Journal of Education and Health Promotion

Abstract

Abstract

Abstract CONTEXT: Medical ethics is a practical subject as well as a branch of ethical philosophy and an
integral part of the proper practice in medicine. However, the ethics changes in places and over time
and is variable. Furthermore, many issues that have occurred as a result of advances in technology
add to the complexity of the ethical issues. Therefore, the objective of this research was to explore
medical teachers’ and interns’ experiences regarding professional ethics.
METHODS: This study was a qualitative content analysis conducted on 10 professionals and 10
interns of the surgery and internal departments of medical and educational centers in Qom University
of Medical Sciences to discover their experiences of the medical professional ethics. The sampling
method was purposive, and data were collected through semi‑structured interviews. Data analysis
was performed using a qualitative content analysis method with a conventional approach.
RESULTS: Three main categories were obtained from the data analysis, including adherence to
professional values, organizational conditions, and individual characteristics.
CONCLUSIONS: Adherence to professional values, paying attention to individual characteristics,
and organizational conditions are among the factors affecting the promotion of medical professional
ethics; therefore, it seems that appropriate interventions on these important components can help
promote the professional ethics training in the clinical practice.

Abstract CONTEXT: One of the most important issues in patients with coronary artery disease is their mental
health indices such as perceived stress and perception of disease.
AIMS: The aim of this study was to evaluate the effectiveness of mindfulness‑based intervention on
the perceived stress and disease perception of patients with acute coronary syndrome.
MATERIALS AND METHODS: This is a clinical trial, two‑group, and three‑stage study on 76 patients
with acute coronary syndrome who were randomly divided into intervention and control groups. Nine
weekly sessions of mindfulness‑based training program were administered to the intervention group.
The control group received routine services during this period. Data collection was done before,
immediately, and 1 month after the intervention, using the Perceived Stress Scale and the Illness
Perception Questionnaire. Data were analyzed using descriptive and inferential statistics.
RESULTS: There was no significant difference between the mean scores of perceived stress and
illness perception before intervention. After the intervention and 1 month after it, the mean score
of perceived stress in the intervention group was statistically significantly lower than the control
group (P < 0.001), and the perception of disease in the intervention group was statistically significantly
higher than that of the control group (P < 0.001).
CONCLUSIONS: It is worthwhile to suggest the mindfulness‑based training program to reduce the
perceived stress and correct the perception of disease for patients with acute coronary syndrome.
Keywords:

Abstract INTRODUCTION: School teachers play an important role in instilling positive behavior changes
among school children. School children at an early age group of 2–7 years face challenges and need
extra support. Utilization of psychological interventions via school teachers for oral health promotion
is minimal. The present study was done to determine the impact of counseling and reinforcement by
school teachers on children for a follow‑up period of 1 year.
MATERIALS AND METHODS: A quantitative research on 58 randomly selected children for a
follow‑up of one year was conducted to determine the prevalence of preoperational characteristics
in school children. The tools to determine characters in preoperational children consisted of classical
cognitive experiments followed by behavior counseling intervention. The interventional group received
reinforcement with school teachers for a follow‑up of one year.
RESULTS: The assessment of the three characteristics revealed a prevalence of ego centralism,
centration, and lack of conservation and reversibility in 84.4%, 89.6%, and 89.6% children,
respectively. A significant difference in behavior change was seen in children who received behavior
counseling and reinforcement.
CONCLUSION: The present study concluded that Piaget’s characteristics were consistent for a
follow‑up period of one year.

Abstract BACKGROUND: Financial information system is one of the subsystems in management information
system that is very important in health institutions. The use of financial information system creating
effective and efficient information flow will greatly assist the management in decision‑making, so that
it can achieve institutional goals easier. This study is endeavored to assess the success of financial
information system in Isfahan University of Medical Sciences.
MATERIALS AND METHODS: This descriptive‑correlational study was performed on the research
population consisting of financial information system users in educational, health, and medical
centers affiliated to Isfahan University of Medical Sciences during 2018 that were studied by the
census method (n = 108) because of a small number of these users. The data were collected using
a questionnaire. The content validity of questionnaire was confirmed by pooling the ideas of five
academic members of the health information management and two financial information system
users. The reliability of questionnaire was also estimated by Cronbach’s alpha. Then, the AMOS
software was used to analyze the gathered data.
RESULTS: The result shows that system quality was positively correlated to the use and user
satisfaction whereas use and user satisfaction was positively correlated to net benefit (P < 0.05).
Furthermore, the information quality was positively correlated to the user satisfaction (P < 0.05).
CONCLUSIONS: As per the finding of this study, to improve user’s intention to use the financial
information system and their satisfaction toward the system, managers need to develop useful,
easy‑to‑understand, easy‑to‑learn, and easy‑to‑use information systems.

