Journal of Education and Health Promotion

Abstract

Abstract BACKGROUND: Fluoride Ion can cause remineralization of primary caries lesions in the presence of
calcium and phosphate. New compounds of calcium‑containing casein phosphopeptides‑amorphous
calcium phosphate (CPP‑ACP), make the remineralization more effective. This research has been
done to evaluate the awareness, attitude, and performance of Isfahan general dentists regarding
the prescription of new caries prevention materials containing calcium and fluoride components.
MATERIALS AND METHODS: This cross‑sectional‑descriptive‑analytic study has been conducted on
152 general dentists in Isfahan ensuring confidentiality of information and obtaining informed consent.
Isfahan general dental offices and clinics were selected using a simple random method. Data of this
research were collected using a questionnaire from previous studies. The questions were divided
into four sections, including demographic information, awareness, attitude, and performance towards
products containing calcium and fluoride prescription. The significance level of P was considered
0.05. Data were analyzed using SPSS version 22, T statistical test, Pearson correlation coefficient,
and one‑way analysis of variance.
RESULTS: The mean score for dentists awareness was 46.3 (standard deviation [SD] = 15.4),
the mean score of attitude was 91.4 (SD = 26.1) and the Mean Score of performance was
54.3 (SD = 27.3) (the scores range from 0 to 100). According to the Pearson correlation coefficient,
there was no significant relationship between dentists’ awareness, attitude besides performance,
and their ages together with dentistry work experiences (P > 0.05).
CONCLUSION: According to the study results, dentists’ awareness of compounds containing
CPP‑ACP is overall average. However, attending to their positive attitudes toward this context,
providing appropriate training programs seem to stimulate them for optimum cooperation as well as
using these products for patients.

Abstract BACKGROUND: Due to the COVID‑19 pandemic, online learning has become the main method of
instruction. This study aimed to evaluate Moroccan medical students’ perceptions of medical online
learning experience and to list its probable related advantages and barriers.
MATERIALS AND METHODS: A cross‑sectional study on 400 medical students randomly selected
from the different national medical institutions was conducted. A questionnaire evaluating the online
learning experience during the pandemic was distributed via institutional e‑mails. Statistical analyses
were carried out using Statistical Package for the Social Sciences (SPSS).
RESULTS: 51.2% of students were satisfied with the online learning experience and reported several
benefits including no need to travel (35.8%), cost savings (20.7%), and flexibility of home studying
(32.3%). Technical issues related to the use of platforms or internet connection, limited interaction
between students and their instructors, and lack of motivation were the major barriers to online learning.
Moreover, results also showed a significant difference when comparing the attendance frequency between
presential classes and online learning (i.e., before vs. during the COVID‑19 pandemic) (P < 0.001).
CONCLUSIONS: The experience of medical online learning was reported in our study to be associated
to several advantages and disadvantages. Hence, students’ perceptions should be considered
to evaluate and improve the quality of this instructional method for a successful and more active
approaches implementation.

Abstract BACKGROUND: The educational environment plays a very important role in determining the overall
performance of students. The aim of this study is to determine the perceptions of undergraduate
medical students about their educational environment in a Nigerian university.
MATERIALS AND METHODS: This was an observational, cross‑sectional study conducted among
final‑year (600 level) undergraduate medical students. The Dundee Ready Education Environment
Measure (DREEM) questionnaire was used for the study to assess the educational environment of
the medical students.
RESULTS: A total number of 100 final‑year (600 level) undergraduate medical students participated in
the study, out of which 27 (27.0%) were males and 73 (73.0%) were females with a male‑to‑female ratio
of 0.37 to 1. The age range of the respondents was 21–30 years with a mean (±SD) of 23.54 (±1.403).
The total mean DREEM score was 116.2/200. The total score of SPL domain was 30.2/48 (62.9%).
The total score of SPT domain was 27.3/44 (62.0%), while that of SASP was 19.2/32 (60.0%). The
total score of SPA domain was 26.6/48 (55.4%) and that of SSP was 13.1/28 (46.8%). For the SPL,
SPT, SASP, and SPA domains, the score was above 50%. However, for the SSP domain the score
was less than 50%.
CONCLUSIONS: The total mean DREEM score in this study was 116.2/200, more positives than
negatives, with the students’ social perspective having the least domain score. There is a need to
provide adequate social support system for medical students in general and particularly for those
who get stressed.

Abstract BACKGROUND: Recent findings show that a longer breastfeeding duration and proper dietary
management could lower the risk of postnatal diabetes. An excellent and interactive education
module on breastfeeding and diet may effectively improve breastfeeding practices and dietary
knowledge among women with gestational diabetes mellitus (GDM). Therefore, this study delves
into developing and validating the content of Breastfeeding and Dietary Education Package (BFDEP)
for women with GDM.
METHOD: The development of the module involved three phases: need assessment, module
development, and validation. Six experts deployed a content validity index (CVI) to evaluate three
areas of the module, including objectives, structure or presentation, and relevance. Sixteen women
with GDM were involved in the face validation process by assessing the “literacy presentation,”
“illustrations,” “material is sufficiently specific,” and “quality of information.”
RESULTS: Generally, I‑CVI, S‑CVI/Ave, and S‑CVI/UA of the objectives, structure or presentation,
and relevance revealed an excellent level of content validity. No alteration was needed for the
domains of objective and relevance (S‑CVI/Ave: 1.0, S‑CVI/UA: 1.0). However, a minor revision was
required in the structure or presentation domain (S‑CVI/Ave: 0.98, S‑CVI/UA: 0.90). The experts
also thought that some module pages were wordy, and a change of font color was needed. The
module was thus modified accordingly. For face validation, “literacy presentation” and “material is
sufficiently specific” had a 99% positive response, while “illustrations” and “quality of information”
had 100% positive feedback.
CONCLUSION: A BFDEP with excellent content validity was developed and can be implemented to
improve breastfeeding practices and dietary knowledge among women with GDM.

Abstract BACKGROUND: The number of older adults with bipolar disorder is increasing and medication
non‑adherence is a major problem that negatively impacts the course of bipolar disorder. This study
aimed to determine the effect of a comprehensive individual motivational‑educational program on
medication adherence in elderly patients with bipolar disorder.
MATERIALS AND METHOD: An experimental study with pretest‑posttest repeated measures with a
control group was conducted on two groups of 62 elderly people with bipolar disorders hospitalized
at Ibn Sina Hospital in Mashhad, Northeast Iran, 2019. For the elderly in the intervention group, a
comprehensive motivational‑educational program was administered for one month (four 30–45 minute
sessions), and for the elderly in the control group, routine clinical care was performed. Medication
adherence in both elderly groups was measured before, immediately after, one and two months after
the intervention. Data were analyzed by SPSS statistical software (version 16) using descriptive
statistics and independent t‑test, Mann‑Whitney, paired t‑test, repeated measures analysis of
variance (ANOVA), and Chi‑square tests.
RESULTS: The mean age of elderlies in the intervention and control groups were 69.03 ± 5.75 and
68.50 ± 6.73 years, respectively. Regardless of the groups to which the patients were assigned, a
significant difference in medication adherence scores was observed during the study period (time
effect; P < 0.001). Also, the medication adherence score was significantly lower in the intervention
group, compared to the control group (group effect; P < 0.001). Also, there was a group time interaction
between the medication adherence score and the time of evaluation (P < 0.001).
CONCLUSION: The results of the present study confirm the positive effect of a comprehensive
educational‑motivational program on improving medication adherence in elderly patients with bipolar
disorder.

