Journal of Education and Health Promotion

Abstract INTRODUCTION: Different types of learners based on sensory modalities are observed. Cognition or
physiological alterations in the sensory pathways might play its role in different modalities of visual,
auditory, read and write, and kinesthetic learners which are based on different sensory modalities
of perception
OBJECTIVE: The objective of this study is to ascertain an objective parameter (neurophysiological
parameters) for the classification of learners based on their preferred sensory modality
MATERIALS AND METHODS: An experimental cross‑sectional study was conducted among
100 medical students. Learners were classified into visual, auditory, read‑write, and kinesthetic
learners based on the interpretation drawn on the basis of the VARK questionnaire. Sensory‑evoked
potentials (SEPs), including pattern shift visual (PSVEPs), brain stem auditory (BAEPs), short‑latency
somatosensory (SSEP), and event‑related potentials (P300) were measured. SEPs measured in
microvolts were recorded from the scalp with the help of active and reference electrodes. Multiple
responses to sensory stimuli (using NIHON KOHDEN Corporation Neuropack X1, Tokyo, Japan)
were recored and averaged using the computerized signal averging technique.
RESULTS: No statistically significant difference was observed in conduction velocities (in terms of
latency and amplitude) of SEP among different type of learners, except latency N145 wave form in
VEP (P < 0.05). A characteristic pattern of minimal comparative latency was observed among the
majority of visual learners. Similary, P300 has shown a characteristic pattern of decreased comparative
latency among majority of read and write learners.
CONCLUSION: Study findings suggested that among existing teaching and learning modalities,
visual modalities were observed faster but to retain it in memory and for abstract thinking, students
should utilize read and writing skills which are lacking in the era of digitalization and overuse of
electronic devices.

Abstract BACKGROUND: Today, one of the biggest concerns of parents is protecting their children and
properly educating them about sex. The aim of this study was to determine the effect of educational
intervention on parental skills in sex education on their children in elementary schools in the northwest
of Tehran‑Iran in 2019 based on literature.
MATERIALS AND METHODS: This quasi‑experimental study was conducted on 125 parents of
elementary schoolchildren in the northwestern of Tehran. The data were collected by valid and
reliable questionnaire. Before the intervention, two intervention and control groups filled up the pretest
questionnaire; the data were collected by valid and reliable questionnaire. Before the intervention,
two intervention and control groups filled the pretest questionnaire, and then the parents participated
in the educational program based on dramatic literature. Two months later, the same questionnaire
was completed by the control and intervention groups. Finally, the data were analyzed by regression
and one‑way ANOVA test.
RESULTS: The results showed that there was a statistically significant difference between the mean
scores of knowledge in the experimental and control groups in the posttest (P < 0.01). There was
also a statistically significant difference between the mean scores of attitude in the experimental and
control groups at the posttest stage (P < 0.01). There was also a statistically significant difference
between the mean scores of performance based on group membership (experimental group and
control group) in the posttest phase (P < 0.01).
CONCLUSIONS: The findings of the study showed that educational intervention on parental skills
in sex education based on the dramatic literature to their children has significant effect on parental
knowledge, attitude, and performance.

Abstract BACKGROUND: In the 21st century, with the epidemiological and demographic transition and
the changing nature of diseases and the increase in the burden of chronic diseases, the need to
strengthen primary health care and the development of the family medical program as a strategy is
felt significantly.
AIM: The purpose of this study is to compare the model of implementation of family physician
program (FPP) in the United States, England, Germany, Singapore, Turkey, Egypt, and Iran.
MATERIALS AND METHODS: This is a comparative study that examines the model of family
physician implementation in selected countries. Data for each country were gathered from the
valid databases, were compared according to the comparative table, and analyzed by a framework
approach. In order to assure the validity of data, the researchers referred to the websites of the
selected nations’ Ministry of Health and also cross‑checked the findings with reports published by
the World Health Organization.
RESULTS: In this study, we used the Control Knobs framework to compare countries’ FPPs because
the framework can demonstrate all necessary features of national health system programs. This
framework includes governance and organization, regulation, financing, payment, and behavior
in each country. The results of this study show that although the principles of FPP in the selected
countries are almost common, they use different methods in FPP implementation.
CONCLUSIONS: As the success of any policy depends on the political, economic, social, and
cultural context of each country, considering these factors and reinforcing each of the control knobs
are critical to the success of the family physician’s policy implementation.