Abstract BACKGROUND: Training of health‑care providers about the various aspects of biomedical
waste (BMW) management and handling (M and H) rules can improve the safe disposal of BMW
and protect the patients and public from related hazards.
OBJECTIVES: Our study objective was to evaluate the existing knowledge regarding BMW
management rules among selected health‑care professionals and to evaluate the impact of training
program on BMW management on the knowledge and practices of health‑care professionals.
METHODOLOGY: The training program on BMW management rules was conducted in April 2018.
A total of 250 participants were trained. A structured validated questionnaire was used. The data
were analyzed, and the mean score of pre‑ and post‑test was compared by the paired‑t test.
RESULTS: Majority of the participants were female (83%) aged 20–30 years (56%). The majority
of the participants were married (74%) and were from urban areas (74%). The mean pretest and
posttest score were 14.00 and 19.94 respectively (P < 0.000).
CONCLUSION: The structured training on all aspects of BMW management led to statistically
significant improvement in the knowledge among health‑care professionals.
RECOMMENDATIONS: Such training programs need to be regularly conducted.

Abstract INTRODUCTION: The ability of physicians to perform endotracheal intubation by laryngoscope is one
of the essential skills. The purpose of this study was to evaluate the effectiveness of the four‑step
python training method with the Halsted’s “See one, Do one, and Teach one” training method in
endotracheal intubation competency in simulated environment.
MATERIALS AND METHODS: This quasi‑experimental study was performed on two independent
groups with posttest. The statistical society consisted of eighth‑semester medical students referred
to the emergency medicine unit. The experimental group received a modified four‑step python‘s
training method that modified for small groups, and the control group received the Halsted’s “See
one, Do one, and Teach one” training method. Researcher‑made checklist used to rate participant
competency as posttest. Data were analyzed using SPSS 19 software.
RESULTS: Sixty‑seven students volunteered for the experimental group and 57 students for
the control group. In posttest, the experimental group more competent than the control group
significantly (P < 0.001). Furthermore, the training course satisfaction of the experimental group was
significantly higher than the control group (P < 0.001).
DISCUSSION AND CONCLUSION: Modified python training method for small groups has shown
a better effect on student performance. This finding is consistent with previous researches.
Modified four‑step python’s training for small group with an emphasis on peer to peer teaching and
receiving feedback from peer can be related to the effectiveness of this training. Further research is
recommended in other clinical education settings.

Abstract BACKGROUND AND AIM: Considering lack of data on clinical acumen and clinical practice readiness
of graduating nurses in India; this cross‑sectional survey was undertaken to assess the self‑reported
clinical practice readiness of graduating nurses from a selected state in India.
MATERIALS AND METHODS: The survey was conducted at randomly selected public and
private nursing institutes in Uttarakahnd, India, during June–July 2017. Total 173 final‑year nursing
undergraduates were selected through cluster sampling technique and they were asked to report
their clinical competencies using a prevalidated and reliable tool, i.e. Comprehensive Nursing
Competencies Questionnaire.
RESULTS: The mean competencies score for basic nursing skills was reasonably high (236.5 ± 25.0).
However, it was significantly low for the advanced nursing skills (148.7 ± 25.6) and selected basic
nursing tasks such as perioperative care, elimination related interventions, and handling of medical
equipment (recoding electrocardiogram and using defibrillator). Graduating nurses with younger age
and longer duration of clinical placement had higher mean competency score in basic as well as
advanced nursing skills (P < 0.05). Whereas, nurses studying at private nursing institutes had lower
mean competency score for advanced nursing skills (P = 0.001).
CONCLUSION: Clinical practice readiness of graduating nurses for basic nursing skills is good.
However, it is seriously poor for the advanced nursing skills. This could be because of lack of sufficient
clinical learning material, experienced clinical nursing faculty, and poorly equipped nursing skill labs.
Nursing regulatory bodies must regularly monitor and ensure that deficiencies are rectified and nursing
faculty remain clinically updated and active to produce clinically competent nurses.

