Journal of Education and Health Promotion

Abstract BACKGROUND: Suicide ideation is one of the common mental health problems among university
students. This study aimed to explain suicide ideation susceptibility by examining the relationships
between psychological factors.
METHODOLOGY: The population of the study included all female undergraduate students at the
University of Isfahan in autumn 2018. A sample of 180 individuals were selected through multistage
sampling from different faculties and majors. The scales used in this study included adults attachments
inventory, Coping Inventory for Stressful Situation, Dysfunctional Attitudes Scale, and Suicide Ideation
Scale. The statistical analyses included t‑test, Pearson correlation, and path analysis.
RESULTS: Suicide ideation was reported in 25% of the participants. The t‑test analysis indicated
that the mean scores for dysfunctional attitudes (P < 0.01) and problem‑focused coping (P < 0.01)
were significantly different in with and without suicide ideation groups. Suicide ideation significantly
correlated with problem‑focused coping (r = −0.42, P < 0.01), emotion‑focused coping (r = 0.25,
P < 0.05), and dysfunctional attitudes (r = 0.23, P < 0.05). Path analysis showed that dysfunctional
attitudes and emotion‑focused coping significantly influenced suicide ideation. Moreover, the indirect
effect of insecure (ambivalent and avoidant) attachment styles by mediating role of dysfunctional
attitudes and emotion‑focused coping was statistically significant (P < 0.01) and the indirect effect
of dysfunctional attitudes by mediating role of emotion‑focused coping as well (P < 0.05).
CONCLUSION: Insecure attachment styles and dysfunctional attitudes work as stress–diathesis
model in predicting suicide ideation and increase suicide ideation susceptibility by affecting
emotion‑focused coping strategy. The hypothesized model in this study can help formulate, evaluate,
and prevent suicide risk.

Abstract INTRODUCTION: Eaching methods are the stimulation, guidance, direction, and encouragement
for learning and also the means to achieve the desired educational objectives.
AIM: This study aimed to assess peer learning (PL) versus conventional teaching (CT)
regarding antenatal assessment in terms of knowledge, skills, and satisfaction among nursing
students.
METHODS: This was a quasi‑experimental study conducted on 51 B.Sc.Nursing 3rd‑year students
who were selected by convenient sampling and randomly assigned to PL (n = 21) and CT (n = 30)
group. Sample characteristics pro forma, structured knowledge questionnaire, observational checklist,
and satisfaction rating scale wereused to collect data from nursing students through self‑report and
observational technique.
RESULTS: The study results revealed that the mean posttest knowledge score (19.1 ± 0.75) in PL
group was higher than that in CT group (17.0 ± 0.741) and the mean rank skill score of PL group (44.90)
was higher than that in the CT group (20.30). There was no significant difference (t = 1.08, P > 0.05)
in mean posttest knowledge score, whereas the significant difference was found in posttest skill
score (Z = 5.00, P ≤ 0.01) among nursing students. Most of the nursing students were satisfied
with the CT method. There was a mild positive correlation (r = 0.25) between knowledge and skills
regarding antenatal assessment among nursing students.
CONCLUSION: Based on the findings of the study, it can be concluded that both PL and CT groups
were found to be equally effective in improving knowledge and skills of nursing students regarding
antenatal assessment.

Abstract INTRODUCTION: Hemophagocytic lymphohistiocytosis (HLH) is caused by overactivation of
immune system. Gene mutations, infections, malignant, and autoimmune trigger the development
of the disease.
MATERIALS AND METHODS: Clinical data and peripheral blood samples of 21 patients suspected of
HLH were collected in Shiraz Medical Centers 2017–2018. Peripheral blood samples were analyzed
for soluble interleukin‑2 receptor alpha (sIL2Rα) marker (sCD25), and the results were compared
with 36 normal controls as well as comparison with clinical findings and other laboratory parameters.
RESULTS: Twenty‑one patients (11 males and 10 females) with an average age of 5.2 were
investigated. In this study, peripheral blood samples were taken from 16 newly diagnosed patients
before treatment, and five were posttreatment blood samples. The mean sIL2Rα level before
treatment in 16 patients was 9023 pg/ml. The mean peripheral blood sample of the 36 controls was
3025 pg/ml. The mean of the five posttreatment samples was 4198 pg/ml. Significant difference
between pretreatment and the control group was observed. However, no significant difference was
detected between after treatment samples and the control group. By comparing the sIL2Rα levels
between patients with increased aspartate aminotransaminase (AST) and patients with normal AST
level, there was a significant difference in the amount of IL2Rα level.
CONCLUSION: This study highlights the importance of IL2Rα marker in the diagnosis and follow‑up,
during treatment and suppression. Furthermore, a significant difference with respect to AST level
requires further investigation.