Abstract BACKGROUND: Underweight is still prevalent in developing countries like India. Prepregnancy body
mass index (BMI) is used as the standard against which the measurements are made in pregnancy.
AIM: To study the association between early pregnancy BMI and feto‑maternal outcome among
nulliparous women
METHODOLOGY: This is a prospective observational study, with a sample size of 294. The antenatal
patients were categorized into four categories of BMI according to the WHO classification, and
pregnancy outcomes were compared. Data were analyzed using SPSS Software Version 17.0.
Statistical tools used were percentages and mean, and categorical variables were analyzed by
Chi‑square statistics.
RESULTS: 48.94% of the patients enrolled in the study had normal early pregnancy BMI, and 44.22%
and 6.8% were underweight and overweight, respectively. Obese women who gained more weight
were at a higher risk of preterm delivery, cesarean section, and more time required for resumption
of normal routine. Underweight women were at higher risk of postterm delivery, low birth weight,
and increased hospital stay.
CONCLUSION: Adverse maternal and fetal outcomes are seen more commonly with the extremes
of BMI.

Abstract INTRODUCTION: Nurse educators need to develop the level of scientific and practical of the students
with the goal of becoming expert nurses. However, the use of modern educational methods to raise
the motivation and satisfaction of learners can help individuals achieve this goal. Therefore, the aim
of this study was to investigate the effect of health education in emergency nurses about triage.
METHODS: A two‑group pool‑blind experimental study was performed on seventy emergency nurses.
Samples were randomly assigned into two groups: e‑learning group (35 individuals = electronic
education) and traditional group (35 = workshop education). The demographic questionnaire and the
satisfaction questionnaire before and 2 weeks after the intervention in both groups were completed.
RESULTS: Independent t‑test showed that the satisfaction scores before intervention in both
e‑learning and traditional groups were not statistically significant, whereas there was a significant
difference between two groups after 2 weeks after the intervention (P = 0/015).
CONCLUSION: Using nursing professors’ electronic education programs can increase the level of
satisfaction and motivation in the nursing mothers. Therefore, the use of this new educational method
is recommended by managers and educational planners as an effective teaching.

Abstract INTRODUCTION: In spite of our general knowledge about psychological roots and defects of
developmental processes in the formation of somatic symptoms, the effect of the interaction of
developmental components with cognitive‑emotional variables is unclear. Previous researches
suggest that individuals with insecure attachment may have a higher risk to experience of somatic
symptoms. The main aim of this study is “Modeling the Relationship between Attachment Styles and
Somatic Symptoms with the Mediating Role of Emotional Processing.”
MATERIALS AND METHODS: This study was a descriptive‑correlational study. Two hundred and
twenty individuals aged 18–59 years living in Tehran were selected by available sampling from
the general population. Collins and Reed’s Adult Attachment Scale, Baker’s Emotional Processing
Scale, and Patient Health Questionnaire were used to collecting data. Data analysis was performed
by Pearson correlation and independent t‑test. The conceptual model presented in this study was
tested with a path analysis approach.
RESULTS: Given the Chi‑squared size (² = 1.214; P > 0.05), it can be said that the proposed
conceptual model fits well with the observed model. Besides, checking the other absolute and relative
indices also shows a very good fit of the model.
CONCLUSION: Our results showed that when the reciprocal effects of attachment styles were
controlled, secure attachment could be considered as a protective factor against deficits in emotional
processing and somatization of negative emotions. On the other hand, we found that when the
dominant attachment style in individuals was anxiety based, it could be possible that they experience
deficiency in the processing of emotion and more severe somatic symptoms.

Abstract BACKGROUND AND OBJECTIVE: Osteoarthritis (OA) is a chronic degenerative disorder which
primarily affects the articular cartilage of synovial joints followed by bony remodeling and overgrowth
at the margins of these joints. The consequences of OA are pain, joint stiffness, decreased muscle
performance, and decreased aerobic capacity, which eventually affect the quality of life (QOL) and
increased risk for disability. The objective of the present study was to investigate the effectiveness
of two nonpharmacological treatment regimens, that is, yoga and conventional physiotherapy, on
QOL in patients suffering from OA of knee joint.
MATERIALS AND METHODS: Atotal of 83 patients with bilateral OA of knee joint, between the age group
of 40 and 80 years, both males and females, were assigned into two groups using computer‑generated
scheme: 43 in the experimental group (yoga with conventional physiotherapy program) and 40 in
control group (conventional physiotherapy program). Western Ontario and McMaster Universities OA
index (WOMAC) and Short‑Form 36 (SF‑36) health survey were measured before, after 15 days, and
after 30 days of treatment sessions, and the data were analyzed using paired and unpaired t‑test.
RESULTS: The results of the study show significant improvement in both groups with regard to
WOMAC and SF‑36 at the end of 15 and 30 days of treatment regimen; however, when compared
to the control group, experimental group had more significant improvement (P < 0.05) in WOMAC
and SF‑36 at the end of 15 and 30 days of treatment.
CONCLUSION: Yoga is more beneficial when added to conventional physiotherapy treatment regimen
in promoting health and improving QOL in patients with OA of knee joint.

