Journal of Education and Health Promotion

Abstract INTRODUCTION: The most important goal of a proper health‑care system is to provide good health.
Today, patients do not consider hospitals as simply a place of rehabilitation; rather, they compare
the hospital with a hotel in terms of environment, facilities, services, and quality of accommodation.
This study aims to use DEMATEL approach to extract factors affecting the hoteling quality.
METHODS: This was a descriptive, cross‑sectional study conducted in 2018. The study was carried
out in two steps. In the first step, the factors affecting the hoteling quality were extracted, and in
the second step, the DEMATEL technique was used to analyze and rank the cause and effect. The
study population consists of all experts in the fields of medicine and health care (hospital managers,
deputies, and faculty members familiar with accreditation and hoteling), among which twenty experts
were selected using purposeful sampling and a questionnaire designed by the researcher consisting
of 11 dimensions was distributed among them. The reliability of the questionnaire was calculated
using Cronbach’s alpha coefficient which was equal to 0.85 while its validity was confirmed using
Delphi technique. DEMATEL approach was used for data analysis.
RESULTS: The results show that among factors, human factors and economical–financial factors
and, among subfactors, maintaining human dignity and quick action in providing emergency services
are among the most important factors affecting the hoteling quality. Maintaining human dignity and
speed of action in providing emergency services to patients was identified as the most important
factor in improving hoteling quality.
CONCLUSION: The results of this study can be used to evaluate the quality of accommodations
and health facilities, medical equipment, and building quality of hospitals, which can lead to effective
actions and improvement of patient satisfaction and the eventual success of health transformation plan.

Abstract BACKGROUND: Government of India recognizes the use of “information, communication, and
technology” in the provision of comprehensive primary healthcare. In 2014–2015, Karuna Trust,
a nongovernmental organization, Bengaluru, India, introduced an electronic health record (EHR)
innovation, namely “Comprehensive Public Health Management” application (CPHM App). Data
could be entered in an offline mode followed by syncing with cloud. The CPHM App was piloted in
primary health center (PHC) Gumballi, in Karnataka, with focus on household survey and maternal
and child health (MCH) services.
OBJECTIVES: To compare the consistency of selected MCH process indicators for Health
Management Information System [HMIS] available from paper‑based records and those generated
through the CPHM App (2016–2017). We also explored the implementation enablers, barriers, and
suggested solutions from the user perspective.
METHODS: A sequential mixed‑method study design was followed. Quantitative phase involved
aggregate data analysis looking into the consistency of selected MCH process indicators available
from paper‑based records and those generated through the CPHM App (2016–2017) followed by
thematic analysis of in‑depth interviews of healthcare providers. Consistency was defined as a
percentage where the numerator was the HMIS‑related process indicator data from CPHM App and
denominator was the data from paper‑based records.
RESULTS: Three out of 12 selected MCH indicators had consistency of  >80%. The quarterly
consistency reduced over the 2 years. Dual burden of entry and regular monitoring of paper‑based
records by district health and family welfare department were the reasons why more importance was
given to entry in paper‑based records. Ability to generate aggregate indicators with CPHM App, easy
to use and retrieve data in the field, and reminder facility for planned health activities were some
of the factors facilitating CPHM implementation. The key barriers were limited technical expertise
and support from the technical team and no internet connectivity in the field and traveling to PHC
to sync the data. Provision of real‑time technical support and availability of data connectivity in the
field were some of the solutions suggested.
CONCLUSION: There should be a minimum of 1–2  years of simultaneous use of EHR and
paper‑based records after which one must shift to EHR.