Abstract INTRODUCTION: Medical education is facing a challenge in meeting society’s demands about their
health improvement. Due to this, it seems necessary to educate creative and thoughtful staff for
health‑care system. By this introduction, this study aimed to compare the effect of “learning based on
classic education” and “learning based on participatory education” on nursing students critical thinking.
MATERIALS AND METHODS: Thirty‑eight nursing students participated in this study. Students were
chosen by census method and were divided into two groups randomly. The California critical thinking
questionnaire was used for data collection. Data were analyzed using SPSS v. 19 by descriptive
statistics and t‑test.
RESULTS: The results showed a significant difference between the mean score of critical thinking
before and after conducting the “learning based on participatory education” method. Difference
between mean score was significant between the two groups. This mean score was more increased
in group which “learning based on participatory education” method was conducted.
CONCLUSION: The increased score of critical thinking among students with “learning based on
participatory education” method showed the welcome of students toward new and dynamic methods
of teaching the critical thinking and proved this that critical thinking can be useful in nursing education.

Abstract Blended learning (BL) refers to a systematic teaching method, which combines the aspects of
face‑to‑face and online interactions using appropriate Information and Communication Technologies.
This mixed‑method systematic review (SR) protocol is developed with the objective to determine the
effectiveness and appropriateness of BL in the health‑care professional education. Mixed‑method
SR protocol: For the purpose of this SR, PICO is defined as P‑entry level graduate students of health
sciences program; I‑BL; C‑traditional face‑to‑face training; and O‑achievement of learning outcomes,
learner’s and teacher’s perception (primary). The search will be done through possible database
using predetermined search strategy. Eligible studies will be appraised independently by authors.
Joanna Briggs Institute’s mixed‑method protocol will be used to assess and synthesis the data. This
protocol is registered with the International Register of Systematic Reviews (PROSPERO) with the
registration number CRD42018082699.

Abstract BACKGROUND AND OBJECTIVE: Data on the factors affecting long‑term mortality following a
stroke in Iran are scarce. The current research aimed at investigating the extent of 2‑year mortality
following a stroke and the factors affecting it in the northwest of Iran.
MATERIALS AND METHODS: This prospective cohort study was conducted in Tabriz, Northwest
of Iran. Patients with computed tomography/magnetic resonance imaging confirmed the first‑ever
stroke were included in this study and followed up to 2 years. Clinical examinations, including the
severity of the stroke using the modified National Institutes of Health Stroke Scale (mNIHSS), were
conducted by a neurologist. The general characteristics, lifestyle factors, and laboratory tests were
also completed. To estimate the survival, Kaplan–Meier analysis was used; and for group comparison,
the log‑rank method was applied. To identify the factors predicting 2‑year mortality, semiparametric
Cox regression analysis was used.
RESULTS: A total of 1036 first‑ever stroke patients were included in the present study. The
mortality rates of stroke in 6‑month, 1‑year, and 2‑years follow‑up periods were 31.6%, 34.5%, and
38%, respectively. The two‑year mortality rate was 33.6% in ischemic and 58.7% in hemorrhagic
stroke (P < 0.001). In the multivariate Cox model, variables age, type of stroke, diabetes, and severity
of the stroke, according to the mNIHSS index, were identified as factors predicting 2‑year mortality
following the stroke.
CONCLUSION: The 2‑year mortality following acute stroke was relatively high compared to that of in
developed countries. Implementation of secondary prevention is recommended to better management
of modifiable predictors of mortality.