Abstract BACKGROUND: Previous studies have shown that psycho‑spiritual state of mothers may have
significant effects on their breastfeeding. The most common cause of nonexclusive breastfeeding is
inadequate breastfeeding; therefore, this study examined the relationship between spiritual health
and perceived stress with breastfeeding adequacy in mothers with infants aged 1–6 months.
MATERIALS AND METHODS: This cross‑sectional, descriptive, correlational study was performed
on 186 mothers with infants aged 1–6 months, who referred to the health centers in Dorud city of
Lorestan province, Iran, in 2021, which were selected based on cluster sampling. Data were collected
through four questionnaires including demographic–fertility, spiritual health, perceived stress, and
breastfeeding adequacy. Data was analyzed by Statistical Package for the Social Sciences (SPSS)
software version 22 using descriptive and analytical statistics.
RESULTS: The mean ± standard deviation (SD) values of spiritual health, perceived stress, and
breastfeeding adequacy were 99.59 ± 12.96, 23.8 ± 72.19, and 55.67 ± 7.67, respectively. There was
a significant positive relationship between spiritual health and breastfeeding adequacy (P < 0.001,
r = 0.268). In addition, there was a significant negative relationship between perceived stress and
breastfeeding adequacy (P = 0.002, r = −0.231).
CONCLUSION: Breastfeeding adequacy has a significant positive relationship with spiritual health and
a significant negative relationship with perceived stress. Since infants are one of the most vulnerable
groups and breastfeeding is the best way to support their health and reduce infant mortality rates,
breastfeeding adequacy can be improved by reducing stress and promoting spiritual health.

Abstract BACKGROUND: Dentists are often overlooked resources in the workforce for disaster
management (DM). To determine the knowledge, attitudes, willingness, and self‑perceived
effectiveness to participate in DM among general dental practitioners (GDPs) of Eastern India.
MATERIALS AND METHODS: A web‑based online survey was conducted among 256 Dental Council
of India registered GDPs of Cuttack district, Odisha. The 45‑item survey comprised closed‑ended
questions on the demographic data of the participants, years of practice, previous experience in DM,
and willingness to participate. Other domains assessed were the participants’ objective knowledge
of DM, attitude, and self‑perceived effectiveness toward participation during disasters. Data were
analyzed descriptively, and the Chi‑square and Mann–Whitney U tests were used for statistical
analysis, with a significance threshold of P < 0.05.
RESULT: A total of 154 responses were analyzed, giving a response rate of 60.16%. The average
age was ≤35 years, 59.1% were BDS dentists and 78.6% had less than 10 years of practice. Only
18% of them had previous experience with DM, and merely 3.2% were formerly trained; however,
95.5% of the dentists were willing to participate in DM. The mean DM knowledge and attitude scores
were 16.12 (CI = 15.4–16.8) and 5.79 (5.45–6.13), respectively. Knowledge and attitude showed
a significant correlation. About 56% indicated that they would be able to respond effectively to a
disastrous event. Significant associations were observed between age group (P = 0.008), years
of clinical practice (P = 0.001), qualification (P = 0.012), previous participation (P = 0.029), and
self‑perceived effectiveness.
CONCLUSION: The knowledge regarding DM among respondents was at an average level. However,
the majority of them were found to have a positive attitude toward participation in DM. Thus, including
DM in dental curricula and drills for dental professionals might prove beneficial as almost all GDPs
were showing greater self‑perceived effectiveness and willingness to participate in disasters.

Abstract BACKGROUND: Self‑medication is the use of unprescribed drugs to treat a disease. Elderly
self‑medication can be more dangerous compared to other age groups because of changes in organ
functions that occur due to senescence. This study aimed to estimate the prevalence of self‑medication
in the elderly, its related factors, and common drugs used in this regard.
MATERIALS AND METHODS: Electronic databases such as PubMed, Scopus, and Web of Science
were searched between January 2016 and June 2021. The search strategy was built on two core
concepts: “self‑medication” and “aged”. The search was limited to original articles in the English
language. A random effect model was used to estimate the pooled prevalence of self‑medication.
Heterogeneity among studies was assessed using both the I2
 statistic and the χ2
 test. Also, a
meta‑regression model was used to investigate the potential sources of heterogeneity of the studies.
RESULTS: Out of 520 non‑duplicate studies, 38 were included in the meta‑analysis. Self‑medication
in the elderly ranged from 0.3% to 82%. The pooled proportion of self‑medication was 36% (95%
CI: 27%–45%). The result of the χ2
 test and the I2
 index (P < 0.001, I2 = 99.90%) revealed notable
heterogeneity among the included studies in the meta‑analysis. The meta‑regression showed a
significant association between the sample size (adjusted β = −0.01; P = 0.043) and the pooled
proportion of self‑medication.
CONCLUSION: The prevalence of self‑medication in the elderly is high. Education through mass
media to raise awareness about the dangers of self‑medication can help solve this problem.

Abstract BACKGROUND: Online learning is the newest and most popular form of distance education today;
within the past decade it has had a major impact on education. The aim of the present study was to
know the effect of online learning basketball using social media on learners’ performance of some
fundamental skills in basketball and determine difference between online learning and in‑person
learning, knowing which one is better than the other.
MATERIALS AND METHODS: The present experimental study was conducted in Sports Academy
for Basketball in Zagazig‑Egypt during March–April 2022. Thirty two female junior basketball players
volunteered to participate in the study from Sports Academy for Basketball (age: 16.23 ± 0.66 years;
body height: 164.5 ± 3.32 cm; body mass: 65.25 ± 3.22 kg). They were divided into two equally sized
experimental groups, online learning (ONL) group (n = 16) and in‑person learning (INL) group (n = 16),
to perform (15) educational sessions for (5) weeks, (3) sessions per week, and the session time
was 90 minutes. Junior basketball players were assessed before and after five‑week training period.
Data were collected by Basketball Passing test, Dribbling Skill test, Lay Up Shoot test, Speed Spot
Shooting, and Free‑Throw Shooting test. The collected data were analyzed using SPSS version 22
software using the descriptive statistical test. The level of significance was set at P ≤0.05.
RESULTS: The results showed that the two groups made significant improvements in all variables but
INL group had significantly greater improvements than ONL group. The percentage of improvement
ranged from 13% to 223% for INL group versus 8% to 158% for ONL group.
CONCLUSION: We conclude that in‑person basketball learning was better than online learning
basketball. Therefore, teachers and trainers must rely primarily on in‑person learning and not rely
on distance learning, especially with regard to learning motor skills, except in emergency cases.

