.32%). The
vaccination rate in 2020 was 103 (30.7%), while 235 (80.4%) students stated that they have received
the vaccine previously. School/work requirements and the student’s awareness of the vaccine’s
importance were the most common reasons for taking the influenza vaccine.
CONCLUSION: Even though students showed a high level of knowledge and a positive attitude
towards the influenza vaccine, they generally had a low level of vaccine uptake. To enhance
immunization rates, we encourage vaccine campaigns in all healthcare colleges. Further studies are
needed to identify influences on students’ attitudes and practices regarding influenza vaccination.

Abstract BACKGROUND: Accurately predicting the intubation risk in COVID‑19 patients at the admission
time is critical to optimal use of limited hospital resources, providing customized and evidence‑based
treatments, and improving the quality of delivered medical care services. This study aimed to design
a statistical algorithm to select the best features influencing intubation prediction in coronavirus
disease 2019 (COVID‑19) hospitalized patients. Then, using selected features, multiple artificial
neural network (ANN) configurations were developed to predict intubation risk.
MATERIAL AND METHODS: In this retrospective single‑center study, a dataset containing 482
COVID‑19 patients who were hospitalized between February 9, 2020 and July 20, 2021 was used. First,
the Phi correlation coefficient method was performed for selecting the most important features affecting
COVID‑19 patients’ intubation. Then, the different configurations of ANN were developed. Finally,
the performance of ANN configurations was assessed using several evaluation metrics, and the best
structure was determined for predicting intubation requirements among hospitalized COVID‑19 patients.
RESULTS: The ANN models were developed based on 18 validated features. The results indicated
that the best performance belongs to the 18‑20‑1 ANN configuration with positive predictive value
(PPV) = 0.907, negative predictive value (NPV) = 0.941, sensitivity = 0.898, specificity = 0.951, and
area under curve (AUC) = 0.906.
CONCLUSIONS: The results demonstrate the effectiveness of the ANN models for timely and reliable
prediction of intubation risk in COVID‑19 hospitalized patients. Our models can inform clinicians and
those involved in policymaking and decision making for prioritizing restricted mechanical ventilation
and other related resources for critically COVID‑19 patients.

Abstract BACKGROUND: COVID‑19 (Coronavirus disease‑19) is an ongoing pandemic. COVID vaccine
administration in adults has provided some degree of protection from infection but children are still
susceptible So, we have to be prepared to handle COVID‑19 infection in children by training our
healthcare workers by updating both their knowledge and skills. We developed a training module to
train our healthcare workers in all domains of learning and also planned related assessment methods
to know the effectiveness of the module.
MATERIALS AND METHODS: This was a quasi‑experimental study with pre‑ and post‑intervention
conducted at a tertiary‑level teaching medical college in southern India from July to September 2021.
The training module was developed as per the “ADDIE” model of the development process module.
It was further validated by five experts before implementation. In addition to the quasi‑experimental
method of evaluation like pre‑ and post‑test, Observed Skill clinical examination (OSCE) had been
also used as an assessment tool at the completion of training. A total of 92 participants have been
trained as per this module in our tertiary‑level care hospital. The association between continuous
and categorical variables was assessed using an independent t‑test and ANOVA, and paired t‑test
was used for comparing the difference between pre‑ and post‑test scores.
RESULTS: Pre‑test scores had no association with years of experience (P = 0.803) and previous
training status of participants (P = 0.350). The mean difference of pre‑ and post‑test scores was 3.8
and it was statistically significant (P value < 0.001) A weak positive correlation between pre‑ and
post‑test was present by the Spearmen correlation test (r = 0.337). The correlation between post‑test
score and OSCE score does not have a significant correlation.
CONCLUSION: Structured training module was effective in training the participants. Multimode
assessment method (Pre‑test, Post‑test, and OSCE) is an important step to evaluate any training
program as compared to only the pre‑ and post‑test methods of evaluation.