Abstract BACKGROUND: Mental health is one of the major determinants of a person’s health which has
a significant impact on the quality of life. Implementing of mental health training programs for
promotion of health affected teenage girls to premenstrual syndrome (PMS) in Shiraz, southern
Iran: a community‑based study.
MATERIALS AND METHODS: This study is randomized controlled trial done on 100 teenage girls
affected to PMS in Shiraz‑Iran (selected from400 girls). Multistage cluster sampling method was
used f or sampling. In the intervention group, six training sessions were held twice a week for 2 h.
For data collection, Standard Goldberg Mental Health Questionnaire‑28 and Premenstrual Symptoms
Screening Tool were used. For data analysis, independent t‑test and Chi‑square statistics were used
at significant level of 0.05.
RESULTS: The average age was (16.56 ± 0.92) and (16.24 ± 1.45) in the intervention and control
groups, respectively. The average intensity of physical complaints, level of anxiety and sleep disorder,
level of social functions disorders and depression were significantly lower in the group of training
classes than control group (P < 0.001).
CONCLUSION: Appropriate training‑care programs are effective in reducing stress and improving
mental health, prevention and treatment of mental disorders, emotional growth, and development
of communication skills among female students with premenstrual syndrome.

Abstract BACKGROUND: Many kidney transplant recipients lack the knowledge, abilities, and support they
need for self‑care. On the other hand, most kidney transplant centers do not have a well‑planned
and specific training program for them, and educational interventions for kidney transplant recipients
have not been adequately effective. This study aimed to describe strategies for improving patient
education in kidney transplantation.
MATERIALS AND METHODS: Data were collected through semi‑structured individual and group
interviews with 24 patients, family members, and health‑care staff in one of the main kidney transplant
centers in Tehran. Participants were selected purposefully, and qualitative content analysis was
used to analyze the data.
RESULTS: The main finding emerged from the data was the shift from current patient education
program to patient‑ and family‑centered education (PFCE). The strategies to achieve this goal were
categorized into four main categories including “continuous patient and family education” (pre‑ and
posttransplant patient education), “facilitating the process” (using new technologies, teamwork
education, and patient and family accessibility), “strengthening human resources” (empowerment
health‑care team, allocation of human resources, promoting staffs’ motivation, and updating
educational content and materials), and “monitoring and evaluation” (correcting patient education
recording, supervising the patient education, and appropriate educational evaluation).
CONCLUSIONS: Transforming from the current patient education program to PFCE seems to be
essential to increase the effectiveness of patient education in kidney transplant process. To this
end, providing continuous patient and family education, facilitating the processes, strengthening
human resources, and monitoring and evaluation in health‑care organizations conducting the kidney
transplantation is necessary.

Abstract INTRODUCTION: Psychological factors affect the tendency of individuals toward cosmetic surgeries
although their contribution has not been clearly understood. Therefore, the current study aimed at
comparing the emotional intelligence, body image, and quality of life between rhinoplasty candidates
and the control group.
METHODS: The current case–control study was conducted on 160 individuals referring to
Rhinoplasty Clinic of Imam Reza Hospital in Tabriz, Iran, from 2018 to 2019. The tools used in
this study including demographic information, Schering’s emotional intelligence questionnaire
(α = 0.75–0.85), the 36‑item Short Form Health Survey Questionnaire (α = 0.75), and body
image (α = 0.77–0.91) were used to collect data. Data were analyzed by the Kolmogorov–
Smirnov and t‑tests for the two independent groups. P < 0.05 was considered as the level of
significance.
RESULTS: There was no significant difference between the groups in terms of the overall
mean of emotional intelligence and its subcomponents (P > 0.05), except social skills, such as
self‑awareness (P = 0.019). Appearance evaluation and appearance orientation variables were
statistically significant between the two groups (P < 0.05), while the quality of life was not statistically
significant (P = 0.051).
CONCLUSION: In the psychological parameters studied, we found that the appearance evaluation
and social skills of the rhinoplasty applicants are low, and it is better to have interventions before
the rhinoplasty in people who have difficulty with these variables.