Abstract BACKGROUND: Social media platforms are progressively developing as a rich source of mass
communication. Increasing mental health awareness with the help of social media can be a good
initiative to reach out to a large number of people in a short time frame. This study was conducted
to understand the usefulness of social media platforms for health promotion.
MATERIALS AND METHODS: It was a qualitative study to evaluate the effectiveness of social
media platforms in hosting health promotion campaigns in the field of mental health, which was
observed over 5 months from May to September 2019 to reach more people for effective information
dissemination. The campaigns were as follows (1) The Buddies for Suicide Prevention: an online
campaign to create awareness about suicide prevention. The campaign included script writing,
slogan writing, poster making, and short films making, organized for the general public who were
interested to take part; (2) The #Iquitobacco was a 21‑day campaign with an idea of tobacco cessation
in the community, conducted among social media viewers who were willing to participate; and (3)
#Migrainethepainfultruth was yet another campaign conducted among the social media viewers who
were interested to participate. All the campaigns were conducted using two famous social media
platforms commonly used by young adults. Descriptive statistics such as frequency and proportions
were computed for the number of likes and shares.
RESULTS: The Facebook and Instagram posts concerning all the campaigns brought about a
considerable amount of reach to the targeted population. After the campaigns, the page reached to
around 10.3 k people (both fans and nonfans).
CONCLUSIONS: Use of social media to conduct mental health campaigns is an effective initiative
as one can reach out to several people over a short time period. There is an increasing trend in the
awareness of mental health with the effective use of digital media as a platform for disseminating
information.

Abstract INTRODUCTION: The present study aims at designing and evaluating the effect of new educational
media‑based educational intervention on students’ stages of behavior change of physical activity.
SUBJECTS AND METHODS: In the present interventional study, 225 students of medical sciences
university were assigned into two experimental and one control groups using proportional stratified
random sampling, where web‑based and software‑based educational interventions were used. Data
were collected using International Physical Activity Questionnaire, Marcus’s stages of change scales,
and a self‑made questionnaire including constructs of barriers, benefits, and self‑efficacy. Evaluation
was conducted through pretest and posttest and immediate and 2 and 6 months of follow‑ups after
the intervention. Data were analyzed by SPSS software using descriptive statistics and Chi‑square,
Friedman, one‑way ANOVA, and ANOVA with repeated measure.
RESULTS: Based on the results, there was no significant difference between the experimental and
control groups before the intervention (P = 0.37); however, immediately and 2 and 6 months after
the intervention, there was a significant difference between the experimental and control groups
in terms of stages of change (P < 0.001). Furthermore, in the experimental group, the educational
intervention led to improvement of individuals in the stages of change of physical activity. At 6‑month
follow‑up, 75.4% of the software group and 60.6% of the web group achieved the maintenance stage.
CONCLUSION: The results suggest that designing intervention based on people’s level of preparation
for changing behavior and using new educational methods such as web and software were effective
on individuals’ progress in different stages of change of physical activity behavior and physical
activity rate.

Abstract INTRODUCTION: Health‑care workers, especially medical intern, are at risk of exposed to blood
and other body fluids in the course of their work. To reduce the risk, standard precaution (SP) is
introduced. Among all communicable diseases that could be transmitted, human immunodeficiency
virus (HIV) is the most stigmatized disease. However, there are some government hospitals that
separated adult HIV patients with other patients to prevent additional infection.   This study aims to
evaluate the impact of ward separation on SP adherence.
MATERIALS AND METHODS: This was an observational study conducted in March 2017 in a tertiary
referral hospital for the eastern part of Indonesia. The participants were 150 medical students who
underwent the past year of their clinical rotation. They were given a three‑part questionnaire, consisting
of their background, their SP practice in the HIV ward and non‑HIV wards, and their perception and
attitude regarding SP. McNemar’s test and Fisher’s exact test were used for the statistical analysis,
using SPSS version 23.0 for Windows.
RESULTS: Participants were more adhered to SP (hand hygiene, wear mask as indicated, and
wear glove as indicated) in the HIV ward compare to non‑HIV wards (P = 0.002, P = 0.001, and
P = 0.001, respectively). Almost all participants were more careful in implementing SP in the HIV
ward than in non‑HIV wards and were more concerned of getting needlestick injury in the HIV ward
than in non‑HIV ward.
CONCLUSION: HIV and non‑HIV ward separation negatively impact medical students’ SP adherence.