Abstract BACKGROUND: Assessment of circulating and scrub skills is an important issue in operating
room (OR) programs. However, there is a lack of well‑designed tools that are specifically developed
for this purpose. Hence, this study aimed to develop and determine the validity and reliability of a
checklist to measure the circulating and scrub skills of OR novices.
MATERIALS AND METHODS: This cross‑sectional methodological study was conducted among 124
OR technology students who were selected during three consecutive academic years (2019–2020 to
2021–2022). The developed checklist was evaluated with face validity, content validity (quantitative
and qualitative), construct validity  (known‑groups validity), criterion‑related validity  (concurrent
and predictive validities), internal consistency  (Kuder–Richardson 20, KR‑20), and inter‑rater
reliability (intra‑class correlation coefficient, ICC). Known‑groups validity was evaluated by comparing
the difference between the checklist scores of first‑semester and third‑semester students using
independent samples t‑test. Additionally, concurrent and predictive validities were evaluated by ICC
through measuring the correlation between the total score of checklist and grades of a multiple‑choice
test and two clinical apprenticeship courses, respectively. Data were analyzed in the Statistical
Package for Social Sciences software.
RESULTS: After reconciling the preliminary checklist in terms of face and content validities, a
checklist with 17 sub‑scales and 340 items called “Circulating and Scrub Skills of Operating Room
Novices (CSSORN)” was developed. Regarding the known‑groups validity, the third‑semester
students had higher scores compared to the first‑semester students (p < 0.001 in most sub‑scales).
Besides, the total score of checklist showed a significant correlation with the criteria of concurrent
and predictive validities (ICC = 0.64, ICC = 0.72; P < 0.001). The KR‑20 for the entire checklist was
0.90 (range: 0.60–0.93). The ICC for inter‑rater reliability was also 0.96 for the entire checklist (range:
0.76–0.99, P < 0.001 in all sub‑scales).
CONCLUSION: The CSSORN had appropriate validity and reliability to be used for measuring the
circulating and scrub skills of OR novices. To shed light on the findings, further testing of this checklist
on larger populations and in different contexts is suggested.

Abstract BACKGROUND AND AIM: This study aimed to investigate and compare the efficacy of cognitive‑motor
rehabilitation (CMR) with methylphenidate on cognitive functions and behavioral symptoms of children
with attention deficit/hyperactivity disorder (ADHD) and specified the near‑transfer and far‑transfer
effects.
MATERIALS AND METHODS: The research was semiexperimental with posttest and follow‑up
assessments, in a single‑blind design. Forty‑eight boys with ADHD, aged 9–12, were selected
conveniently regarding the inclusion/exclusion criteria, matched base on severity and Intelligence
quotient (IQ) and were randomly assigned to CMR (n = 16), methylphenidate medication (MED,
n = 16), and placebo CMR groups (PCMR, n = 16). CMR and PCMR received 20 3‑h training
sessions, and the MED group received 20 or 30 mg/day methylphenidate. Tower of London (TOL),
Swanson, Nolan, and Pelham, Version IV Scale (SNAP‑IV), Wechsler’s digit span and mathematic
subscales, dictation test, and restricted academic situation scale (RASS) were completed at
posttest and follow‑up. The data were analyzed by repeated measures multivariate analysis of
variance.
RESULTS: CMR outperformed PCMR on forward digit span, backward digit span, ToL score at both
posttest, and follow‑up (P < 0.05). CMR scored lower than MED on ADHD‑PI and ADHD‑C at both
posttest and follow‑up (P < 0.05). Moreover, CMR outperformed MED on dictation at both assessment
phases (P < 0.01) and RASS at the follow‑up phase (P < 0.05). CMR outperformed PCMR on
mathematics at post‑test (P = 0.038) and also, in dictation and RASS, at both post‑test (P < 0.001)
and follow‑up (P < 0.05).
CONCLUSION: CMR Improves near‑transfer cognitive functions and behavior symptoms of ADHD
as much as MED, but only CMR has more generalizable and endurable improvement on complex
Efs and academic performance (far‑transfer effects).

Abstract BACKGROUND: Clinical‑based mobile learning courses have great demand among the nursing
graduates as learners look for possibilities to update skills. The present study explores the
feasibility, familiarity, utility, and attitude of nursing graduates of South India toward mobile learning
applications (m‑apps).
MATERIAL AND METHODS: An online‑based cross‑sectional descriptive survey was conducted in
May 2021 among the South Indian nursing graduates of Tamil Nadu and Kerala, using a questionnaire
consisting 49 items categorized under six sections with items related to socio‑demographic
information; m‑app usage; online learning experience; preference in using m‑apps for learning
purposes before COVID‑19 and during COVID‑19; students’ engagement through e‑learning; and
anxiety related to online assessment. Descriptive and inferential (ANOVA, Chi‑square, and t test)
statistical data analysis were done using SPSS version 23.
RESULTS: A total of 447 student nurses responded. The result shows that most of them, 96% (432)
used android phones and 94% (422) owned a mobile. Age was highly influencing mobile learning
application (m‑learning apps) usage; students of less than 20 years of age used applications more
frequently and possessed more educational applications. Majority of them, 84% (377) of them had
started using m‑learning apps only after COVID. 57.7% (249) commonly used m‑learning apps for
acquiring nursing knowledge resources, nursing exam preparatory, and drug resources. Students
rated high for the interactive nature of these m‑learning apps, while abundant learning materials
and usage with ease were rated as other attractive features. Sixty‑six percent (305) had mostly
downloaded these apps from Google Play Store.
CONCLUSION: The findings would help the m‑learning application developers to offer customize
solutions to address learning gaps that prevail among the South Indian nursing graduates and help
with sustainable growth.