Abstract BACKGROUND: Breast cancer is the most prevalent cancer and a major cause of mortality among
women. Breast self‑examination (BSE) is a key technique for early diagnosis of breast cancer,
which, along with lifestyle changes, can alleviate the risk of mortality. This study aimed to examine
the effect of self‑care training programs on lifestyle change and BSE of immigrant Afghan women
residing in Iran.
MATERIALS AND METHODS: In this quasi‑experimental study, 140 immigrant Afghan women visiting
health‑care centers in Shiraz (Iran) were selected via convenience sampling during 2019–2020. The
data were collected using a lifestyle questionnaire, a demographic information checklist, and a BSE
checklist. Following the pretest, the experimental group received three sessions of self‑care training
and took the posttest 2 months after the intervention. The control group did not receive any intervention,
but took the same posttest 2 months after the pretest. Data analysis was performed using paired and
independent t‑test and Chi‑squared test in Statistical Package for the Social Sciences (SPSS) 22.
RESULTS: The post‑intervention level of knowledge and performance of the experimental group
significantly increased in terms of a healthy lifestyle (P < 0.001) and performance of BSE (P < 0.001)
compared to the control group. The intervention also had a significant positive effect (P < 0.000) on
all dimensions of lifestyle.
CONCLUSION: Self‑care training for lifestyle and BSE can promote the prevention and early diagnosis
of breast cancer in immigrant Afghan women who have limited access to health care.

Abstract BACKGROUND: This exploratory study was done to assess the multidimensional perfectionism
trends among various core and allied health care professionals in a major Indian metropolitan city of
western India. Unlike other scales, here we considered both individual and intersubjective components
of perfectionism by introducing three trait dimensions – self‑oriented perfectionism, other‑oriented
perfectionism, and socially prescribed perfectionism.
MATERIALS AND METHODS: A cross‑sectional descriptive type of study was conducted with total
sample consisting of 500 participants with the main motive of evaluation and comparison of the
multidimensional perfectionism among interns of the core and allied health care professionals from
fields of medicine, dentistry, ayurveda, and homeopathy residing in the major Indian metropolitan
cities of western India.
RESULTS: This study showed that under the self‑oriented domain, highest mean score is of medical
faculty (73.97). In other‑oriented domain, dental (62.62) and homeopathy (62.38) professionals have
almost similar mean. Lowest being of ayurveda (61.65) compared to the highest score of the medical
fraternity (67.62). In the socially prescribed domain, medical professionals (65.53) have the highest
mean though it is the lowest mean value of the medical faculty compared to other two domains.
Chi‑square test is applied to the data for the questions among all the three domains. Correlation has
been deduced by applying Pearson’s correlation to the collected data from the study. The degree of
correlation between self‑oriented with self‑oriented is 1, self‑oriented with other‑oriented is 0.763,
and that of self‑oriented with socially oriented is 0.678.
CONCLUSION: Medical professionals scoring maximum in self‑oriented perfectionism compared to
other two domains reflect their extreme personal standards. Medical professionals are followed by
dental professionals in self oriented perfectionism who are demanded of perfection in their routine
practice. Ayurveda and homeopathy professionals scored better in other‑oriented and socially
prescribed perfectionism attributing to their sentiments of fulfilling the expectations and demands
of others.

Abstract BACKGROUND: Prevention of smoking is very important at a young age and during the student
period. Because of the lack of a questionnaire based on the prevention of smoking behavior,
this study was conducted to design and standardize a tool according to the protection motivation
theory (PMT).
MATERIALS AND METHODS: This was an analytical cross‑sectional study where information
and opinions of experts and then designing tools and assessing the face validity in the first phase
and content validity, construct validity, test–retest reliability, and internal consistency of questions
in the second phase were examined. The initial themes and structures were determined based on
the literature Review and the opinion of experts. Three hundred students of Yazd Universities were
selected by cluster sampling and included in the study. All analyses were performed in SPSS and
AMOS software version 24 with a significance level of less than 5%.
RESULTS: The final version of the scale had 39 questions in eight dimensions. The overall Cronbach’s
alpha value was 0.89, and for each dimension, it was more than 0.7. The content validity ratio and
content validity index for the whole tool were 0.87 and 0.94, respectively. The results of confirmatory
factor analysis showed that the latent construct model had good fit (X2/df = 4.31; RMSEA = 0.07;
CFI = 0.94; NFI = 0.92; TLI = 0.91, P < 0.001).
CONCLUSION: In this study, a valid and reliable tool based on PMT to predict smoking behavior
in students was introduced. This tool can be used in interventional and etiological studies. It also
has questions related to the coronavirus disease 2019 (Covid 19) virus and can be used in the
coronavirus pandemic.