Abstract Fire buildings is considered as one of the most common and the most devastating disasters and
emergencies. Saving school buildings against incidents such as fire is very important since students
are so vulnerable to incidents especially fire. The most school classes were devoid of safety
conditions and oil‑burning heaters were used. Such a condition has increased the risk of disaster
and is considered as a serious menace for students’ lives. The present study conducted with aim of
review the Health, Safety and Education Measures for Fire in Schools. To this purpose, we selected
suitable keywords some articles published in Scientific Information Database of PubMed, Web of
Science, Scopus, and ProQuest were searched. The search was limited to reviewed articles in English
and Persian language published between 1970 and 2019, based on inclusion and exclusion criteria.
Furthermore, the selected articles were reviewed for relevant citations. The reviewing of articles was
conducted by two member of research team independently. The primary search found 194 relevant
studies. After eliminating the duplicates and articles which were not related to the review of the abstract,
51 references were identified for inclusion. Finally, 13 articles were selected after screening and
evaluated by two authors to final review main factors and dimensions of schools’ health, safety and
education include the rules and laws, allocating sufficient budgets, education the teachers, students
and their families, exercise, risk analysis, intersectional relations, fire extinguishing equipment, early
warning system, and also optimization and reformation of heating system. Applying these new
approaches prevents disasters and increases the level of preparedness in case of fire occurrence.

Abstract INTRODUCTION: Attention deficit hyperactivity disorder (ADHD) is a common disorder in child
psychiatry, which has a greater impact on the future life of the children affected in case of being
untreated and undiagnosed. Given the undeniable role of teachers in improving this disorder and
preventing its destructive consequences on children, the present research has examined the
knowledge, attitude, and practice of elementary school teachers regarding ADHD.
MATERIALS AND METHODS: This was a descriptive, cross‑sectional study carried out in 2019.
One hundred and twenty teachers were randomly selected as samples among public and private
schools in three districts of Isfahan. Data were collected by a self‑administrated questionnaire
including demographic variables, knowledge, attitude, and practice of teachers regarding ADHD
and were analyzed by descriptive and analytical statistics. The Spearman’s and Kendall’ correlation
coefficient, t‑test, and Kolmogorov–Smirnov test were employed, and P < 0.50 was considered
statistically significant.
RESULTS: The findings indicated that 65% of teachers had favorable knowledge toward ADHD, 50%
of them had a favorable attitude, and 56% of their practice was desirable. The questionnaire showed
that only their knowledge about ADHD symptoms was desirable, but their knowledge about cause
of the disorder and its treatment was not sufficient. There was an inverse relationship between the
knowledge, attitude, and practice of teachers with age, and between education and having a child, a
significant direct relationship was discovered. Teachers of public schools compared to private school
teachers had significantly better knowledge, attitude, and practice.
CONCLUSION: Teachers’ knowledge, attitude, and practice regarding ADHD was relatively high.
However, it is necessary to educate teachers about etiology and methods of treatment of this disorder
and behavior management of these students, especially private school teachers who need more
education.

Abstract INTRODUCTION: Professionalism is an essential theme in both undergraduate and postgraduate
medical education. The current study aimed to assess the preclerkship medical students’ perception
on medical professionalism.
METHODS: A cross‑sectional qualitative study using the critical incident technique was conducted at
the University of Sharjah in the United Arab Emirates (UAE). An online survey was sent to 300 medical
students  (years 1–3). Participants were asked to describe an official doctor–patient encounter
that they have experienced in a health‑care setting and to highlight the professional behaviors
in that encounter. They were then requested to list the top five characteristics of a professional
doctor. Thirty (10%) medical students responded to the study; only 13 reported real incidents. The
responses were independently reviewed by the authors. The descriptions of the professional attitudes
were grouped according to the six domains of professionalism defined by the American Board of
Internal Medicine (ABIM) Physicians Charter and then plotted against the nine domains of medical
professionalism published in the UAE Consensus Statement.
RESULTS: The most common professional behaviors reported were patience, honesty, respect, and
patient care. The participants addressed all six domains of professionalism described by the ABIM
physicians charter (altruism, accountability, duty , excellence, honor and integrity, and respect for
others) and all the domains of medical professionalism published in the UAE Consensus Statement,
except for “commitment to advocacy” and “commitment to education” domains.
CONCLUSION: Preclerkship medical students had an insight about the professional behaviors
needed from doctors before formal teaching about professionalism in the curriculum.

Abstract BACKGROUND: Sedentary habits may increase the noncommunicable disease risk factors, and
few teens get enough physical activity. Therefore, the current study aimed to examine the effects
of a web‑based intervention on the promotion of physical activity among adolescents using the
transtheoretical model (TTM).
METHODS AND MATERIALS: A quasi‑experimental study was conducted on 278 high school students
who were randomly allocated into one of the three groups: two web‑based intervention groups. The
intervention groups 1 and 2 received education through web (www.salamat.family), but the second
group received educational strategies based on TTM. Five questionnaires were applied two times
before the intervention and 6 months after the intervention. And, in the control group, the data were
collected using stage of exercise behavior change questionnaire and the International Physical Activity
Questionnaire. Student’s t‑test and two‑way analysis of variance, and McNemar’s test were applied
to compare before and after the intervention. P < 0.05 was considered statistically significant.
RESULTS: The mean differences for TTM constructs related to exercise behaviors (processes of
change, self‑efficacy, and decisional balance) in intervention groups 1 and 2 were very higher than
the control group. Participants in intervention groups 1 and 2 who had low or moderate physical
activity before the intervention were placed in high physical activity after it.
CONCLUSION: According to the obtained results, education on PA based on website effective, but
if we use education based on TTM, it will be more useful on the behavior.