Abstract BACKGROUND: Family caregivers of hemodialysis patients experience various physical,
psychological, social, economic, and spiritual problems that reduce their quality of life. The present
study aimed to determine the effect of a family‑centered education program on the quality of life of
family caregivers of patients undergoing hemodialysis.
MATERIALS AND METHODS: This was a randomized controlled trial that was performed on 70
caregivers of patients undergoing hemodialysis in the medical centers of Hazrate Ali Asghar and
Hazrate Zahraye Marzieh in Isfahan. Caregivers were randomly divided into experimental and control
groups, and the experimental group received an eight‑session family‑centered education program.
Data were collected using the Quality of Life Scale (QOLS)‑short form immediately after and 1 month
after the intervention. Data analysis was performed using the Statistical Package for the Social
Sciences (SPSS) software version 18 and analysis of variance and covariance.
RESULTS: The results showed that both experimental and control groups were homogeneous in
terms of demographic information and there was no significant difference between them in this regard.
Analysis of data on quality of life and its four domains showed that the mean scores of quality of
life (P = 0.089) and its four domains including physical health (P = 0.367), mental health (P = 0.429),
community relations (P = 0.132), and environmental health (P = 0.232) increased significantly
immediately after and 1 month after the intervention (P < 0.001 in all cases).
CONCLUSION: Educational programs can improve the quality of life of family caregivers of
hemodialysis patients. Therefore, it is recommended that programs be developed and evaluated in
various studies in the future.

Abstract BACKGROUND: The safety of patients remain at risk due to a higher workload and lower
nurse‑to‑patient ratio. However, in India, most hospitals still adhere to long‑known nurse staffing
norms set by their statutory or accreditation bodies. Therefore, the present study was undertaken
to recommend a standard workload‑based estimation of nursing manpower requirement in the ICU
of a tertiary care teaching hospital.
MATERIALS AND METHODS: It was a descriptive, observational, time and motion study was
conducted in the medicine ICU of a tertiary care teaching hospital. Data collection was done by using
demographic and clinical profile sheet of patients, NPDS‑H dependency assessment scale, time and
activities record sheet, and WHO WISN tool. The nurses’ activities were observed by nonparticipatory and
non‑concealment technique. Data analysis was done using descriptive statistics and the WHO WISN tool.
RESULTS: The bed occupancy rate and the average length of stay in the medicine ICU were 93.23%
and 7.18 days respectively. Distribution of dependency level of the medical ICU patients was very
high (41.67%), low‑high (33.33%), and medium‑high (25.0%) dependency level. Considering available
resources and workload in tertiary care hospitals in India, the study recommended a nurse‑to‑patient
ratio of 1:1.2 in each shift for the medicine ICU of a tertiary care hospital.
CONCLUSION: The study suggested minimum nurse-to-patient ratio in medical ICU should be
1:1.2 with provision of power to ICU incharge nurse to allocate nurses according to the workload in
different shifts. Also, nurse staffing norms in hospitals need to be estimated or selected with serious
consideration of health care demands when employing nurse staffing norms.

Abstract BACKGROUND: The aim of this study was to investigate the living experience of coronary patients
in Shiraz and the peak prevalence of the second stage in summer. This study could further examine
these experiences in broader groups in subsequent studies. Identifying the psychological causes
and effects of this disease with the help of patients involved in some countries has been considered.
MATERIALS AND METHODS: The method, which was used in this study, was a qualitative method
and content analysis. Participants in this study were 13 patients with COVID‑19, some of whom
were members of the medical staff. The participants were selected purposefully. The semi‑organized
interview with the participants continued until the theoretical saturation was reached.
RESULTS: After extracting the codes, researchers classify them, and then the results were examined
in more depth and categorized. About 120 extracted codes were classified into seven general
categories; three of them were directly related to psychological issues. The other four of them were
related to the subject of psychological effects and consequences.
CONCLUSION: In general, during the interview process, it was proved that the more severe the
symptoms of the disease, the psychological experiences of confronting the disease because of its
outbreak, and the processes of coping with it were deeper.

Abstract BACKGROUND: The birth of a pre‑mature infant and subsequent hospitalization and separation
from the family can impair maternal and neonatal attachment and quality of maternal care. This
study aimed to assess the effect of instructing mothers in attachment behaviors on short‑term health
outcomes of pre‑mature infants admitted to neonatal intensive care units (NICUs).
MATERIAL AND METHODS: In this quasi experimental study, 80 mothers of pre‑mature infants who
were admitted to NICUs at two referral health centers in northern Iran were studied in two groups in
2018. Attachment behaviors were taught to mothers in the test group during four consecutive sessions.
Mother–infant attachment behaviors were evaluated at both the beginning and the end of this study
using a checklist derived from Avant’s Maternal Attachment Assessment Strategy. Moreover, infants’
short‑term health consequences were investigated in two groups. SPSS 18 statistical software was
used for data analysis.
RESULTS: On average, it took respectively 34.90 ± 12/65 and 31/15 ± 14/35 days for the infants in
the control and the intervention group to reach full oral feeding and 38/5 (38/4–42/11) and 37 (31/85–
42/14) days to gain the minimum weight required for discharge. Moreover, the mean length of stay
for the infants in the control and the intervention group was 41/80 ± 13/86 and 39/02 ± 16/01 days,
respectively (P > 0/05).
CONCLUSION: Instructing mothers in attachment behaviors clinically improved short‑term
health‑related outcomes. Hence, this intervention is recommended to be incorporated in the care
program for mothers with pre‑mature infants.

Abstract BACKGROUND: Chemotherapy is a complex, multi‑disciplinary, and error‑prone process. Information
technology is being increasingly used in different health care settings with complex work procedures
such as cancer care to enhance the quality and safety of care. In this study, we aimed to develop
a computerized physician order entry (CPOE) for chemotherapy prescribing in patients with gastric
cancer and to evaluate the impact of CPOE on medication errors and order problems.
MATERIALS AND METHODS: A multi‑disciplinary team consisting of a chemotherapy council group
and system design and implementation team was formed for chemotherapy process evaluation,
requirement analysis, developing computer‑based protocols, and implementation of CPOE. A before
and after study was conducted to evaluate the impact of CPOE on the chemotherapy process and
medication errors and problem orders. To evaluate the level of end‑user satisfaction, an ISO Norm
9241/110 usability questionnaire was chosen for the evaluation.
RESULTS: Before the implementation of the CPOE system, 37 medication errors (46.25%) and
53 problem orders (66.25%) were recorded for 80 paper‑based chemotherapy prescriptions. After
implementation of the CPOE system, 7 (8.7%) medication errors and 6 (7.5%) problem orders were
recorded for 80 CPOE prescriptions. The implementation of CPOE reduced the medication error by
37.55% and the problematic order by 58.75%. The results for usability evaluation indicate that the
CPOE was within the first class of the ISONORM level rating; this shows that a CPOE is with very
high satisfaction and a very high functionality rate.
CONCLUSION: Developing a CPOE system significantly improved safety and quality of the
chemotherapy process in cancer care settings by reducing the medication error, deleting unnecessary
steps, improving communication and coordination between providers, and use of updated
evidence‑based medicine in direct chemotherapy orders. However, the CPOE system does not
prevent all medication errors and may cause new errors. These errors can be human‑related factors
or associated with the design and implementation of the systems.