Abstract BACKGROUND: Nutrition is essential for schoolchildren to reach their full potential psychologically
and cognitively. Malnutrition, which is prevalent among aboriginal schoolchildren in Malaysia,
can interfere their learning and academic performance. Developing a module to be used during a
school‑based nutritional intervention program is essential to ensuring that students develop healthy
eating habits and lifestyles. Thus, this study aims to develop and validate nutrition education module
focusing on aboriginal schoolchildren for the eat right future bright (ERFB) nutrition education program.
MATERIALS AND METHODS: This cross‑sectional study was conducted in three steps: Step 1:
development of module based on literature reviews, Step 2: content and face validation of the module
by the expert panels, and Step 3: face validation of the module by target users. This study has used
the validation form proposed by de Castro. This form consists of seven aspects, two aspects related
to content validity and another four aspects related to face validity. A content validity index (CVI) was
used to analyze the content validity. Two formulas were used to calculate CVI, which were I‑CVI and
S‑CVI. Meanwhile, the data for module’s face used the level of agreement.
RESULTS: Both I‑CVI and S‑CVI obtained more than 0.78 and 0.80, respectively, which indicate
that the module has good content validity. Moreover, for face validity, the total of agreement from
expert panels and target users was more than 75%, which is considered face validated.
CONCLUSIONS: In conclusion, the module that has been developed has good content validity and can
be used by teachers in teaching appropriate nutrition knowledge to aboriginal primary schoolchildren.

Abstract BACKGROUND: Non‑technical skills as a complement to technical skills have become increasingly
important in cardio‑pulmonary resuscitation, and teamwork is one of the most prominent of these
skills. Because of the limited number of tools introduced and validated for measuring teamwork in
resuscitation, this study was conducted to develop and evaluate the psychometric properties of the
Teamwork Scale in Resuscitation (TSR).
MATERIALS AND METHODS: This study was a sequential exploratory mixed‑method study and was
conducted between March 2020 and April 2021 and in two phases. In the first phase (qualitative),
semi‑structured interviews were performed with resuscitation team members who were selected using
a purposeful sampling method with maximum variation in terms of experience, level of education,
age, and gender. Using directed qualitative content analysis, the data were analyzed and the primary
item pool was developed. In the second phase (quantitative), assessing face, content, and construct
validity as well as reliability via the internal consistency and stability, the psychometric properties of
the instrument are evaluated.
RESULTS: The initial tool consisted of 54 items; after assessing the face validity, ten items were
removed during content validity, and the final tool consisted of 44 items and three main categories
including the essential prerequisites for resuscitation, leadership, and teamwork, which was scored
based on a 5‑point Likert scale from strongly disagree to strongly agree. The convergent validity and
concurrent validity of the tool were confirmed. The reliability of the instrument was also confirmed
using Cronbach’s alpha test and re‑test and the intra‑class correlation coefficient (ICC) between raters.
CONCLUSION: The validity and reliability of TSR for measuring teamwork in resuscitation in
a simulated environment are approved. Further studies are suggested for different contexts of
resuscitation and with trained raters to evaluate its use in real resuscitation situations.

Abstract Appropriate oral health education (OHE) plays a vital role in prevention of oral diseases and would bridge
the gap between dentists and visually impaired individuals. Hence, this systematic review was planned
with an aim to evaluate effectiveness of various OHE techniques on the oral hygiene status and oral
health knowledge of visually impaired young individuals. An electronic search extended to September
30, 2020 was conducted on PubMed, Wiley, ProQuest, ScienceDirect, Cochrane library, EBSCO, and
Google Scholar. Two independent reviewers assessed the studies using a two‑stage process; data were
extracted according to PRISMA statement. Risk of bias assessment of selected studies was executed
according to the study designs. Meta‑analysis using the random‑effects model was conducted for the
outcomes for all oral health education techniques using STATASE 16.1 software. Hand and electronic
search identified 3829 articles. After screening for titles and duplicates, 37 articles were retrieved, which
were screened through abstract and full text. Of the 37 articles, 17 articles were included for qualitative
synthesis, and out of that, 13 were for meta‑analysis. Ten variations in oral health education (OHE)
techniques were used in the included 17 studies to impart oral health education to visually impaired
young individuals. Overall, all OHE techniques demonstrated a positive impact on oral hygiene status.
The pooled overall cumulative mean difference of the oral hygiene status after imparting education in
ATP, Audio, and Braille was 1.33 [1.06, 1.59], 1.76 [1.11, 2.42], and 1.96 [1.40, 2.55], respectively.
An appropriate OHE technique boosts confidence in visually impaired young individuals, making the
learning process an enjoyable experience. Use of either Braille or the ATP OHE technique was found
to be a reliable and useful method to improve oral hygiene of visually impaired young individuals.