Abstract INTRODUCTION: Chronic diseases leave a huge impact on the life of children and their family
caregivers (FCGs). Therefore, the present study was conducted to determine the effect of the
combination of Benson’s relaxation technique (BRT) and brief psycho‑educational intervention (BPI) on
religious coping (RCOPE), sense of coherence (SOC), and quality of life (QoL) of FCGs in children
with chronic disease.
MATERIALS AND METHODS: The study population, consisted of 100 FCGs whose children were
afflicted by chronic diseases, and participated in the current quasi‑experimental pretest posttest
design. The children were recruited from two state pediatric hospitals in Tehran, Iran. The RCOPE,
SOC, and QoL of FCGs were assessed twice, through pretest (T1) and posttest (T2), four weeks
after the intervention, by means of RCOPE, SOC and SF‑36 questionnaires. The FCGs participated
in four training sessions lasting up to 70 min over one week, followed by four more weeks of training.
The Chi‑square, Fisher’s exact tests, independent t‑test, and paired t‑test were performed.
RESULTS: Positive RCOPE had a significant rise at T2 (P = 0.020) compared with negative RCOPE
that did not show significant changes in T2. SOC scores for the intervention group remarkably rose
at T2 (P = 0.022); but, for the control group, the drop was marginal. The QoL scores of both physical
and mental components were statistically significant in the intervention group at T2 (P < 0.05).
CONCLUSION: Findings of the present study suggest that BRT and BPI can help significantly improve
the RCOPE, SOC, and QoL of families with children suffering from chronic diseases. Measures that
could enhance the RCOPE, SOC, and QoL include low‑cost interventions, good safety, and decent
outcome.

Abstract BACKGROUND AND AIM: Considering the important role of universities in advancing educational,
social, cultural, economic, and political affairs and given the significant and effective role of social
determinants of health (SDH) in personal and social life, this study aimed to design a preliminary
questionnaire to assess the awareness and attitude of students and professors of relevant medical
sciences departments toward the SDH.
METHODS: This is a descriptive survey study of the instrumentation type and is done on the
students and professors of Isfahan and Kashan medical sciences universities in 2019. The
content and face validity of the questionnaire were assessed. Cronbach’s alpha coefficient and
the correlation coefficient for each question as well as the total score of the questionnaire were
reported for this attitude measurement questionnaire. The difficulty coefficient, optimum difficulty
level, discrimination coefficient, and the relevant variance were calculated for every question in the
awareness measurement questionnaire.
RESULTS: The internal consistency of the questionnaire for the awareness toward the SDH for 15
questions was 0.742. This consistency was acceptable for 18 questions in the attitude measurement
questionnaire after omitting two questions with not appropriate distinguishing ability. The difficulty
level of the questions was relatively high.
CONCLUSION: Given that no tool was observed in the search strategy to measure the SDH,
therefore, the design and psychometrics of such a tool can be used to measure the awareness and
attitude of the target audiences; since this tool had an acceptable validity and reliability at its initial
stages, researchers are suggested to apply it for standardization in different academic societies.

Abstract BACKGROUND: Total knee arthroplasty (TKA) can cause operational anxiety in patients. The
purpose of this study was to determine the effects of a hospital rehabilitation program on operational
anxiety in patients following TKA.
MATERIALS AND METHODS: A nonrandomized clinical trial was conducted on 96 patients who
were total knee replacement (TKR) candidates in Milad Hospital, Tehran, Iran. The participants
were allocated to two groups of control and experiment each with 48 participants. A rehabilitation
training program was implemented in the experimental group and the routine care program was
administered to the control group. The data collected through demographic form and Spielberger
anxiety questionnaire. The collected data were analyzed using Fisher’s exact test, covariance,
independent t‑test, and paired t‑test (P = 0.5).
RESULTS: The results of the paired t‑test indicated that the mean score of anxiety in both groups
was decreased. Independent t‑test showed that there was a significant difference between the two
groups in terms of the mean scores of anxiety so that it was significantly higher in the control group
compared to the experimental group (P < 0.001).
CONCLUSIONS: The implementation of the rehabilitation education by a rehab nurse can improve
the surgical outcomes in patients under TKR. Despite the positive results in this study, the results
should be interpreted and clinically used with caution given the small number of participants and the
specific circumstances of this study.