Abstract BACKGROUND: Due to increasing number of the world population, elderly individual’s quality of
life (QOL) is a matter of concern and marital status as one of the objective measures of QOL is of
paramount importance. This study was done to compare the QOL between single and remarried
elderly.
MATERIALS AND METHODS: This case–control study was conducted on 200 elderly people in
Qaen (Southern Khorasan province), Iran. The research sample consisted of two groups of single
and remarried elderly, 100 in each group. A demographic and LEIPAD (an acronym deriving from
the name of Leiden and Padua universities) QOL questionnaires were completed by the participants
via interview.
RESULTS: There was a significant difference between single and remarried elderly groups
in the QOL (P < 0.001). Linear regression showed that marital status (P < 0.000), economic
situation (P < 001), primary education (P < 0.0002), and diploma (P < 0.030) opposed to the illiterate
were significantly related to the QOL. In other words, being married and higher economic situation and
education increase the QOL. There was a significant negative correlation between the age (P < 0.000)
and QOL. The strongest factor was age.
CONCLUSIONS: Marital status, income, and education play an important role in all aspects of QOL in
older adults. Thus, being married can be a protective factor against physical, psychological, and social
problems in old age. Realizing this issue in consultation process of elderly peoples is recommended.

Abstract INTRODUCTION: In this era of globalization, urbanization, and rapidly expanding unhygienic food
corners across the globe, the incidence of food poisoning is very common nowadays.
AIM: The aim of our study was to investigate the perceptions and readiness of schoolteachers to
accept notifications on food poisoning as a part of education to the students.
METHODOLOGY: A descriptive cross‑sectional study was carried out with the help of a validated
questionnaire for data collection. Our research involved schoolteachers from both primary and
secondary schools in Muar. The questionnaire was pretested among the eligible trainee teachers
and yielded an internal consistency reliability coefficient (c = Cronbach’s alpha) of 0.082. This study
was conducted from October 29, 2017, to December 14, 2018, in Muar. Our sample size was 259.
Ethical consent was obtained from the Institution Ethical Committee.
RESULTS: A total of 259 schoolteachers from both primary and secondary schools in Muar were
included in this study. In our study, 81.1% of the teachers responded that they can easily educate
their students about food poisoning. Most of them (93.1%) were ready to receive notifications on food
poisoning in any mode, and about 72% of the teachers preferred WhatsApp as their mode of receiving
notification. The least (1.2%) preferred mode of notification was LINE (a social app). Teachers’
willingness to disseminate the information regarding food poisoning was also higher (98.5%).
CONCLUSIONS: We concluded that majority of the schoolteachers had a good perception and
were ready to receive the notifications on food poisoning through WhatsApp as a part of education
to the students.

Abstract INTRODUCTION: Due to the increasing prevalence of diabetes in the world, the assessment of
the patient needs is essential. Understanding the needs of patients will play a very important role
in providing an effective training program for patients. This study aimed to explain the health‑care
needs of patients with diabetes in Iran’s health‑care system.
MATERIALS AND METHODS: The present study was conducted using a modified Delphi technique
in three rounds in 2017–2018. In the first round, patients’ needs were extracted based on qualitative
interviews and a review of the literature. Then, the second and third rounds were determined through
surveys, achieving maximum consensus and grading the importance of the patients’ basic needs.
Participants selected using purposeful sampling and included 58 diabetes patients, family, and
providers of the health system who were referred to urban health centers, rural, and one of the clinics
of Darreh Shahr, Ilam Province. For data analysis, qualitative content analysis was used in the first
Delphi round and descriptive statistics were used in the second and third rounds.
RESULTS: Regarding health‑care needs of patients with diabetes, four main themes included:
information and knowledge needs, need for reinforcement/reform of religious‑cultural beliefs, need
for health self‑management, and ultimately supportive needs have emerged.
CONCLUSIONS: According to the results, before designing and developing effective educational
programs, the need assessment to improve knowledge, correcting unrealistic attitudes and beliefs, as
well as modifying their self‑care behaviors and performance in preventing diabetes is recommended.

Abstract INTRODUCTION: Stroke causes physiologic functional changes such as vascular resistance and
arterial remodeling. This study aimed to explore the effects of 3‑month regular home‑based exercise
rehabilitation on brachial flow‑mediated dilation (FMD), daily physical activity, and upper and lower
extremity sensorimotor of the acute ischemic stroke patients.
MATERIALS AND METHODS: This randomized control trial was done from August 2017 to September
2018. Patients with unilateral ischemic stroke were recruited from inpatient wards at an educational
hospital. Patients were randomly assigned to the home‑based rehabilitation program (intervention
group) or usual care (control group). Fugl‑Meyer upper and lower extremity sensorimotor score and
Barthel score were evaluated in both the groups before and 3 months after baseline assessment.
Furthermore, brachial artery vasomotor reactivity (FMD) hemiparetic arm assessed vascular health.
The intervention group received home‑based rehabilitation exercise program for 3 months. The
control group did not receive home‑based rehabilitation program and incentive telephone call. All
data were collected and analyzed by SPSS software (version 20) and appropriate statistical tests.
RESULTS: Forty ischemic stroke patients (twenty in the intervention group and twenty in the control
group) were examined. Results showed that Barthel score and Fugl‑Meyer upper and lower extremity
score and FMD in the intervention group were significantly higher than the control group after 3‑month
home‑based exercise rehabilitation (P < 0/001).
CONCLUSION: Twelve‑week regular home‑based exercise training was well tolerated by the
intervention group. After this period, improvements were reported in brachial FMD as well as daily
physical activity and upper and lower extremity functional capacity.