Abstract BACKGROUND: Preclinical students often fail to appreciate the clinical relevance of basic sciences
during the first year of undergraduate medical training, leading them to lose interest in the subject,
and preventing them from achieving the desired goals. In order to rectify this gap in the curriculum,
Medical Council of India (MCI) in 2011 published a document announcing curricular strategies
including Early Clinical Exposure (ECE) to effectively modify the Indian system of education. Lack
of proper guidance prevented many institutions from implementing ECE. Since our institution had
run a similar program of “Clinical Observership” as early as 2001, we were able to implement ECE
in an efficient way.
MATERIALS AND METHODS: Early clinical exposure was implemented as a structured program,
with the participation of 10 clinical departments since 2013. Feedback from the students, soon after
ECE and also from the batch of CRRIs, who had undergone this program while they were preclinical
students amply support the effectiveness of ECE in its contents and methods of implementation.
Manual content analysis was performed on open comments. After reading the responses, they were
broken down to meaning units, and these were then condensed. The condensed meaning units
were labeled with codes. The codes were grouped into categories. Themes were derived from the
categories.
RESULTS: Out of the 70 CRRIs, 52 responded to the questionnaire. All the CRRIs except one said
that ECE was very helpful during their clinical postings and internship period. They suggested that
the number of hours of posting should be increased and also reiterated the fact that a greater number
of clinical departments could be included in the program. Though the beneficial effects were felt in
all the domains of learning, the most remarkable impact was felt in the affective domain, wherein
changes are not easy to come by.
DISCUSSION: Recently, National Medical Council has come out with plans of including ECE in
the syllabus with strict time schedule. It is felt that the faculty will find our experience of running the
program for the past five years helpful in implementing this program, for the fullest benefit of the
preclinical students.

Abstract BACKGROUND: Gestational diabetes is the most common medical complication and a common
metabolic disorder during pregnancy. Increasing people’s self‑efficacy is one of the best ways to
control this disease. As there is a lag of intervention in this regard, the purpose of this study was to
determine the effect of couple supportive counseling on self‑efficacy in women with insulin‑treated
gestational diabetes.
MATERIALS AND METHODS: In this randomized clinical trial, 64 women with gestational diabetes
who referred to diabetes clinic of Mashhad Ommolbanin Hospital were divided into intervention and
control groups through block randomization during 2019. Their gestational age was in 26–30 weeks.
For the couples in the intervention group, three couple supportive counseling session was held. Each
session lasted 1 h and was held one time per week. The instruments were diabetes self‑efficacy
questionnaire, fasting and 2‑h postprandial checklist and Cassidy social support, which were assessed
before and 4 weeks after intervention in both groups. Data was analyzed by SPSS software version 25
through Mann–Whitney and Wilcoxon test. P values of < 0.05 were reported to be significant.
RESULTS: In the preintervention, the diabetes self‑efficacy score had no significant difference
in the intervention (30/6 ± 38/50) and control groups (09/8 ± 56/51) (P = 515/0). However, in
the postintervention, the diabetes self‑efficacy score was significantly higher in the intervention
group (58/6 ± 41/71) compared to the control group (15/7 ± 31/51) (P < 001/0). Also, before the
intervention, there was no significant difference between the intervention (30/2 ± 72/10) and control
group (87/1 ± 63/11) (P = 137/0) regarding social support. However, after the intervention, there was
a significant difference between the intervention and control groups (879/0 ± 53/13, 03/2 ± 41/11,
P < 0/001 respectively). Also, data analysis showed a significant correlation between self‑efficacy
and social support (r = 0.451, P < 0.001), self‑efficacy and fasting blood sugar (P < 0.001, r = ‑0.577),
and 2 h post prandial (r = ‑0.778, P < 0.001).
CONCLUSION: Couple supportive counseling leads to increased self‑efficacy and social support
in pregnant women with gestational diabetes. Therefore, it is recommended to use this counseling
as an effective method in the management of diabetic pregnant women during their prenatal care
to have a healthier pregnancy.

Abstract BACKGROUND: Simulation debriefing influences learning from healthcare simulation activities.
Health sciences educators must be competent in conducting simulation debriefing for healthcare
students. A structured faculty development intervention for health sciences educators must be
informed by educator needs to enhance its utility. This paper describes the needs of health sciences
educators regarding simulation debriefing at a faculty of health sciences.
MATERIALS AND METHODS: A parallel convergent mixed methods study design was applied on
a selected population of 30 health sciences educators at the University (x) who integrate immersive
simulation for first‑ to final‑year students in their undergraduate programs. The Objective Structured
Assessment of Debriefing tool underpinned observations which informed the quantitative strand of the
study, while semi‑structured interviews were conducted as part of the qualitative strand. Descriptive
statistics and thematic analysis were used to analyze the data.
RESULTS: Health sciences educators struggled to establish the learning environment for
simulation (median 1), facilitate learning (median 3), and evaluate their debriefing activities. However,
they were able to apply an appropriate approach toward simulation (median 4). They identified the
need to be educated on the fundamentals of simulation‑based education.
CONCLUSION: A continuing professional development program must be developed aimed at
transforming approaches toward facilitating learning, explaining the fundamentals of simulation‑based
education, modeling of best‑practices related to debriefing, and applying appropriate strategies for
evaluating debriefing activities.

Abstract BACKGROUND: Because of the spread of coronavirus disease 2019 (COVID‑19), the preventive
measures have increased, such as focusing on the use of medicinal plants in most communities,
including Iran. The purpose of this study was to identify the knowledge, attitude, and performance of
individuals toward the use of medicinal plants and to identify the predictors of the use of medicinal
plants in the prevention of COVID‑19.
MATERIALS AND METHODS: This descriptive‑analytical study (February–April 2021) was performed
on 3840 Iranian men and women aged 20–70 years selected as a multi‑stage cluster study. At the
first stage, all provinces were divided into five regions: North, South, East, West, and Center. In the
second stage, a provincial center and a city were randomly selected from each region (North: Sari,
Babol; South: Bushehr, Bandar Genaveh; East: Mashhad, Sabzevar; West: Hamedan, Toisarkan;
Center: Yazd, Ardakan). Data were collected by a researcher‑made scale based on the Health
Belief Model (HBM). Data analysis was performed applying Pearson correlation coefficient, logistic
regression, and linear regression.
RESULTS: The results showed that people have relatively high knowledge and positive attitude toward
the use of medicinal plants in prevention of COVID‑19. The most important reason for positive attitude
was the perceived benefits with the mean of 75.06%. Also, half of the people had poor performance.
Correlation coefficient showed that the use of medicinal plants with perceived sensitivity (p = 0.000,
r = 0.3), perceived benefits (p = 0.012, r = 0.126), perceived barriers (p = 0.000, r = 0.179), and
perceived self‑efficacy (p = 0.000, r = 0.305) had a significant correlation. The strongest correlation
between perceived self‑efficacy was observed with the use of herbs in prevention of COVID‑19. The
HBM constructs can predict 26% of the variance for the use of medicinal plants in the prevention
of COVID‑19, among which perceived self‑efficacy (β = 0.230) was the most powerful predictor.
CONCLUSION: Based on the results, the predictive role of self‑efficacy constructs for the use of
medicinal plants in prevention of COVID‑19 has been confirmed according to the HBM. Therefore,
methods of increasing self‑efficacy such as training programs and providing appropriate intervention
models can be used not only as promoters of using medicinal plants in prevention of COVID‑19 but
also for improving people’s performance in the proper use of medicinal plants.