Abstract BACKGROUND: Hospitalization in intensive care units (ICUs) can cause physiological and
psychological challenges for patients and their family members. Using a family‑centered approach
in provision of visiting hours promotes the health of patients. The purpose of this study is to review
the perception of nurses and family members of patients in ICUs about visiting their patients.
METHODOLOGY: The published articles in the last 10 years from 2008 to 2018 on the perception of
nurses and family members of patients in critical care units about visiting their patients searched for
in databases including ScienceDirect, PubMed, Cochrane, Google Scholar, SID, Scopus, CINAHL,
OVID, IRANDOC, and Magiran using keywords “family members perception,” “nurses’ perception,”
“intensive care units,” and “visiting” in English and Farsi, and finally, 15 articles were selected.
RESULTS: Results showed that nurses do not have appropriate viewpoint about visiting patients in
ICUs, and they discussed and outlined the barriers of visiting patients given the benefits of family
members’ presence.
CONCLUSION: There are several limitations on the process of family members visiting their patients
in the ICUs. It is essential to modify the nurses’ attitudes and remove the organizational limitations
in this area.

Abstract INTRODUCTION: Educating a mother of a premature baby and providing a structured written
educational information can enhance better understanding and practice. This article describes the
development and implementation of a health educational package for preemie moms in the care of
their premature baby after neonatal intensive care unit discharge.
SUBJECTS AND METHODS: The package known as “Preemie Mom: A Guide for You” was designed
based on Stufflebeam’s model and has four phases: (1) content evaluation from available sources of
information, (2) input evaluation based on mothers’ need related to premature baby care, (3) process
evaluation for package designing and content drafting, and (4) product evaluation to determine its
feasibility. The contents were extracted and collated for validation by consulting various specialists
in related fields. A final draft was drawn based on comments given by experts. Comments from the
mothers were taken for formatting, visual appearance, and content flow for easy understanding and
usage.
RESULTS: All ten existing articles and eight relevant documents were gathered and critically
appraised. The package was designed based on 11 main components related to the care of premature
baby after discharge. The content validation was accepted at a minimum score of 0.85 for the item‑level
content validity index analysis. Both experts and mothers were agreed that the package is easy to
use and well accepted as a guide after discharge. The agreement rate by the mothers was at 93.33%
and greater for the front page, writing style, structure, presentation, and motives of the package.
CONCLUSIONS: “Preemie Mom: A Guide for You” is a validated health educational package and
ready to be used to meet the needs of the mother for premature baby care at home.

Abstract INTRODUCTION: Majority of critical care nurses do not have desirable skills in performing
endotracheal tube suctioning (ETS) despite related training taught in the curricula. This study aimed
to investigate and compare the effect of education through video and performance feedback (PF)
on nurses’ skills in performing ETS.
METHODS: This was a quasi‑experimental study. The sample size comprised of all nurses (n = 49)
working in the intensive care unit of one of the educational hospital located in one of the western
cities of Iran. Nurses were assigned to either one of educational video (EV) and PF groups. Data
were collected using a 25‑item structured best practices information sheet. Data were analyzed using
SPSS software version 20 (SPSS Inc., Chicago, IL, USA).
RESULTS: After the interventions, no significant difference was found in the total mean score of
nurses’ practice in ETS between those who received education through EV and those who received
through PF (16.3 vs. 15.1) (P > 0.05). Before and after the intervention, a significant improvement
was observed in the total mean score and other dimensions of nurses’ practice in endotracheal
suctioning (P < 0.0001).
CONCLUSIONS: The results showed that both of methods through feedback and EV are useful
in improving nurses’ ETS practice. However, further studies are required to examine the effects of
such interventions in the long term.

Abstract INTRODUCTION: The aim of this study was to evaluate the cognitive, psychomotor, and attitudinal
readiness of faculty members and students of Shiraz University of Medical Sciences for using
e‑learning in 2019 in order to move toward the desired future of e‑learning in medical education,
promote the benefits of e‑learning in the country, and provide training to each of the research groups
if needed.
METHODS: This is a cross‑sectional study conducted in Shiraz University of Medical Sciences,
Iran, in 2019. The study population consisted of 379 students and 281 professors selected through
the systematic random sampling in Shiraz University of Medical Sciences. The e‑learning readiness
questionnaire developed by Zarif Sanaei et al. was used to evaluate the students’ and teachers’
viewpoints.
RESULTS: The results showed that the average level of skill, knowledge, and attitude among students
and teachers was positive and higher than the mean (P < 0.05). It had only a significant relationship
in the level of education of the teachers and the marital status of the participants. There was also a
significant interaction between skill, knowledge, and attitude.
CONCLUSION: There is a need for successful implementation of e‑learning by creating appropriate
infrastructure, applying the required standards, as well as taking measures to reduce the existing
resistance in this regard, which can be achieved through training workshops. The experience of
successful universities in the country and abroad can also be used to implement e‑learning.