Abstract INTRODUCTION: One of the psychiatric disorders related to childhood is attention deficit hyperactivity
disorder that can negatively affect the family interactions of these children. Parents of these children,
especially the mother as the main caregiver, need comprehensive training to make a positive difference
in their attitudes and behaviors with these children. The purpose of this study was to investigate the
effect of emotion regulation training on family relationships in hyperactive children.
METHODS: This was a randomized clinical trial study with a control group performed on eighty
mothers of hyperactive children who were selected randomly. The intervention group members
attended emotion regulation skills training sessions for one session of 90 min each week for 8 weeks.
During the training course in the intervention group, the control group did not receive any training.
Data collection tools included demographic information questionnaires, Mother–Child Relationship
Evaluation, and Rahim Organizational Conflict Inventory‑II. Data analysis was performed by
descriptive statistics and the analysis of covariance.
RESULTS: The mean scores of the mother–child relationship in the intervention group
showed a significant improvement in the subscales of acceptance, overprotection, facilitation,
and rejection (P  <  0.0001). The results of this research also showed improvements in all the
five communication styles of integrating, avoiding, compromising, obliging (P  <  0.0001), and
dominating (P < 0.012) between spouses.
CONCLUSION: It seems that the emotion regulation training approach in mothers with hyperactive
children improved both the mother–child relationship and the interactive spousal styles and can be
considered by the managers of treatment and rehabilitation field as an adjunctive therapy for the
families of these children.

Abstract BACKGROUND: An unhealthy lifestyle can threaten the health of nursing staff, especially in the
context of cardiovascular diseases  (CVDs). Considering the importance of health education in
promoting preventive behaviors against these diseases, this study aimed to evaluate the effect of
an educational program based on the health belief model (HBM) on improving preventive behaviors
of nurses against CVDs.
MATERIALS AND METHODS: This is a randomized controlled trial with a pretest–posttest design
conducted on 104 nursing staff of Imam Khomeini Hospital in Kuhdasht, Lorestan, Iran, in 2017.
They were randomly assigned into two groups of HBM (n = 52) and control (n = 52). The HBM group
received the educational intervention for 6 weeks, one session per week each for 30–40 min. They
were measured before and after the intervention using a demographic form, a researcher‑made HBM
questionnaire, Baecke Habitual Physical Activity Questionnaire, and the 3‑day food intake record all in
Persian. The collected data were analyzed in the Statistical Package for the Social Sciences (SPSS)
v. 24 software using the Chi‑squared test and paired t‑test.
RESULTS: The educational program could only increase the perceived severity (22.64 ± 2.22),
perceived benefits (50.83 ± 5.22), and perceived self‑efficacy (42.37 ± 5.93) of nurses in the HBM
group compared to the controls (P < 0.05). The nurses’ perceived sensitivity was also increased,
but it was not significant (P  >  0.05). In the HBM group, a significant change was found in the
food intake level for energy (t = 4.79, P = 0.000), protein (t = −2.99, P = 0.004), and unsaturated
fat (t = −2.94, P = 0.005) after intervention. No significant difference was observed in the total physical
activity score after the intervention (P > 0.05).
CONCLUSION: An educational program based on the HBM model can be used to increase the
severity, benefits, and self‑efficacy of the nurses’ preventive behaviors against CVDs and modify
their dietary regime.

Abstract INTRODUCTION: Marital quality is an important predictor of marital continuity, which can lead to
mental health, well‑being, and happiness for couples, and marital quality is equivalent to marital
satisfaction and adjustment. This study was carried out to purpose the effectiveness of metacognition
therapy on marital quality of women in the city of Isfahan.
MATERIALS AND METHODS: The research method was quasi‑experimental with a pretest–posttest
and control group design. The study population included all married women visiting consultation
centers in the city of Isfahan during March 2018–March 2019. The sampling method was nonrandom
voluntary sampling used to select 30 participants who were then randomly divided into experiment
and control groups (15 individuals each). The research tool was the Revised Dyadic Adjustment
Scale(RDAS). The experiment group participated in eight sessions of metacognition therapy, each
lasting 90 min. Covariance analysis method was used to analyze the data via SPSS21.
RESULTS: The result of covariance analysis showed that metacognition therapy has been effective
in improving the marital quality of the women in the city of Isfahan (P < 0.01).
CONCLUSION: The results of this study emphasize that metacognition therapy is effective on the marital
quality of the women in the city of Isfahan. Using this treatment plan can result in improved marital quality
and marital satisfaction and therefore improve the relationship of couples. Therefore, the results of the
current study can provide empirical support for the use of metacognition therapy to improve marital quality.