Abstract INTRODUCTION: An oral health program for mothers starting from pregnancy in a disadvantaged
district of İzmir was performed in 2013–2016. Dental behaviors and their determinants among
intervention and control groups were compared in the third phase of the program.
METHODS: This nonrandomized‑controlled study was conducted in Phase 3. The intervention group
began with 248 pregnant women; 69.4% (n = 172) of mothers with 6–9‑month‑old babies participated
in Phase 2, 2014. At Phase 3 (18–24 months), 68.6% (n = 118) of mothers in the intervention group
and 113 mothers living in another district as controls were included. Sociodemographic characteristics,
determinants of behaviors, and outcomes defined as dental behaviors in the last week were assessed
using a questionnaire.
RESULTS: Regarding knowledge, perceived severity, and fatalistic beliefs, the intervention group
had higher correct answer percentages. The percentage of mothers who could clean their children’s
teeth before sleep was higher in the intervention group (76.3%; P < 0.05), but the difference was
lost by a child’s resistance. The significant difference on avoiding bedtime nursing (65.3%) and
sugary snacks (74.4%) in the intervention group disappeared with the obstacle of a child’s protests
or interference from relatives. In the intervention group, 32.2% of the mothers reported that they
did not give any sugary snacks, 43.2% had never fed during sleep, and 26.3% cleaned their
children’s teeth during the last week. The results in the control group were 24.8%, 18.6%, and 8.8%,
respectively (P < 0.05).
CONCLUSIONS: The program improved the mothers’ views regarding the determinants of dental
behaviors, but greater support against obstacles was needed. Social environmental support is planned
for the following stages of the program.

Abstract OBJECTIVES: This study discussed about challenges and opportunities of institutional accreditation
in Iranian medical universities. The lesson learned of the first round of the accreditation would direct
initiatives and solutions for future accreditation.
METHODOLOGY: This research is a qualitative content analysis research that studied the experience
of the survey visit teams. Semistructured interviews with a purposive sampling approach were done
to reach data saturation. Constant comparative method was used to analyze the data.
RESULTS: The emergent themes were incompatible scheduling with accreditation workload,
accreditation sustainability, the weakness of the survey instrument, advantage of the survey
instrument, the quality of evaluators’ survey, the opportunity of progress for universities, accreditation
perspective, defendable cost opportunity, perceived injustice, and the leading strategies. In this study,
the relationship between categories and themes was shown with a systematic approach.
CONCLUSION: In medical education systems, it is necessary to continue the research and
development studies using the findings in each accreditation period to achieve the prospect of
international accreditation.

Abstract CONTEXT: Iran’s health system has always faced many challenges in the field of disaster risk
management. The establishment of early warning systems in countries has been identified as an
important component of preparedness and risk reduction.
AIMS: This study aims to extract the experiences of those involved in the field of risk management
in relation to the challenges and problems of early warning system establishment in the Iran’s health
system.
SUBJECTS AND METHODS: This was a qualitative study, which has been conducted using a content
analysis method. Data were collected through semi‑structured interviews with 16 individuals who
had at least one disaster management experience at the emergency operation centers. Sampling
was done purposefully. The data were then analyzed using the Grenheim method.
RESULTS: Nine subcategories of data were analyzed that included legal vacancies, challenges
related to protocols and guidelines, weaknesses in the prediction infrastructure, weaknesses in
the communication infrastructure, poor coordination, scarcity of resources, inadequate education,
information management challenge, and evaluation challenge, and three main categories were
extracted that included policy challenges, infrastructure challenges, and management challenges
that represented the issues experienced in establishing an early warning system in the Iranian
health system.
CONCLUSION: Policy‑makers and managers of health system need to pay special attention to
improve the legal framework and standard protocol, strengthening infrastructures, increasing
management performance in the field of coordination, education, allocation of resources, flow of
information, and evaluation system.