Abstract BACKGROUND: A teacher’s appropriate use of nonverbal communication skills, mainly kinesics, can
play a crucial role in the success of the students. Medical educators are unaware of the effective use
of nonverbal communication as an instructional skill that can be used to engage learners, balance
learners’ participation by controlling the classroom environment, and motivate them to have a passion
for learning. The purpose of the study was to explore the students’ perceptions regarding the effect
of teachers’ kinesics on students’ learning and their learning environment. This can be helpful for
teachers in modifying their teaching styles and delivering quality education.
MATERIALS AND METHODS: A qualitative study with an exploratory design was conducted at a
private medical institute in 2021 for a duration of 6 months. Fourteen medical students volunteered
to participate in the study. Focus group discussions were conducted with the students to explore the
experiences of the medical students regarding the use of nonverbal communication skills by their
teachers and its effect on their learning in the classroom. The data collected was analyzed manually.
RESULTS: The results of the study revealed that teachers’ nonverbal behaviors in the classroom
significantly influence students’ motivation, engagement, and learning in the classroom. Students
preferred interaction with the teachers who were friendly and confident and used their nonverbal
communication skills (eye contact, facial expressions, hand gestures) effectively, compared to strict
and judgmental teachers.
CONCLUSION: Teachers need to motivate their students by improving their teaching styles and
incorporating nonverbal behaviors positively in the classroom. By creating an impactful learning
environment, students’ participation and learning will increase, which will, in turn, improve their
academic performance.

Abstract Emotions are universal in academic and clinical settings. A student is likely to hope for success,
maybe be worried about failure, or may feel comfortable after an exam. These feelings undoubtedly
affect his/her motivation, effort, academic performance, and progress. This study aimed to investigate
the role of emotion in the learning and performance of medical students and its mechanism. This
study was a scoping review conducted in 2022 to examine the role of emotions in medical education.
The three databases PubMed, ERIC, and Science Direct and the search engine Google Scholar
were searched using the following keywords: “emotion,” “medical student,” “teaching,” “learning,”
and “medical education.” English articles published from 2010 to 2022 were reviewed, and finally,
34 articles that met the inclusion criteria were reviewed. Review of the selected articles showed that
there was a significant relationship between the cognitive system and emotions in the brain. The
conceptual framework of the relationship between cognition and emotion can be explained in the
form of dimensional and discrete views of emotions and based on cognitive load theory. Emotions
affect cognition with the four mechanisms of memory, cognitive resources, cognitive strategies,
and motivation and can be effective in learning self‑regulation, clinical reasoning, and academic
achievement of medical students. Emotions in medical education is a double‑edged sword. In other
words, it is highly recommended to divide emotions into activating and inactivating, instead of dividing
them into positive and negative ones. In this context, medical educators can use the positive aspects
of nearly all emotions to improve the quality of their teaching.

Abstract BACKGROUND: E‑learning is the delivery of learning and training through digital resources. Although
e‑learning is based on formalized learning, it is provided through computers, tablets, and even
cellular phones those are connected to the Internet. This makes it easy for users to learn anytime,
anywhere, with few, if any restrictions.
MATERIAL AND METHODS: A cross‑sectional study was done, and data was obtained through
an online survey method from September 14, 2020 to October 08, 2020. Questions were created in
“Google Forms.” The targeted population was all nursing students from all over Nepal. There were
a total of 365 respondents. A pilot study was done on 10 students. After the pilot study, the same
question was distributed to all the respondents.
RESULTS: Almost half (40.8%) got disturbed in their online class because of electricity; around half of
the respondents (41.9%) are disturbed in their online class because of Internet problems. Moreover,
around half of the respondents (44.4%) use the data pack daily, and 38.6% use the data sometimes.
CONCLUSION: The study concludes that most students suffered from Internet disturbance and
electricity problems during online classes. Because of electricity and Internet problems, most students
feel anxious during class, and most of the students are not able to attend classes. Most students
are compelled to use data packs for online classes. However, the course may not be completed if
the problems arising during online classes are not solved.

Abstract BACKGROUND: Sexually transmitted infections (STIs) have always been considered as a health
problem in the world. Also, vulnerable women (addicts, jail breakers, and prostitutes) are at the highest
risk. According to the World Health Organization’s (WHO) approach, the only effective way to prevent
and control this disease is public health education, and high‑risk and vulnerable groups should be
prioritized in educational programs. The aim of the study was to investigate the effect of health belief
model (HBM)‑based education on changing the behaviors related to STIs in vulnerable women.
MATERIALS AND METHODS: The present study is an intervention (field trial) study in vulnerable
women. Convenience sampling method was used in this study and the sample size was determined
to be 84 subjects. Through tossing a coin, the social support center was selected as the intervention
group and the drop‑in center as the control group. Quantitative data analysis was performed, and
descriptive and inferential statistical methods were used.
RESULTS: The mean scores of perceived threat, perceived benefits, perceived barriers, and
perceived self‑efficacy and changes in performance between the three measurement stages, as
well as changes in the scores of perceived threat, perceived benefits, perceived barriers, and
perceived self‑efficacy over three measurement times were significantly different between the two
groups (interaction) (P < 0.001). The mean score of performance 3 months after the intervention
was significantly higher than before the intervention (P = 0.001).
CONCLUSIONS: The present study confirmed the effectiveness of the HBM in promoting behavioral
modifiers that lead to STIs. Therefore, educational interventions with emphasis on understanding
the threats, benefits, barriers, and self‑efficacy and, ultimately, performance improvement in relation
to STIs are recommended.