Abstract INTRODUCTION: Schools are a valuable platform for promoting oral health through oral health
education as the children spend most of their active time in schools. Training school teachers on oral
health promotion will help to inculcate healthy oral habits in children during their formative years of life.
OBJECTIVES: The objective of this study was to assess the knowledge, attitude, approach, and
action change of school teachers toward oral health and the impact of this training intervention in
improving their knowledge.
MATERIALS AND METHODS: An interventional study was conducted among 50 primary
school teachers across the country selected by the Ministry of Human Resource Development.
A self‑administered, 28‑item questionnaire in Google document format was developed to evaluate
the knowledge and practice of teachers toward oral hygiene before and after the teachers’ training
program. The training was done using a validated training manual on oral health promotion for school
teachers developed by the Ministry of Health and Family Welfare. Needs assessment for training
was conducted 1 week before this training program.
STATISTICAL ANALYSIS: Wilcoxon signed‑rank test and Mc Nemar tests were used to assess the
difference between the scores before and after oral health education.
RESULTS: The needs assessment revealed that majority of the teachers felt the need to participate
in oral health promotion training. A significant increase (P < 0.001) in mean knowledge scores of
school teachers was seen after a 1‑day training program.
CONCLUSION: The training improved the knowledge of school teachers on oral health which
indicates that the adopted method of oral health education was well received by the participants
from all over the country.

Abstract BACKGROUND: The empirical assessment of the health outcomes associated with migration caused
by climate change is still unclear. However, health outcomes in the early stages are expected to be
similar to the health outcomes associated with refugees. The objective of the present study was a
systematic review of the health effects of migration caused by climate change.
METHODOLOGY: A systematic review was conducted according to the Preferred Reporting Items
for Systematic Reviews and Meta‑Analyses guidelines. Online databases (PubMed, Scopus, Web
of Science, and Google Scholar) were used to identify papers published that evaluated the health
effects of migration caused by climate change. The search, article selection, and data extraction were
carried out by two researchers independently. All English‑language articles on the health effects of
migration caused by climate change were included in this study.
RESULTS: An analysis of the complex ways in which climate change influences populations can
be facilitated using a three‑class classification: compulsory displacement, resettlement planning,
and migration. Subsequent to climate changes, other changes, and environmental deficiencies,
compulsory displacement may occur in case of inadequacy of compatibility responses. A part of
migration‑related health outcomes caused by climate change is from displacement from rural to urban
areas, especially in developing countries. There is significant documentation on health and livelihood
inequalities between migrant groups and host populations in developed countries.
CONCLUSION: If climate change continues in its current direction, it is likely that the number of
refugees and crises will increase in the coming decades. Although the domain and the extent of health
hazards caused by the displacement of the population associated with climate change cannot be
clearly predicted, by reducing global greenhouse gas emissions, along with social and environmental
adaptation strategies, migration caused by climate change, health risks and its relevant crises can
be greatly reduced.

Abstract BACKGROUND: Childbearing is an important biological and social event in the life of most women. It
is a voluntary behavior that can be affected by many factors. Behavioral theories are a potential path
way to study and influence childbearing behavior. The present study was conducted to determine the
effect of an educational intervention based on the theory of planned behavior (TPB) on childbearing
intentions in women presenting to premarital counseling centers in Tehran.
MATERIALS AND METHODS: This randomized controlled quasi‑experimental study was conducted
on 150 women aged 20–35 years presenting to premarital counseling centers. The participating
women were randomly divided into an intervention (n = 75) and a control (n = 75) group using
randomized sampling in Excel. The intervention group received two 90‑min sessions of training. The
effect of training was assessed 6 weeks after the intervention using the researcher‑made questionnaire
based on the components of the TPB. The questionnaires included subjects’ demographic details,
knowledge (11 items), attitude (13 items), subjective norms (10 items), perceived behavioral control (8
items), and behavioral intention (4 items). Data were analyzed by SPSS software (version 22) and
independent t‑test, Chi‑square, Mann–Whitney U‑test, and Wilcoxon test. P <0.05 was considered
statistically significant.
RESULTS: There were significant differences between the intervention and control group after
the intervention in the Mean ± SD scores of knowledge (6.73 ± 2.63 vs. 4.73 ± 2.85, P = 0.001),
attitude (48.23 ± 7.19 vs. 40.13 ± 5.80, P = 0.001), perceived behavioral control (33.19 ± 5.28 vs.
23.59 ± 3.47, P = 0.001), and behavioral intention (13.84 ± 2.95 vs. 11.77 ± 2.12, P = 0.027).
CONCLUSION: The findings showed that an education based on the TPB increased women’s
childbearing intentions by affecting their knowledge, attitude, perceived behavioral control, and
intention. It is therefore essential to implement better public policies, create a more conducive
educational setting for women of different age groups, and build a social support system.