Abstract BACKGROUND: Negative attitudes toward vaginal delivery are an important reason for pregnant
women to undergo a cesarean section. Therefore, this study was performed to evaluate the effect
of motivational interviewing on attitude and choice of primigravida women on type of delivery in
requesting elective cesarean section.
MATERIALS AND METHODS: In this single‑blind clinical trial, 120 primigravida women in
28–31 weeks of gestation with normal pregnancy determined by a multistage sampling were randomly
chosen from ten health centers of Zahedan city in 2019 and were divided into two groups. Motivational
interviewing was performed in four sessions within 90 min in the experimental group, and the
control group received routine care service. Attitude (before and 1 month after the intervention) and
performance (after delivery) were evaluated using a valid and reliable researcher‑made questionnaire.
The collected data were analyzed using different proportions, paired t‑test, independent t‑test,
covariance analysis, and Shapiro–Wilk and the Chi‑square methods.
RESULTS: There was a significant difference in the attitude of participants between the two groups
after the intervention (P = 0.001). The mean difference of pre‑ and posttest was significant in relation
to attitude scores in the two groups (P = 0.001), and the difference between the two groups was also
statistically significant between the two groups in terms of delivery type (P = 0.03).
CONCLUSION: We conclude that motivational interviewing can be a useful tool to change the attitude
and decrease the rate of unnecessary cesarean among pregnant women. It is recommended to
examine the impact of this method on women from different societies who have various educational
backgrounds and cultures.

Abstract BACKGROUND: The attitude of nurses with regard to patients’ rights bears greater influence on
its practice in the health‑care settings. As health‑care organizations grow toward standardization,
positive changes in the attitude of health‑care professionals are demanding.
OBJECTIVES: The objectives of this study were to assess the attitude of nurses with regard to patient
rights in two teaching hospitals, to devise a training program on patient rights for nurses, and to compare
the impact of training with regard to patient rights on the attitude of nurses in two teaching hospitals.
MATERIALS AND METHODS: This quasi–experimental study with one‑group pre‑ and post‑test
research design for a sample of 200 nurses was carried out during the year 2017 at two multispecialty
hospitals in India. The sample size was selected based on convenience sampling method. For the
pretest, attitude was measured on a 5‑point Likert scale through a questionnaire containing 27 items.
Small‑group teaching method was used to train nurses in groups of 8–10. Posttest was done through
the same attitude questionnaire 1 week after the training program.
RESULTS: In both the hospitals, the nurses had a favorable attitude toward patient rights before
the training program; after training, majority of the nurses had the most favorable attitude toward
patient rights. A statistically significant difference was observed in the attitude of nurses with regard
to patient rights within the hospitals, before and after training nurses on patient rights (P < 0.001).
CONCLUSIONS: Health‑care organizations require developing planned teaching programs for nursing
care professionals in order to influence their knowledge and attitude on patient rights. Their positive
attitude toward patient rights leads to improved outcomes and effective nursing care practices.

Abstract BACKGROUND: The most important reasons for choosing cesarean include negative attitude of
pregnant women toward natural childbirth, and it is not easy for many women to make a decision
about the choice of delivery, Midwives as responsible individuals, play an important role in providing
maternal counseling and care during pregnancy and childbirth and the postpartum period. This study
was carried out to determine the effect of individual counseling on attitudes and decisional conflict
in the choice of delivery among nulliparous women.
MATERIALS AND METHODS: This clinical trial was performed on 90 nulliparous women with
28–30 weeks of gestational age, who were referred to health‑care centers in Mashhad. They were
divided randomly into intervention and control groups. The intervention group received the counseling
program individually during three sessions, while the control group received routine care, childbirth
attitudes, and decisional conflict on choice of delivery were compared on women of 34–36 weeks
of pregnancy. Data collection tools included demographic details form, Childbirth Attitudes Scale
and Decisional Conflict Scale; data were analyzed using Chi‑square tests, Fisher’s exact test,
Mann–Whitney test, t‑test, parried t‑test, and ANCOVA in SPSS v. 16, and P < 0.05 was considered
statistically significant.
RESULTS: After consultation, there was a significant difference in attitude score between the
intervention group (86.577 ± 13.531) and the control group (69.955 ± 19.858) (P < 0.001), And there
was a significant difference in decisional conflict score between the intervention group (0.614 ± 0.626)
and the control group (1.216 ± 0.949) (P < 0.001), and there were significant differences between
the two groups in terms of preferred delivery (P < 0.001).
CONCLUSION: According to the results of this randomized control trial, individual counseling in
nulliparous women during pregnancy leads to a positive attitude toward natural childbirth, informed
decision‑making, and increase in the selection of natural childbirth.