Abstract BACKGROUND: Advanced stages of dementia interfere with elderly self‑care. Consequently, they
need caregivers who take responsibility for their care in the long‑term. Restrictions to the caregiver’s
access to information, resources, and organizational support have created problems in their caregiver
role, which is why the World Health Organization (WHO) emphasizes caring for caregivers by providing
evidence‑based information and training programs. As there is no clinical practice guideline for home
care in the Islamic Republic of Iran, this study aims to develop a home health care guideline for the
elderly with dementia.
MATERIALS AND METHODS: The ADAPTE process provided by the Guidelines International
Network was considered as the basis. In order to identify the care needs of Iranian patients with
dementia, semi‑structured interviews were added to this guideline.
DISCUSSION: The identification and implementation of the perspectives of patients and caregivers
during the process of guidelines adaptation increase the applicability of the guidelines. Improved
quality of life for the patients in their place of residence is one of the expected consequences of this
guideline’s implementation. The developed guidelines will be used at home health care centers, and
dementia and Alzheimer’s associations in Iran.

Abstract BACKGROUND: The relationship between personality traits and learning styles is an attractive
subject for researchers. “Learning Style” indicates on a method of education for effective studying. The
Kolb’s Learning Style is a known theory in the field of learning style. The Kolb’s four learning styles
include: Divergent, convergent, assimilating, and accommodating. Furthermore, personality, known
as relatively fixed and durable characteristics that distinguish people from each other, and personality
contains five broad identified traits of extraversion, agreeableness, openness, conscientiousness,
and neuroticism. In this study, we intended to evaluate the relationship between personality traits
and learning styles in medical education students.
MATERIALS AND METHODS: This research was an observational analytic cross‑sectional study
that was conducted on medical education students at Iran University of Medical Sciences, between
2018 and 2019, and 31 students were participated as volunteers. NEO Five‑Factor Inventory and
the Kolb’s learning style inventory (version 3.1) were used to evaluate the students’ personality traits
and learning styles, respectively. The simple and multiple analysis of multinomial logistic regression
were used for statistical analysis.
RESULTS: The results indicated that if one unit would be added to the score of the “Extraversion”
personality trait, the estimated odds, by which the student’s learning style would become
“Accommodating” rather than “Assimilating,” is 1.3 times more than the basic condition, in which
“Extraversion” score would be remained unchanged (P = 0.035).
CONCLUSION: It seems that “Accommodating” learning style might be related to “Extraversion”
personality trait in medical education students. However, researches with a larger population are
suggested.

Abstract BACKGROUND: Physical changes in high‑risk pregnancy (HRP) can lead to changes in mood and
social relationships and negative effects on women’s well‑being. Individuals in different sociocultural
contexts have different perceptions of well‑being. Yet, there is limited information about perceptions of
well‑being in HRP. This study aimed to explore the Iranian women’s experiences of well‑being in HRP.
MATERIALS AND METHODS: This qualitative study was conducted in 2019–2020 through directed
content analysis based on the conceptual framework of well‑being in HRP. Participants were 26
women with HRP purposively recruited from public and private healthcare settings in Mashhad, Iran.
Face‑to‑face semistructured interviews were held for data collection until data saturation. Data were
analyzed through directed content analysis proposed by Elo and kyngäs (2008) and were managed
using the MAXQDA (v. 10) program.
RESULTS: Well‑being in HRP had seven attributes in the five main dimensions of physical,
mental‑emotional, social, marital, and spiritual well‑being. The seven attributes of well‑being in HRP
were controlled physical conditions, controlled mood, emotions, and affections, perceived threat,
self‑efficacy, and competence for multiple role performance, maintained social relationships, meaning
seeking and relationship with the Creator, and positive marital relationships.
CONCLUSION: The present study provide an in‑depth understanding about well‑being in the Iranian
women with HRP. It is a complex and multidimensional concept with physical, mental‑emotional,
social, marital, and spiritual dimensions. Comprehensive multicomponent interventions are needed to
promote well‑being among women with HRP and designed the guidelines to provide woman‑centered
care.