Abstract INTRODUCTION: Hypertension is one of the major health threats in the world today. The purpose
of this study was to find the relationship between hypertension with irrational health belief and health
locus of controls.
MATERIALS AND METHODS: The current work is a descriptive (case–control) study. One hundred
patients with hypertension and 100 healthy individuals were included in the study through available
sampling method. The Irrational Health Belief Scale and Multidimensional Health Locus of Control
questionnaire were used. Data were analyzed using independent t‑test and logistic regression.
RESULTS: The findings showed a significant relationship between the variables of irrational health
beliefs and the external health locus of control in hypertension. For a unit increase in an irrational
health belief score, the chance of having high blood pressure increases by 6%, and for a unit increase
in the score of external health locus of control, there is a 17% higher chance of having hypertension.
The independent t‑test of irrational health belief also showed a statistically significant difference
between the two groups (P < 0.01). There was also a statistically significant difference regarding
the health locus of control in the two groups of hypertension and healthy individuals in the subscale
of chance control (P < 0.01) and external locus of control (P < 0.01).
CONCLUSION: The results of this study make it necessary to identify irrational health beliefs as
well as the health locus of control in individuals. Modification of these structures can be useful in the
prevention and management of this chronic disease.

Abstract INTRODUCTION: Problem‑solving skills and learner‑centered approaches provide students with the
ability to solve health challenges by placing them in simulated situations. The aim of this study was to
determine the effect of inter‑professional learning based on problem‑solving on critical thinking (CT)
and satisfaction with learning experience in nursing and midwifery students.
METHODS: This quazi‑experimental study of a single group used pretest–posttest design. 20
undergraduate nursing and 28 midwifery students at the final academic year participated in the study.
The research intervention was interprofessional learning based on problem‑solving conducted in five
2‑h training sessions. California’s CT Scale and 10‑point visual analog scale were used to measure
CT skills and satisfaction with learning before and after the intervention. Finally, data were analyzed
by SPSS software version 23 using descriptive statistics and paired t‑test.
RESULTS: The findings of this study indicated that the mean score of students’ CT before the
intervention was poor, while it statistically significant increased after the intervention (P < 0.05). It
was also found that students’ satisfaction with learning, in the scale of 0–10, was reported from 5 to
9 indicating students had a high level of satisfaction with their learning experience.
DISCUSSION: Based on the findings, it can be concluded that the interprofessional education based
on problem‑solving has been able to significantly enhance the overall critical skills of students,
especially in the dimensions of analysis, inference, and deductive reasoning, and also, students’
satisfaction with learning experience was also increased.

Abstract BACKGROUND AND AIM: Little information is available on the use of text messages through
mobile phones to address overweight/obesity in children. This study aims to evaluate the impact
of a text message‑based intervention for weight control and health‑promoting lifestyle behaviors of
overweight/obese children.
MATERIALS AND METHODS: This quasi‑experimental study was conducted among
overweight/obese school students. Data on sociodemographic, dietary intake, sleep, sedentary
behavior, physical activity (PA), and anthropometry were collected before and after the intervention.
Weight and height were examined according to the standard protocols. The intervention was consisted
of tailored messages for weight control and healthy lifestyle, including diet, PA, sedentary behavior,
and sleep. Child attitude and his practice were asked before and after the intervention. The paired
t‑test was performed to compare means of continuous variables before and after the intervention for
normal distribution data. The Wilcoxon test was also used for nonnormal data.
RESULTS: A total of 71 boy students were included in the study (62% obese). The mean age was
10.07 years. The means of attitude score for PA, nutrition, and sleep after intervention were greater
than before it, but it was significant only for PA. The mean of nighttime sleep duration of students after
the intervention was significantly less. Furthermore, unhealthy score decreases after the intervention.
CONCLUSION: Three‑month lifestyle intervention as text messages had positive effects on the
nutritional intake of obese children and their attitudes toward PA, but no effect on child body mass
index.