Abstract INTRODUCTION: It is less than a decade in Iran that integrated health kiosks have been limitedly
provided to public by private sector. Considering the significant benefits of them, this study aimed
to identify the barriers and facilitators for deploying kiosks in Iran’s formal health system in three
phases, “design and construct, implement, and use.”
MATERIALS AND METHODS: This was a qualitative study in Iran, and the data were collected
through 20 semi‑structured interviews with experts in 2019. Participants were selected by purposeful
method with the most diversity in terms of background and work experience; the interview texts were
coded in MAXQDA10 software and analyzed through framework analysis. Participants’ viewpoint
was used to verify the data and observers’ review to confirm them.
RESULTS: The barriers for designing and constructing kiosks were identified in the form of two main
themes: the overall structure of the country and the structure of the health system; the obstacles for
implementing were categorized in one main theme, lack of sources; and the barriers to use were also
fall into four themes related to people, policymakers, service providers, and designers of kiosks. The
facilitators at construction and implementation phases included the overall structure of the country
and the structure of health system. At the use stage, the facilitators related to people, health and
insurance policymakers, and owners and constructers were identified.
CONCLUSION: It is possible to deploy health kiosks in the Iranian formal health system, although
there are some time‑consuming and costly barriers which can be overcome by the strengths and
opportunities of the system.

Abstract BACKGROUND: This study has been carried out to study the usefulness of the clinical posting at the
National Referral Hospital in Bhutan. It is important to know whether the clinical experience leads to
gaining nursing skills, and nursing being a skill‑oriented profession, clinical placement provides an
opportunity, and education that carry a heavy weight in their wholesome nursing education.
OBJECTIVE: The objective was to explore how nursing students commonly perceive their clinical
experience.
METHODS: A focus group discussion was conducted with eight to ten students/group from three
levels of nursing education. The groups were 1st‑, 2nd‑, and 3rd‑year students who expressed their
clinical experiences during the focus group discussions. The data were analyzed by content analysis
using a thematic analysis.
RESULTS: Four themes emerged from the focus group discussion. The themes were “good exposure,”
“connect theory to practice,” “anxiety and fear,” and “learning by task participation and helping.”
CONCLUSION: The clinical environment is different to classroom. In clinical areas, the students
experience stress and anxiety, and learning is through working together, moreover, it finds out that
real situation is not what is taught in the classroom.

Abstract BACKGROUND: Desirable sexual function is one of the symptoms of mental and physical health.
Many causes can cause sexual dysfunction. Emotional problems in marriage are one of the main
causes of sexual dysfunction. The purpose of this study was to investigate the relationship between
emotional intelligence and its components with sexual function of women of reproductive age.
MATERIALS AND METHODS: The present study was a co‑relational–analytic study that was
performed on 165 women of childbearing age in the second half of 2018 in selected health centers.
Data were collected using a three‑part questionnaire including demographic questionnaire, FFI
standardized sexual function questionnaire, and Bar‑On Emotional Intelligence Questionnaire. Data
were analyzed using descriptive statistics, Spearman, and Pearson correlation.
RESULTS: Most of the study participants were in the age group of 26–30 years (30.4%). The results
showed a positive correlation and a statistically significant relationship between the mean score of
all the components of emotional intelligence except the interpersonal relationships, responsibility,
empathy, and self‑esteem with sexual performance score (P < 0.05).
CONCLUSIONS: Based on the positive correlation between some components of emotional
intelligence and sexual function, emotional intelligence can be considered as an important and effective
variable in improving women’s sexual function, so focus on emotional intelligence in counseling and
education Individuals and emphasis on promotion are recommended.