Abstract BACKGROUND: It’s already known for certain that SARS‑CoV‑2 can affect any vital human
organ, and super‑complex cases are even characterized by multiple organ pathology. In particular,
complications of COVID‑19 for the kidneys can be irreversible. Consequently, this virus forces us
to review the approaches and standards of diagnosis and treatment in most nosologies to minimize
the risks as much as possible. Thus, a low level of prediction of the course of coronavirus infection
requires a comprehensive approach considering the psychological characteristics of the individual
suffering from this disease.
MATERIALS AND METHODS: The method of chronometric testing is used to predict the predisposition
to the course of SARS‑CoV‑2 with nephrotic complications (using an electronic chronoscope) and
calculate the duration of an individual’s biological life cycle to predict the severity of the course of
coronavirus infection. Experimental study of the localization of symptoms of chronic nephrological
diseases in typological groups of patients with SARS‑CoV‑2 using the method of psychodiagnostics.
The duration of the study is six months 2020–2021. The study was conducted under the guidance
of a nephrologist at the Odrex Clinic I.I.
RESULTS: The results of an experimental study show that the psychological type determines the
predisposition to the course of SARS‑CoV‑2 with nephrotic complications; in most of these patients,
severe (834 patients) forms of the course coincided with the end of quarters of the long biological
cycle of an individual’s life.
CONCLUSION: The chronopsychotype makes it possible to predict the predisposition of individuals
to the course of SARS‑CoV‑2 with nephrological complications and the severity of the disease.

Abstract BACKGROUND: Sexually transmitted diseases are a major health problem in all countries. Human
papillomavirus (HPV) infection is the most common viral sexually transmitted disease in both genders.
High‑risk sexual behaviors (HRSBs) are among the major risk factors for HPV infection. Lack of
knowledge can contribute to HRSBs and hence, education can potentially reduce HRSB risk. This
is a study using theory of reasoned action to reduce the high‑risk sexual behaviors among patients
with HPV.
MATERIALS AND METHODS: This study was a two‑grouped, randomized, controlled trial. The
educational program was developed based on the results of a survey into the most important
components of the theory of reasoned action contributing to HRSBs among 100 patients recruited
from Razi hospital, Tehran, Iran. Then, 110 patients from the same hospital were consecutively
recruited and randomly allocated to a control (n = 55) and an intervention (n = 55) group. Then,
each participant in the intervention group was provided with the developed educational program.
Their counterparts in the control group solely received routine care services. Three months after
the first educational session, HRSBs were reassessed in both groups. Data were analyzed via the
SPSS software (v. 21.0).
RESULTS: After the intervention, the mean score of HRSBs significantly decreased in the intervention
group (P < 0.001) but did not significantly change in the control group (P = 0.70). The post‑test mean
score of HRSBs in the intervention group was significantly less than the control group (P = 0.015).
CONCLUSION: Education based on the theory of reasoned action is effective in significantly reducing
HRSBs. Nurses can develop and use educational interventions based on this theory to reduce
HRSBs and HPV infection.