Abstract INTRODUCTION: The principal objective of clinical guidelines is to improve the quality of medical
care. However, standardized evaluation of the adoption into daily practice is missing. The aim of our
study was to investigate the implementation of guideline recommendations on the management of
arterial hypertension (AH) in German general practitioner’s (GPs) offices.
METHODS: A questionnaire focusing on the implementation of the German guidelines for the
management of AH was developed and prospectively rolled out in 3.200 GPs and field‑based
specialists in internal medicine in Germany. Data were interpreted in an explorative way.
RESULTS: Data from 689 German physicians that participated in the survey were analyzed.
Effectiveness of lifestyle changes in the management of AH was rated as very high or high in 36.6%.
When lifestyle changes only will not normalize blood pressure (BP), medical treatment will be initiated
after 2–6 months by majority of physicians. Decision for mono‑ or combination therapy was driven
by BP and patient’s risk profile. Choice for a specific antihypertensive substance was based on the
recommendations of scientific guidelines in the majority of GPs.
CONCLUSIONS: Medication treatment algorithms recommended in 2015 by German guidelines
are well accepted by GPs. Lifestyle changes are voted by only slightly more than one‑third as a
reasonable tool for the management of AH in the setting of the medical office. This might reflect a
lack of certified medical education regarding this topic. Our study was not designed to register the
time from publication of guidelines to practical implementation.

Abstract BACKGROUND: Sexual health education, especially in adolescents, faces excess challenges in
many cultures. Iranian adolescents, especially boys, have many educational needs in the field of
sexual health that have not been met due to various obstacles. The main purpose of this qualitative
study was to explore the challenges of sexual health education for Iranian adolescent boys.
MATERIALS AND METHODS: This qualitative content analysis study was conducted through
individual semi‑structured in‑depth interviews from 45 participants (20 adolescents and 25 key
adults). Data were analyzed using inductive conventional content analysis based on the Graneheim
and Lundman’s approach via MAXQDA software (version 2010) by VERBI GmbH Company, Berlin,
Germany.
RESULTS: In total, 2 categories and 11 subcategories emerged; including, “extrapersonal barriers
to sexual health education for adolescent boys” containing seven subcategories of lack of clear
policies, family inadequacy, social barriers, cultural heterogeneity, school inadequacy, cyber threats,
and educational process inadequacy concerning adolescent sexual health education as well as
“intrapersonal barriers to sexual health education for adolescent boys” comprised four subcategories
of uncontrolled emotions of adolescence, adolescent rebellion, information and communication
weaknesses, and adolescents’ concerns about being judged by others.
CONCLUSION: The findings clarify some barriers to sexual health education for adolescent boys.
Therefore, it was recommended to develop community‑based educational programs to change
attitudes of families and society toward addressing the challenges of providing sexual health
education to adolescent boys. Moreover, it was suggested to utilize an educational program specific
to adolescent boys, tailored to the Iranian culture, using the potential of religion.

Abstract BACKGROUND: Spiritual healing is a complementary and alternative treatment with different
meanings in different cultures and religions. However, the concept has not been defined from the
cancer patients’ points of view. The present study was done with the aim of concept analyses of
spiritual healing from Iranian cancer patients’ viewpoints.
METHODOLOGY: The study was done using a hybrid method at three phases including of theoretical
study, field study, and final analysis. In the theoretical study phase and using the keyword “spiritual
healing,” pertinent articles were searched in main databases. In the field study phase, ten cancer
patients were interviewed, and in the final phase, the two other phases were analyzed. After
determining features, antecedents, and consequences, a conclusive definition of spiritual healing
from Iranian cancer patients’ viewpoints was proposed.
FINDINGS: Spiritual healing from Iranian cancer patients’ viewpoints was featured with four themes,
including connection with paranormal forces; effective, noninvasive, inexpensive, and efficient
therapeutic method; a way to achieve piece, adaptation, and health and influenced by cultural and
religious beliefs. Spiritual healing is a complementary and alternative treatment that helps careseekers
to achieve health through paranormal forces and energies. As the findings showed and according to
the participants’ viewpoints, the source of such forces and energies was divine force and the healers
were mediums to transfer the energy.
CONCLUSION: The findings supported that religion and faith were the key elements of spiritual
healing in the Iranian Islamic context.