Abstract INTRODUCTION: Internationalization of higher education involves mutual exchanges as well as a
consensus based. Political, economic, sociocultural, and scientific reasons recommend the need to
move toward the internationalization of higher education. The current study highlights the strengths
of the internationalization of Iran’s medical sciences education.
MATERIALS AND METHODS: This descriptive exploratory study was carried out in 2016–2017 in
Iran. The techniques used for data collection included review of articles, interview with subject experts,
and the focus group and the nominal technique group to explore the views of various stakeholders.
The data were analyzed with the qualitative content analysis method.
RESULTS: The inductive qualitative content analysis of all data generated 13 categories and 88
subcategories. The categories were geographical and geostrategic position of Iran; the historical,
cultural, religious, and tourist attractions of Iran; the security of Iran; priority to internationalization
policies and programs in Iran’s macro plans; the existence of regulations, laws, and approvals for
international activities; same language with neighboring and regional countries; the low cost of
studying and living in Iran; the ability of Iranian faculty members and experts for internationalization;
the background, reputation, and the progress of medical education, health, and care in Iran; the
cheaper forces of Iran and their welcome to foreigners; the existence of motivation, zeal, and belief
for internationalization; the existence of proper infrastructure; and the existence of a suitable capacity
for internationalization.
CONCLUSIONS: Iran has some positive points that can be used to promote international activities,
provided it does some good advertising in this regard. It is suggested that the challenges, opportunities,
and threats to Iran’s internationalization should be collated from the perspective of the various
stakeholders.

Abstract INTRODUCTION: Clinical education is one of the most important parts of medical students’ education,
and it is a major part of the education of qualified and professional people. Therefore, this study was
conducted to determine the effect of applying Direct Observation of Procedural Skills (DOPS) on
midwifery students’ clinical skills.
MATERIALS AND METHODS: This is a quasi‑experimental, two‑group study conducted as a
pre‑ and post‑study on midwifery students in 2017–2018. Cluster and randomized sampling method
was used. The processors involved in this study were three main skills of vaginal examination, pelvic
examination, and vaginal delivery. The DOPS method was used to assess the practical skills in the
interventional group during three times the process at day, 1 day, and at least 1 week later; the
usual logbook method was used in the control group. Two groups were evaluated at the end of the
midwifery course by Comprehensive Final Midwifery checklist. The tools were checked for validity
and reliability, and data were analyzed using descriptive and analytical statistics.
RESULTS: There was no statistically significant difference between the two groups in terms
of important demographic variables such as age, grade, marital status, and initial assessment
score (P > 0.05). The mean of final scores in the normal delivery, vaginal examination, and pelvimetry
was statistically significantly higher in the interventional group (P < 0.001). On the other hand, the
functional field of the students in the interventional group was statistically significantly improved
in normal delivery and pelvimetry (P < 0.05), and this difference was not significant in the vaginal
examination. In addition, the mean scores of students before and after the DOPS method were
statistically significantly different in every skill in Comprehensive Final Midwifery checklist (P < 0/05).
CONCLUSIONS: The DOPS assessment methodology is not only a useful tool of clinical evaluation,
but also an effective tool for clinical learning of students. For this purpose, it is suggested that
educational members of midwifery take enough time to design DOPS method in the same process.

Abstract BACKGROUND: The high incidence of dental diseases among Indian children can be attributed to low
awareness regarding the oral health maintenance. The school health curriculum in India is deficient
of an oral health component, and there are no organized oral health programs for schoolchildren
existing at present. Therefore, the present study was conducted to assess the effectiveness of an oral
health curriculum in improving the oral health behavior and dental caries experience in schoolchildren.
METHODS: A nonrandomized trial with pretest/posttest design was conducted among 600
schoolchildren. Two intervention arms were designed with one group receiving health education from a
dental health professional and other from a school teacher. The oral health curriculum was customized
for three sections of different age groups (lower primary [LP], upper primary [UP], high school [HS])
and implemented for a period of 1 year. Oral health behaviors were recorded using a Knowledge,
Attitude and Practice (KAP) questionnaire and were evaluated at baseline, 6 months, and 1 year of
the educational intervention. Dental caries experience was measured Pre and Post - intervention
using deft and decayed, missing, and filled teeth indices. Descriptive statistics were calculated for
continuous data, and the change in KAP scores and dental caries experience was analyzed using
the repeated measures of ANOVA, independent t‑tests, and paired t‑tests.
RESULTS: There were significant improvements in KAP regarding oral health among Indian
schoolchildren. Significant reductions in decayed primary teeth were observed in LP and UP
schoolchildren post-intervention. However, there was no significant difference in primary outcome
between the two intervention arms.
CONCLUSIONS: A curriculum‑based health education intervention customized for different age
groups was found to be effective in improving oral health behavior and dental caries experience
among Indian schoolchildren.