Abstract BACKGROUND: The lack of fundamental knowledge and awareness about the biological process of
reproduction is low worldwide but has reportedly higher incidence rates in under‑developed countries.
Infertility can have a tremendous effect on a woman’s psychological and social well‑being, pushing
her toward mental stress, anxiety, depression self‑blame, self‑isolation, feeling of worthlessness,
and lack of interest in life. The present study was conducted to determine the level of knowledge and
awareness regarding factors affecting fertility and also to ascertain the emotional status of females
visiting the Obstetrics and Gynecology out‑patient department for fertility assistance.
MATERIALS AND METHODS: A cross‑sectional study was performed by using a questionnaire
which had two parts; the first part had questions about awareness and knowledge of the subject
of infertility, and the second part had 12 questions that assessed the psychological and emotional
status of the participants, and it also explored prevailing myths about infertility based on a validated
questionnaire.
RESULTS: There was a significant difference in mean knowledge score; those who were more
educated had better knowledge of various aspects of infertility. The overall adequacy for knowledge
and awareness revealed that only 62 (47.7%) of the participants had adequate knowledge (score >6)
regarding female infertility. The mean score for knowledge among all the respondents was 6.61 ± 1.48.
The overall emotional and psychological score suggested that 30 (23%) of the respondents were
disturbed because of stress because of infertility.
CONCLUSION: Infertility can have a serious impact on the psychological well‑being of females,
and social pressure and stigma associated with childlessness can further worsen the physical and
emotional well‑being of couples, which needs to be addressed before starting treatment of infertility
for a better response to treatment. The limited knowledge and prevailing mis‑conceptions regarding
infertility need to be sincerely dealt with to complement the medical treatment of infertility.

Abstract BACKGROUND: Potentially inappropriate medication (PIM) prevalence in older adults is increasing
day by day due to lack of knowledge among medical students and professionals.
OBJECTIVE: To determine the knowledge of medical students toward American Geriatric
Society (AGS) Beers criteria for PIM prescribing.
MATERIALS AND METHODS: This cross‑sectional study employed a self‑administered questionnaire
which was validated and designed to assess the knowledge, attitude, and practice of medical interns
and postgraduate residents on Beers criteria for PIMs in older adults. The study was conducted
in Faridkot region of Punjab in 2019. This study will utilize a purposive sampling strategy and a
convenience sampling of up to 183 participants. Mann–Whitney U or Kruskal–Wallis tests were used
to compare different issues as appropriate. P values of <0.05 were considered significant.
RESULTS: Out of 183 questionnaires distributed, only 155 participants (response rate 84.6%) had
filled the survey and were included in the study. 61.3% (n = 95) of the respondents were males. The
mean knowledge score of 155 participants was (5.16 ± 1.56), where the highest score was 9 and the
lowest score was 2 out of 10. 15.5% (n = 24) of the participant strongly agreed that Beers criteria use
is necessary in clinical setting and would be very helpful. While 22.5% (n = 35) of the participants
strongly agreed that PIMs cause adverse drug event (ADE) and drug‑related problems (DRPs) in
older adults. Age of the participant had a significant effect on the knowledge score (p = 0.009), and
participant aged between 31 and 40 years had significantly higher knowledge scores compared with
participants falls under 20–30 years.
CONCLUSION: Medical students and postgraduate residents had average knowledge of PIMs and
are unaware of the standard guidelines in older adults such as the Beers criteria. Lack of formal
education or training about Beers guidelines was the main reason responsible for average knowledge
among participants.

Abstract BACKGROUND: Patients with heart failure experience severe and chronic physical and psychological
manifestations while the disease progresses. Assessing the degree of distress caused by
manifestations of the disease in patients is the first step in designing and evaluating intervention
programs to improve patients’ symptoms. The aim of this study was to investigate the psychometric
properties of the Persian version of the Symptom Distress Scale in HF patients.
MATERIALS AND METHODS: This study was conducted via methodological research design from
March to November 2019. The translation process and cross‑cultural adaptation were performed
using a process recommended by the World Health Organization. The face and content validity and
internal consistency were used to evaluate the validity and reliability of the instrument. The scale
was evaluated by exploratory and confirmatory factor analysis in 300 patients with heart failure, and
the obtained data were analyzed using SPSS‑22 and AMOS‑22 software.
RESULTS: The content validity of the scale was approved based on the results of the study. One‑factor
scale with 13 items was used in the confirmatory factor analysis, and the results showed that the
instrument had high goodness‑of‑fit indices. Spearman correlation test for convergent validity showed
a correlation between the score obtained by the Scale of Symptoms of Disease and the scores of
The European Heart Failure Self‑care Behavior scale (9 items) (P < 0.0001).
CONCLUSION: The Persian version of the Symptom Distress Scale can be used as a valid instrument
for people with heart failure due to its desirable psychometric properties.