Abstract INTRODUCTION: Effective communication is one of the most important factors in advancing the goals
of library services and the identifying factors affecting it and having a single model for such factors
are of utmost importance. The aim of this study was to develop a structural model of self‑compassion
measured based on spiritual intelligence (SQ) as factors affecting communication in medical library
and information science students.
MATERIALS AND METHODS: This was a correlational study done by structural equation modeling
method. A total of 290 undergraduate and graduate students of Medical Library and Information
Sciences of Iran’s Universities of Medical Sciences were selected by simple random sampling. In this
study, the data were collected by the Neff’s Self‑Compassion Scale and the King’s Spiritual Intelligence
Self‑report Inventory. Self‑compassion measured based on SQ was tested by goodness‑of‑fit indices.
Statistical analysis was performed using SmartPLS software.
RESULTS: The results showed that there was a significant relationship between SQ and
self‑compassion. Furthermore, the positive values of predictive indices could confirm the
self‑compassion measured based on SQ. Composite reliability indicated the high reliability of SQ
and self‑compassion.
CONCLUSION: According to the fitting indices of the model, it can be concluded that the
self‑compassion model has an acceptable fit on the basis of SQ.

Abstract BACKGROUND: Occupational stress is known as harmful physical and emotional responses that
occur when the requirements of the job do not match the resources, needs, or capabilities of an
employee, leading to poor mental and physical health.
OBJECTIVE: The objective of the present study was to assess the effect of 1‑week residential yoga
training program on occupational stress and its subscales among principals.
METHODS: Thirty‑three principals with ages 40–59 years completed the assessment. They received
yoga training at Kaivalyadham Yoga Institute. All the participants were recruited by Kendriya Vidyalaya
Sangathan as part of their on‑duty yoga training. At the baseline and after 1 week of yoga training
participants were assessed for occupational stress. The yoga intervention was given in the morning
and evening for 105 min. Apart from yoga training, all the participants were engaged in lectures based
on stress management, yoga for total health, meditation, yoga in school education, and scientific
basis of yoga, daily for 3 h.
RESULTS: The principals showed a significant decrease in role overload (P < 0.001), role
ambiguity (P < 0.01), role conflict (P < 0.05), under participation (P < 0.001), powerlessness (P < 0.001),
intrinsic impoverishment (P < 0.01), law status (P < 0.001), and overall occupational stress (P < 0.001)
after 7 days of yoga training intervention. However, there was no significant change in unreasonable
group and political pressure (P > 0.05), responsibility for persons (P > 0.05), poor peer
relations (P > 0.05), strenuous working conditions (P > 0.05), and unprofitability (P > 0.05) after
yoga training intervention.
CONCLUSION: The present study suggests that 1 week of residential yoga training program can
improve occupational stress in principals.

Abstract INTRODUCTION: Knowledge management enhances efficiency, empowers employees, and
enhances organizational health. Social capital provides a good basis for more productive human
resources, and training hospitals also play a key role in the health‑care system. The purpose of this
study was to determine the relationship between knowledge management and social capital with
organizational health in selected educational hospitals of Tehran in 2018.
METHODS: This analytical cross‑sectional study was performed on 310 medical staff of hospitals using
proportional sampling method. The data gathering tools consisted of three standard questionnaires
of knowledge management, social capital, and organizational health. Data were analyzed using
descriptive and inferential statistics using SPSS version 22 software.
RESULTS: Most participants in this study were male (8/66%) and in the age group 31–36 years. The
mean of knowledge management and organizational health were 3.43 and 3.49, respectively. There
is a significant direct relationship between knowledge management components and organizational
health. Moreover, there is a significant but weak direct relationship between knowledge management
and social capital with organizational health dimensions (P ≤ 0.05).
CONCLUSION: Considering the relationship between knowledge management and social capital
with organizational health, enhancing the level of organizational health can help to improve the
dimensions of knowledge management and social capital. It is suggested that hospital managers, using
knowledge management and social capital components, enhance organizational health so that the
hospital is more prepared to adapt to the complexities and changes in the market providing services.