Abstract BACKGROUND: Poor adherence in treatment and medication is a global issue in curing the chronic
diseases such as hypertension. The present study was conducted to identify the factors related with
medication adherence among hypertensive patients referred to the health centers of Borujerd based
on the Pender’s Health Promotion Model (HPM).
MATERIALS AND METHODS: This cross‑sectional study was conducted on 463 patients who were
referred to the comprehensive health centers of Borujerd city by cluster sampling method in 2019.
The data were collected using a questionnaire including demographic variables and Pender’s HPM
constructs. Data were analyzed by SPSS 18 software using Pearson correlation coefficient and
linear regression.
RESULTS: The mean and standard deviation of the participants’ age was 63.29 ± 11.2 years. The
results showed that hypertensive patients had a relatively desirable level of medication adherence
behavior. Perceived barriers (β = −0.169), perceived self‑efficacy (β = 0.196), activity related affect
(β = 0.232), and following medication regimen (β = 0.225) were the best predictors of performing
the medication adherence behavior. In total, different structures of the HPM explained 42.2% of the
variation of medication adherence behavior changes.
CONCLUSIONS: According to the findings, the design of educational programs using HPM is
recommended to increase the medication adherence among hypertensive patients.

Abstract

Abstract INTRODUCTION: A large number of women experience sexual health problems during the postpartum
period. This study aimed to evaluate the effect of sexual health education on sexual function and
time of sexual intercourse resumption after childbirth in primiparous women in Southeast Iran.
MATERIALS AND METHODS: This randomized clinical trial was conducted on 94 primiparous
women randomly divided into two groups of intervention and control. The intervention group was
subjected to three training sessions 3–5, 10–14, and 30–45  days after childbirth  (first session
lasting 20 min and other sessions 60 min). On the other hand, the participants in the control group
only received the routine postpartum training. The Female Sexual Function Index  (FSFI) was
completed by all participants before and 8 weeks after the intervention. Data were analyzed in SPSS
software (version 22) using descriptive and inferential statistics, such as Chi‑square test, independent
t‑test, and paired sample t‑test. P < 0.05 was considered statistically significant.
RESULTS: The mean score of FSFI in the intervention group was increased from 12.70 ± 6.166
before the onset of the intervention to 17.36 ± 5.407 after 8 weeks (P = 0.01). In the control group,
the mean score of FSFI was decreased from 13.09 ± 4.306 to 12.29 ± 3.511 on the 8th  week
postpartum (P = 0.06). The mean times of sexual intercourse resumption in the intervention and
control groups were 5.82 ± 0.17 and 5.81 ± 0.22 weeks, respectively, which were not significantly
different between the two groups (P = 0.879).
CONCLUSION: Sexual health education for women in the postpartum period could improve their
sexual function after childbirth. However, it is recommended to use sexual health education programs
in women during the postpartum period to promote female sexual function.

Abstract

Abstract BACKGROUND: First point‑of‑care (FPC) at the primary health care (PHC) level is an important public
health issue at the global level. Patients directly come to tertiary health centers without a referral.
AIMS AND OBJECTIVES: Hence, the current study was done to assess the proportion of individuals
availing health‑care services from rural health center (RHC) as FPC and reasons for not availing it.
METHODS: A community‑based cross‑sectional study was conducted in Puducherry, coastal South
India, among 367 households with 1510 individuals. Sociodemographic details, recent FPC during the
past 6 months, morbidity profile, and reasons for not seeking were collected from all the individuals.
RESULTS: About 44.5% (672/1510) of individuals used any health facilities, of which 70.4% (473/672)
used RHC as the FPC. About 33.2% of individuals had a respiratory illness, 22.3% had general
signs and symptoms. About 24.6% (32/130) mentioned the reasons for not seeking care as lack of
appropriate health facilities.
CONCLUSION: More than one‑fourth of the study population not utilized services at PHC level.
Improving the health facilities may help to increase these services.