Abstract BACKGROUND: Inadequate lifestyle practices among individuals with diabetes may influence
the progression of diabetes and its complications. The aim of this study was to assess the lifestyle
practices among individuals with diabetes in Sudan.
METHODOLOGY: This was a descriptive, cross‑sectional, health facility‑based study conducted in
3 diabetes centers treating individuals with diabetes. The data were collected using a standardized
pretested metabolic questionnaire about lifestyle and were analyzed by performing descriptive and
inferential statistics through SPSS program version 23.
RESULTS: A total of 528 patients with diabetes answered the questionnaire. There were 52.1% of
female participants and 72.9% of urban residents. 23.9% were obese, regular exercise was reported
by 27.7%, and no exercise by 17%. There was a statistically significant association between
lifestyle practices and gender (P < 0.001), age (P < 0.001), educational level (P = 0.002), marital
status (P < 0.001), duration of diabetes (P < 0.001), hypertension (P < 0.001), high‑density
lipoprotein (P < 0.001), low‑density lipoprotein (P < 0.001), and HbA1c level (P < 0.001). Logistic
regression analysis showed male gender and education were significantly associated with lifestyle
changes. Men were more likely to engage in favorable lifestyle practices than women (P < 0.001),
while those with no formal education were less likely to engage in healthy lifestyle (P < 0.001).
CONCLUSIONS: Health authorities in Sudan will need to put more efforts into education for promoting
self‑awareness and good lifestyle practices in the population with diabetes.

Abstract BACKGROUND: According to the importance of health education (HE) in disease control and
prevention and inadequacy of HE in the Iran’s health‑care system, clarifying the HE barriers is
necessary.
OBJECTIVES: This study aimed to clarifying the comprehensive model of HE barriers of health‑care
system in Iran.
METHODS: This qualitative study was conducted in 2019. Twenty‑one health experts and physicians
at different levels of the health system, a former health deputy of the Ministry of Health, and 26
community health workers (CHWs) were selected through purposive sampling. Data were collected
through semi‑structured individual interviews and group discussions and analyzed simultaneously
by conventional content analysis.
RESULTS: Five themes were extracted including individual barriers (most important categories:
inadequate ability of CHWs in HE, poor motivational factors at individual level, and educator’s wrong
beliefs), interpersonal (most important categories: weakness of other health‑care providers in the
education of CHWs, lack of proper understanding by health authorities of scientific and correct HE,
inappropriate communication, unrealistic expectations from CHWs, problems with monitoring and
supervision, poor work commitment, and client‑related problems), organizational (most important
categories: high workload of CHWs, problems related to educational resources, inappropriate attitude
of managers and officials, and inappropriate evaluation and monitoring), community (most important
categories: not believing CHWs by people, people’s disinterest and lack of motivation in education,
cultural problems, problems with the Internet and virtual social networks, and weak cross‑sectoral
cooperation), and contextual barriers (most important categories: barriers related to universities,
broadcasting, the nature of HE science, as well as gap between practical education and theory).
CONCLUSION: Considering the multidimensional barriers such as individual, interpersonal,
organizational, community, and contextual barriers, compiling and executing a comprehensive
document with the participation of authorities, specialists, and service providers is recommended to
remove barriers. This is in line with the Ottawa Charters’ “reorienting health services.”

Abstract INTRODUCTION: Emotional intelligence (EI) and self‑efficacy are important factors that lead to
success in work, life, and education. Various studies assessed the relationship between EI and
well‑being, performance, and self‑efficacy in educational levels, but this topic has been rarely
assessed in the occupational and administrative environments. The present study aimed to examine
the relationship between EI and self‑efficacy among administrative staffs of Kerman University of
Medical Sciences.
METHODS: The study employed a descriptive‑correlational design and was conducted in six deputies
supervised by the Kerman University of Medical Sciences in 2019, and 275 participants were selected
using a census method. The research data were collected using the Goleman’s EI framework with a
reliability coefficient of α = 0.87 and Sherer General Self‑Efficacy Scale with a reliability coefficient of
α = 0.78. Data analysis was performed through Kolmogorov–Smirnov, analysis of variance, Tukey,
and Pearson’s correlation coefficient techniques at P < 0.05 significance level.
RESULTS: The mean score of EI was 98.8 ± 11.1 and the mean score of self‑efficacy was 60 ± 7.17.
There was a significant positive relationship between the scores of EI and self‑efficacy. In addition,
the findings indicated a positive significant correlation between self‑efficacy with self‑awareness,
self‑regulation, and social skills.
CONCLUSION: The findings of the current study confirm that EI has positive relationships with
administrative personnel’s self‑efficacy. Therefore, implications of the findings can help in the selection,
training, counseling, and retention of administrative personnel to the improvement of medical sciences
universities’ occupational performance.

Abstract