Abstract BACKGROUND: The usage of smartphones has become common among adolescents, despite
knowing the health‑related problems of the user. Currently, the availability of electronic gadgets has
become economical and this has an impact on society, especially on the behavior of adolescents.
MATERIALS AND METHODS: A cross‑sectional survey design was used to find the pattern of
smartphone usage, smartphone addiction, and subjective health problems associated with smartphone
usage. The data were obtained from 270 nursing students using the convenient sampling technique
using a sociodemographic proforma, semi‑structured questionnaire on the pattern of smartphone
usage, Smartphone Addiction Scale, self‑reported subjective health problems questionnaire, and
study habits scale.
STATISTICAL ANALYSIS: Descriptive and inferential statistics was used for the analysis using
SPSS 16.0.
RESULTS: The study findings revealed that most of the participants 243 (90.0%) were using 4G
phones. The majority 88 (32.60%) of the participants were using a smartphone for less than 2 hours
at a stretch in a day. Most uses of a smartphone were in the night 155 (57.40%). The main usage of
a smartphone was for entertainment purposes 213 (78.90%). Most of the participants 196 (72.6%)
were moderately addicted to smartphones. One‑third 109 (40.2%) of the participants complained of
headache, followed by straining of the eyes 83 (30.6%).
CONCLUSION: The awareness of smartphone addiction and health‑related problems associated with
smartphone usage has been shown to decrease its impact. The study concluded that it is very much
necessary to identify the pattern of smartphone usage, to prevent the consequences of addiction
and health problems associated with smartphone usage.

Abstract The COVID‑19 pandemic has had considerable consequences in many areas of life, including the
social area and childbearing plans. The present narrative review aimed to examine the childbearing
decisions and its related factors during the COVID‑19 pandemic. This review was conducted by
searching in scientific databases, including Web of Science, Science Direct, Google Scholar, Scopus,
Cochrane, PubMed, ProQuest, Scientific Information Database (SID), Iranian Research Institute
for Information Science and Technology (IranDoc) and Iranian Journal Database (Magiran) in June
2022. The search resulted in 111 sources, of which 16 were in line with the research objective.
Couples have mainly cancelled or delayed their previous plans related to childbearing decisions.
There are two groups of direct and indirect factors related to childbearing decisions during the
COVID‑19 pandemic: The former includes (1) well‑being‑related factors such as economic conditions,
interpersonal relationships and gender roles in terms of task division; and (2) health‑related factors,
including health emergencies and physical and psychological health. The latter includes factors such
as social distancing and social media. Based on the results, governments should facilitate childbearing
by adjusting existing policies, addressing economic insecurity and protecting the livelihoods of
those affected by the crisis. Health policymakers and planners must also prioritize women’s access
to reproductive health services in a safe environment while promoting equity in access. It is also
necessary to promote the quality and quantity of indirect care and virtual counseling based on the
needs of women in crisis.

Abstract BACKGROUND: Healthcare professionals have fought hard to restrain the COVID‑19 pandemic
by providing high‑quality care for their infected patients, but in doing so they have developed
fears of becoming sick and feelings of isolation and loneliness. The lived experience of respiratory
therapists (RTs) in Saudi Arabia who works with these infected patients needs further investigation.
The study sought to describe the experiences and coping strategies of Saudi RT managing patients
with COVID‑19.
MATERIALS AND METHODS: The study utilized qualitative research methods, specifically employing
a phenomenological research design. A total of 25 Saudi RT (RTs) who were in direct contact with
COVID‑19 patients were selected after they agreed to participate in this study. The study followed
a one‑on‑one semi‑structured interview process using the Zoom platform. This qualitative data
collection technique focuses on the participants’ lived experiences and feelings to discover shared
patterns. The data were analyzed via an inductive approach.
RESULTS: Six themes were found in the RT perceptions including stress while treating COVID
patients, managing the fear of catching of Covid 19, feelings towards COVID‑19 patients, challenges
faced by female RTs, workplace experiences, and excessive workload.
CONCLUSIONS: RTs feelings dramatically changed throughout the COVID‑19 pandemic. All the
RTs have developed a self‑copying style that has helped them improve their psychosocial behavior
to face the pandemic. During the outbreak, frontline RTs’ positive and negative emotions intertwined
and coexisted. Negative emotions predominated in the beginning, while good feelings emerged
gradually. Self‑coping methods and psychosocial development were significant factors in RTs mental
health while caring for COVID‑19 patients.

Abstract BACKGROUND: Caring for a family member with cancer is a challenging issue for families. Family
caregivers often need the help of supportive resources to solve problems in their care role. A deep
understanding of the requirements of caregivers to seek help is an effective step toward their ability
to use supportive resources. This study aimed to identify and describe the requirements for promoting
help‑seeking behaviors in Iranian family caregivers of cancer patients.
MATERIALS AND METHODS: This qualitative study was conducted through in‑depth semi‑structured
interviews with 28 participants selected using purposeful sampling method from 2019 to 2021. An
interview guide with general questions about seeking help was used to maintain coherence in data
collection. The interviews continued until data saturation. All interviews were recorded, transcribed
and analyzed through qualitative content analysis.
RESULTS: The requirements of promoting help‑seeking behaviors in family caregivers
were grouped into four main categories: (1) improving social paths toward seeking help, (2)
spiritual‑psychological‑cognitive empowerment toward seeking help, (3) strengthening the motivations
behind seeking help, and (4) modifying the perception of cultural barriers to seeking help.
CONCLUSION: According to the results of this study, it is expected that by identifying the requirements
of caregivers for seeking help and by health stakeholders designing comprehensive programs to
address these needs, caregivers will be empowered to use supportive resources and provide a
better care role.

Abstract BACKGROUND: Mobile phones have become a widely accepted learning mode due to the impact
of COVID‑19. This study explores the mobile technology acceptance, among nursing students at
selected educational institutions in South India.
MATERIALS AND METHODS: Quantitative cross‑sectional descriptive design. First‑year 176 B.Sc.
nursing students who underwent blended learning were selected by the purposive sampling method.
The tool “Technology Acceptance Model” was used to collect responses. Bivariate analysis was used
to determine the relationship between the demographic and study‑related variables with the mobile
technology acceptance using SPSS version 25.0.
RESULTS: The majority 73.9% of the students belonged to the age group of 18–19 years,
females 76.7% and, 98.9% were unmarried. Among the constructs of TAM, a mean (SD) value of
22.08 (2.26) was found for material (mobile device audio/video) characteristics the mean (SD) value
was 22.08 (2.26), attitude about use 17.58 (1.95), behavioral intention 17.46 (1.78) and system
characteristics 17.21 (2.27). The mobile technology acceptance revealed that 126 (71.6%) strongly
agreed, 49 (27.8%) agreed, and 1 (0.6%) was neutral with a mean (SD) of 105.19 (8.68), respectively.
A positive correlation was found between the system characteristics, material characteristics, perceived
ease to use, perceived usefulness, attitude about the use, behavioral intention with a P value <0.001.
There was a statistically significant association between Mobile technology acceptance and time spent
by the students for independent studies shown the Chi‑square value of 12.7, with P value <0.05.
CONCLUSION: Nursing students had a positive acceptance and behavior toward smartphone use.