Abstract OBJECTIVE: The aim was to explore the relationship between mental health problems (MHPs) and
health‑promoting lifestyle (HPL) in the medical students.
METHODS: This cross‑sectional study was carried out on medical students in 2017 at Semnan
University of Medical Sciences applying a stratified random sampling. The Symptom Checklist‑25
and the HPL profile scales were used. Logistic regression models were used to analysis.
RESULTS: Of the participants, 84 were male and 148 were female. The mean age was
22.69 years (±2.42). Most students (95.3%) were single and 40.1% were in the preclinical stage.
The mean MHP score was 44.14 (±13.99), and 3% were in the severe category. The mean HPL
score was 104.88  (±16.84); 95.7% and 4.3% of them had average and satisfactory lifestyles,
respectively. The MHP score of the female (P < 0.001), younger (P < 0.001), single (P = 0.045),
preclinical (P < 0.001), and who were away from home (P  =  0.009) were significantly higher.
The HPL score of female (P < 0.001), older (P = 0.041), and married students (P = 0.028) were
significantly higher. The female gender (odds ratio [OR] = 4.45, P < 0.001) and studying in the clinical
level (OR = 0.30, P < 0.001) were the most important associated factors with MHP. Adjusting for
them, there was a significant relationship between an increase in the HPL score and a decrease in
the likelihood of MHP (OR = 0.96, P < 0.001).
CONCLUSIONS: The mental health of medical students was shown to be in association with lifestyle
independent of other important determinants, including gender and academic level. It seems that
modifying the lifestyle to a healthier way can improve students’ mental health.

Abstract BACKGROUND: Evidence is accumulating that the pattern and nature of marital relationships are
very different in different cultures. This nationwide study aimed to determine marital satisfaction
and the prevalence of emotional divorce as well as to identify the sociodemographic correlates in
a Muslim population.
MATERIALS AND METHODS: In this cross‑sectional study, one‑third of Iran’s provinces were
selected randomly and a representative sample of inhabitants of their central city was included in
the study. The ENRICH marital satisfaction scale was used to determine marital satisfaction levels.
A single‑item measure with confirmed validity and reliability was used to find out about emotional
divorce. The demographic variables included respondent’s age, spouse’s age, gender, educational
level, residency, childbearing, and premarriage familiarity.
RESULTS: Of the 2033 participants, 1034 were women (50.9%). Nearly one‑third of both men and
women had academic degrees. Almost 53% of them were satisfied with their marital life and 9.7% had
emotional divorce. Men with academic degrees had a higher probability of marital satisfaction (odds
ratio [OR] =1.26, 95% confidence interval [CI]: 1.04–1.53) and a lower prevalence of emotional
divorce (OR = 0.37, 95% CI: 0.24–0.58).
CONCLUSION: This study showed a relatively high percentage of marital dissatisfaction as well
as emotional divorce. Policymakers should strengthen premarriage education programs and
postmarriage counseling centers.

Abstract BACKGROUND: Thinking styles’ effect on academic achievement is a challenging topic that has
been raised with very different results in previous studies. Since thinking styles are influenced by
the contexts, this study was conducted in the context of the occupational therapy, which is one of
the disciplines in the rehabilitation sciences in Iran and its educational studies are still developing.
The purpose of this research is to study thinking styles and their relationship with the educational
achievement of occupational therapy students at Shiraz School of Rehabilitation Sciences.
METHODS: This was a descriptive correlational study conducted at Shiraz School of Rehabilitation
Science in 2015. As sampling was considered by the census of all students in the 2nd–4th year
of Bachelor of Occupational Therapy, demographic data questionnaire and the “Short form of
Wagner‑Sternberg Thinking Styles Inventory (1992)” were distributed among all 78 students. Students’
academic achievement was also considered by grade point average obtained from the educational
office at school. The data were analyzed by descriptive and analytic statistics utilizing SPSS21
software. Pearson’s correlation coefficient and linear regression tests were used for data analysis.
RESULTS: Forty‑two students participated in this study with their personal consents. The results
revealed that hierarchic  (18.47  ± 2.54) and external  (18.47  ± 3.23) were the dominant thinking
styles of the occupational therapy students, followed by judicial, legislative, oligarchic, executive,
conservative, liberal, monarchic, anarchic, local, global, and internal thinking styles. In addition,
there was no correlation between any of the thinking styles and students’ achievement (P = 0.354).
Thinking styles predicted only 4.9% of changes in academic achievements in this study.
CONCLUSION: Thinking styles could predict only limited amount of the academic achievements
of occupational therapy students. Furthermore, as the dominant thinking styles of the occupational
therapy students are hierarchic and external, it seems that occupational therapy students prefer to
have a hierarchy of academic goals and seek tasks that provide them with the opportunity to interact
with the others.