Abstract INTRODUCTION: Due to time constraints and a significant increase in medical information, one
of the ways to keep physicians and medical teams up to date is to use evidence‑based medicine.
The current research focused on the effects of the educational role of clinical informationist (CI) on
improving clinical education among medical students based on the Kirkpatrick (KP) model.
METHODS: The method was semiexperimental research in two group designed with pretest and
posttest. The research population included thirty medical students for each group that was selected
by the convenience time‑based sequential sampling method. The study data were collected using a
researcher‑made two questionnaires and a checklist. Data were analyzed by the descriptive statistics
and inferential statistics using SPSS version 20 software.
RESULTS: Based on the first level of the KP model, the total mean of medical students’ satisfaction
in the experimental group was 4.06 from 5. Based on the second, third, and fourth levels of the model,
the independent t‑test showed that before the intervention, the mean scores of attitude, knowledge,
information‑seeking skills and behaviors, and also clinical skills were not significantly different in both
the intervention and control groups (P > 0.05). After the intervention, the results of covariance test
showed that attitude, knowledge, information‑seeking skills and behaviors, and also clinical skills of
the intervention group are significantly better than that of the control group (P < 0.001).
CONCLUSION: Training and the presence of the CIs in the clinical round had resulted in the
improved satisfaction, attitude, knowledge, and information‑seeking skills while also improving
information‑seeking behaviors and clinical skills of medical students.

Abstract INTRODUCTION: Assessment interprofessional collaboration (IPC), in community health‑care
setting usually has been neglected due to the lack of standard tools and assessors. In the present
study, the IPC checklist extracted from CANMEDS collaborator toolkit for teaching and assessing
the collaborator role is contextualized in Iranian community healthcare.
MATERIALS AND METHODS: According to CANMEDS Toolkit, an instrument extracted for IPC
assessment. Using Chavez’ toolkit, face and content validity were studied through two rounds of
Delphi by 12 experts of TUMS. Qualitative content validity including content validity index (CVI),
and content validity ratio (CVR) were assessed following watching a standard video about IPC by
them. Construct validity was studied by confirmatory factor analysis through LISREL software. To
check reliability, Cronbach’s alpha was calculated, and the other 12 experts completed checklists in
test–retest process with a 2‑week interval.
RESULTS: Face and qualitative content validity were confirmed using the Delphi method. CVI and
CVR were calculated as 0.61 and 0.86. In factor analysis, x2/df and RMSEA were calculated as
1.363 and 0.036; CFI, IFI, GFI, and AGFI were >0.7, and hence, the construct validity was confirmed.
Cronbach’s alpha was 0.953 for internal consistency. Test–retest was also calculated as 0.918
indicated to confirm reliability.
CONCLUSION: CANMEDS framework as an assessment tool for evaluating IPC in community health
setting is not only valid and reliable in the Iranian context but also it is easy to use for respondents
resulted from the rational number of items in community.

Abstract BACKGROUND: In the dedicated intensive care settings, health‑care providers need to have higher
temporal cognition and sympathovagal balance to optimally deliver critical care interventions.
OBJECTIVE: The objective of the study was to estimate the parameters of the temporal cognition
and autonomic function of paramedical staffs in acute health‑care settings.
MATERIALS AND METHODS: In this study on 81 healthy adult paramedical personnel, temporal
cognition was assessed using auditory reaction time (ART), visual reaction time (VRT), critical
flicker fusion frequency (CFFF), Stroop test (ST), and digits forward test (DFT); Autonomic functions
were assessed by heart rate (HR) and blood pressure (BP) variability, and all these outcomes were
analyzed with their academic performance.
RESULTS: Out of 81 healthy adult nonteaching technical personnel, majority was female; the mean
age was 25.10 ± 3.93 years. Age and gender were not significantly related with screen times in terms
of smartphone use, playing video games, or regularly using computer; academic performances
were also not significantly related with screen times in terms of smartphone use, playing video
games, or regularly using computer. In the conventional domains, during analysis of physiological
and psychological variables under study, there was no significant relation with screen times when
compared with HR, systolic BP, diastolic BP, mean arterial pressure, body mass index, ART, VRT,
CFFF, ST, and DFT. Playing video games and regular computer use were significantly correlated
with age, gender, AP, CFFF, ST, and DFT.
CONCLUSION: This study on paramedical personnel showed a positive relation of temporal cognition
and sympathovagal autonomic balance with performing a task or function.