Abstract BACKGROUND: Incivility is one of the significant challenges that affect nursing education. Uncivil
behaviors have a significant upward trend compared to the past in nursing education. This study
was conducted to explore academic incivility from the perspective of nursing students and faculty.
MATERIALS AND METHODS: This study was conducted in 2021 using a descriptive qualitative
method. Fifteen baccalaureate nursing students and six faculty were selected using purposeful
sampling method. Data was collected through in‑depth semi‑structured interviews, and a qualitative
content analysis was applied for data analysis.
RESULTS: Data analysis revealed four categories, namely, ineffective teaching–learning, inapposite/
unreasonable requests, behaviors disrupting mutually respectful environment, and academic
dishonesty, and 14 subcategories.
CONCLUSION: To reduce incivility, closer attention needs to be paid to the admission of faculty as
well as training them to use effective communication techniques and interactive teaching methods.
In addition, nursing students must be provided with the training about uncivil behaviors. Furthermore,
clear and precise rules and regulations concerning incivility incidence should be developed and
implemented in the universities.

Abstract BACKGROUND: To motivate students toward the path of lifelong learning, it is important to train
them for a self‑directed learning (SDL) approach, where they identify the need of learning the content
as well as look forward to attaining the learning outcome, independently. The level of readiness
for SDL will allow the learner to be self‑disciplined, self‑organized, an effective team builder and
communicator, a self‑assessor, and a self‑reflector, thus being a self‑learner with the ability to accept
and give constructive feedback. The aim of the study was to develop, validate, and implement the
SDL readiness scale for health professional students.
MATERIALS AND METHOD: The readiness scale of 43 items was used in four sub‑titles (awareness,
learning strategies, and style, motivation, team building) was developed using the Delphi method with
12 experts and was implemented for the medical students at Karamsad, Gujarat as a cross‑sectional
survey after a pilot trial scale from May 2021 to September 2021, using mean, the standard deviation
for each item, and arrived sub‑titles. The ANOVA test was used to find differences in readiness
scores as per different years of the medical program.
RESULT: The result demonstrates that the maximum score was obtained for the first‑year medical
student (149.89 ± 24.72), which dropped in year 2 (136.35 ± 32.26) but increased by the final
year (147.67 ± 56.66), although not as high as the initial joining year. However, a statistically
significant difference per gender was identified for a few items of the scale [(items 24 (P < 0.034),
26 (P < 0.0005), 37 (P < 0.035), and 40 (P < 0.013)]. The logistic regression analysis showed no
statistical significance for the DSVS‑self‑directed learning readiness scale (SDLRS) score and
demographic variables.
CONCLUSION: The outcome of the study strongly suggests training/sensitization sessions for
students to highlight the importance of a SDL approach in a digital millennium. Moreover, a longitudinal
follow‑up needs to be conducted for the readiness score of the students based on the developed
scale and subsequent training sessions need to be organized for students as well as faculty for better
outcomes for the students toward SDL sessions.

Abstract Educational policymaking is a kind of public policy that is done in order to achieve the goals of the
educational system in fields areas such as education and students’ health. The purpose of this study
was to determine the components of educational policymaking model in education. The method of
the present study is systematic review. This is done using the SPIDER framework. The statistical
population of the study included all related Persian and English articles published in the years
2010–2021 consisting of 98 articles that are indexed in ScienceDirect, Sage, Springer, Wiley, Eric,
and PMC English language databases and SID, Irandoc, and Magiran Persian language databases.
The research sample included 52 articles selected in the article screening stage. The number of
Persian language references was 12 and English language references was 40. Sterberg thematic
analysis was used for coding the selected texts of articles. Results of coding the selected texts of
the articles showed that the components of the educational policymaking model are included in 11
themes: quiddity of policy and public policy, educational policy’s necessity, quiddity of educational
policy, process of educational policy, consequences, factors, obstacles, stakeholders, evaluation
criteria, and change in educational policies. Paying attention to all the dimensions and factors
interacting in educational policy can lead to better education and improve the quality of education in
all dimensions, especially in the field of health education.

Abstract The mortality rate of non‑communicable diseases (NCDs) contributes more in low‑income and
middle‑income countries, also among individuals with lower socioeconomic status in high‑income
countries, making NCDs a big hurdle to minimizing global and national health disparities. Among 55
million fatalities worldwide in 2019, NCDs accounted for about 41 million (71%) deaths. The purpose
of this scoping review was to comprehend the available literature on the burden of NCDs in India.
This review included the studies that have been published between the period of 2009–2020. For
this review, 18 full‑text articles have been selected. A preliminary search was done to obtain articles
from the search engines such as PubMed, Google Scholar, web of science, and Scopus. Our scoping
review was focused on five major NCDs which are cardiovascular, hypertension, diabetes, cancer,
and stroke. In 2019, around 17.9 million individuals died from cardiovascular disease (CVD), which
is accounting for 32% of all deaths. As compared to Chandigarh and Jharkhand (0.12 million and
0.96 million, respectively) Tamil Nadu and Maharashtra (4.8 million and 9.2 million, respectively)
have a higher percentage of the population affected by diabetes. In India, stroke is the fifth‑significant
cause of disability and the fourth‑leading cause of fatality, which is accounting for 3.5 percent of all
disabilities. India should construct a higher‑level coordinating framework and devise an overarching
policy or strategy tailored to NCDs. To limit risk factor exposure, it is necessary to emphasize health
promotion and preventive actions.

Abstract BACKGROUND: Breast cancer is the most common type of cancer and the second leading cause
of death among women. Religion and spiritual behaviors are effective strategies for maintaining
human health. The aim of this study was to determine the relationship between religious orientation
and spiritual intelligence with general health dimensions in women with breast cancer.
MATERIALS AND METHODS: The present study is a correlational study that was performed on
50 women with breast cancer referred to medical centers affiliated to Isfahan University of Medical
Sciences in 2020. Data were collected through questionnaires of religious orientation, spiritual
intelligence, and general health. Data were analyzed by Spearman and regression tests.
RESULTS: The results showed that religious orientation had a significant positive relationship with
the overall score of general health, but the components of religious orientation had a significant
negative relationship with the number of components of public health (p < 0.05). Spiritual intelligence
also had a significant positive relationship with general health. However, the number of components
of spiritual intelligence has a significant negative relationship with the number of components of
general health (p < 0.05).
CONCLUSION: Considering the relationship between religious orientation and spiritual intelligence
with public health and considering educational programs based on spiritual intelligence and religious
orientation in this group of people can be an important step in promoting their general health.