Abstract BACKGROUND: In recent decades, the use of psychological methods has been considered to
improve the barriers and challenges of abuse adolescent females. This study focuses on comparing
the efficacy of trauma‑focused cognitive‑behavioral therapy (TF‑CBT) and theory of mind (ToM) on
social competence among abused children.
MATERIALS AND METHODS: A clinical trial was performed with 39 abused children as the subjects
of the study. Participants are residents in Ahvaz (Iran) host‑family centers and were randomly divided
into two groups of experimental subjects and control subjects. The data collection method utilized
the Social Competence Questionnaire. Descriptive statistics, covariance analysis, and Tukey’s post
hoc test were used for the data analysis.
RESULTS: Comparison of the groups showed that the average behavioral and cognitive competence
increased in both TF‑CBT and ToM groups, but the average emotional, social competence is
significantly higher in the ToM group. It is also found that the average social motivational competence
is significantly higher in the TF‑CBT group than in the ToM group.
CONCLUSION: TF‑CBT and ToM can be effectively used to improve the social competence of
abused adolescent females.

Abstract INTRODUCTION: Teacher empowerment is thought to improve student learning by fostering teaching
quality. Therefore, the purpose of this study is investigating the relationship between empowerment
and self‑efficacy of Iranian English as Foreign Language teachers.
MATERIALS AND METHODS: The present study is an experimental study; the population of the
study includes all the English language teachers of the universities of Ilam, Iran. Among whom by
random sampling, the sample which was consisted of 60 teachers were selected. Participants in
this study answered the School Participant Empowerment Scale questionnaire (Short and Rinehart,
1992) as the instrument of the study. The Pearson product‑moment correlation was computed to
determine the relationship between teacher empowerment and teacher self‑efficacy.
RESULTS: The results showed that there was a positive correlation between teacher empowerment
and their self‑efficacy (r = 0.55, P <  0.01) and differences among teachers’ self‑efficacy is not
significant according to age (r = −0.14, P = 0.23).
CONCLUSIONS: Based on the results of the study, empowerment and self‑efficacy have interactive
relationships; i.e. self‑efficacy in teachers leads to empowerment and empowerment in teachers
leads to self‑efficacy.

Abstract

Abstract BACKGROUND AND AIM: Given the prevalence of novel coronavirus disease 2019 (COVID‑19)
and the lack of information on coronavirus and pregnancy, the purpose of this study was to evaluate
the association of COVID‑19 and perinatal outcomes in pregnant women.
MATERIALS AND METHODS: In the present review article, the search process was conducted on
English and Persian scientific databases of PubMed, Scopus, Google Scholar, Magiran, Irandoc,
Iranmedx, and SID as well as the websites of international organizations of World Health Organization
and Centers for Disease Control and Prevention using the main keywords of “Pregnancy,” “Perinatal
outcomes,” “Coronavirus,” “COVID‑19,” “MERS‑CoV,” “MERS,” “SARS‑CoV‑2,” and “SARS‑CoV‑1”
and their Persian‑equivalent keywords from inception until March 16 2020.
RESULTS: The findings of studies on mothers with COVID‑19 were limited, and insufficient information
is available on the adverse pregnancy outcomes in pregnant women with COVID‑19. In cases of
infection with other coronaviruses such as Middle East respiratory syndrome and severe acute
respiratory syndrome during pregnancy, there have been reports on adverse pregnancy outcomes
such as miscarriage, stillbirth, preterm labor, low birth weight, and congenital malformations following
high fever in the first trimester.
CONCLUSION: Pregnant women may be more susceptible to viral respiratory infections, including
COVID‑19, due to immunological and physiological changes. Therefore, pregnant women should
take routine preventive measures, such as washing their hands frequently and avoiding contact with
infected people, to prevent infection.