Abstract CONTEXT: Universities of medical sciences are responsible for educating and training human
resources (HRs) that provide services to all members of the community. Clinical educators play a
significant role in the promotion of health and education in medical sciences universities.
AIMS: The aim of this study was to prioritize and develop a model to illustrate the relationship between
faculty recruitment challenges in medical sciences universities.
SETTINGS AND DESIGN: Interpretive structural modeling (ISM) is a system design method initially
introduced by Warfield (1974). This method helps create order in the complex interconnections
between components of a system by interpreting the opinions of a group of experts. It both determines
the priority of elements influencing one another and uncovers the association between the elements
of a multipart set in a hierarchical structure.
SUBJECTS AND METHODS: In this method, the identified challenges were built into a paired
comparison questionnaire to be completed by policymakers and experts. By the same token, the
obtained results were analyzed with the ISM technique.
STATISTICAL ANALYSIS: The four steps include identified variables related to the issue, structural
self‑interaction matrix, initial reachability matrix, and final reachability matrix was used for analysis.
According to these steps, the ISM model was portrayed.
RESULTS: The ISM model was developed in ten levels that divided into three parts including key
challenges, strategic challenges, and dependent challenges.
CONCLUSION: Health promotion and quality of education in medical sciences universities is
dependent on quality of faculty recruitment system. According to the results, it is imperative that HR
managers and policymakers improve existing rules and develop policies to solve the challenges in
this area.

Abstract INTRODUCTION: Midwifery screening is one of the duties of midwives according to national
guidelines. It is possible to increase midwives’ knowledge and practice through effective education.
The aim of this study was to compare the effect of standardized patient‑based education and feedback
lecture on midwives’ knowledge and practice in screening counseling for fetal malformations.
METHODS: This quasi‑experimental, two‑group study (standardized patient‑based training and
feedback lecture) was performed on 67 midwives (licensed by the office) in Mashhad in 2018.
Midwives’ knowledge and practice before and 2 weeks after training (a 4‑h training program)
were assessed by the Objective Structured Clinical Examination and a questionnaire. The data
were analyzed by the SPSS software version 16 using Mann–Whitney, Chi‑square, Wilcoxon and
independent t‑test while P < 0.05 considered as a significant level.
RESULTS: Before intervention, the total score of knowledge and practice showed no statistically
significant difference between the two groups (P > 0.05). After intervention, knowledge score
in feedback lecture group was statistically significantly higher than that of standard patient
group (P < 0.001). In addition, there was no statistically significant difference in performance scores
between the two groups after intervention (P = 0.761).
CONCLUSION: Both educational methods can increase midwives’ knowledge and practice in fetal
screening counseling. However, in raising midwives’ awareness, feedback lecture group was more
effective than standard patient group.

Abstract INTRODUCTION: Sexual problems in elder people are considered as a public health concern and
can affect their overall health and quality of life. This study aimed to investigate the sexual quality of
life and its relationship with general health in older men in the west of Iran.
METHODS: This was a cross‑sectional study among 362 older men aged 60 years or older attending
Comprehensive Health Care Centers in Ilam, Iran. Samples selected through Quota sampling method
and simple random sampling. Data were collected using the Sexual Quality of Life Questionnaire‑Male
and General Health Questionnaire‑28.
RESULTS: The mean ± standard deviation (SD) of age was 69.9 ± 8.1 years. The mean ± SD
score of sexual quality of life and general health of older men was 46.6 ± 14.6 and 19.2 ± 9.7,
respectively. A positive and significant association was found between sexual quality of life and
general health (P < 0.001, r = −0.41). Moreover, general health, age, sleep problems, and the level
of education were the important predictors for sexual quality of life in elder men (P < 0.05).
CONCLUSION: According to the results, the sexual quality of life of participants was at a moderate
level. Since only some factors influencing the sexual quality of life were ascertained, further studies
are required to investigate all factors influencing older men’s sexual quality of life.

Abstract CONTEXT: Emotional communications play an important role in having a satisfying relationship
and a more successful marriage. If marriage does not provide suitable conditions to satisfy couple’s
needs, not only it does not help to mental health but also results in negative and irreversible effects.
AIMS: This research was performed with the aim of determining the impact of emotional intelligence
training on marital satisfaction, sexual quality of life, and psychological well‑being of women.
SETTINGS AND DESIGN: The present research is an experimental study conducted on 70 women
referring to community health centers of Shahid Beheshti University of Medical Sciences in 2019.
SUBJECTS AND METHODS: The sampling was performed using multistage cluster sampling.
Before implementing the training intervention, the research instruments (general questionnaire,
Kansas Marital Satisfaction Scale, Iranian version of Sexual Quality of Life‑Female questionnaire,
and World Health Organization Five Well‑Being Index) were provided to the participants in order
to complete them. All participants recompleted the instruments immediately and 1 month after the
training intervention.
STATISTICAL ANALYSIS USED: The significance level was considered as P < 0.05.
RESULTS: The mean scores of marital satisfaction in the control group had no significant difference
before, immediately after, and 1 month after the intervention (P = 0.895). However, in the intervention
group, over time, the mean scores of marital satisfaction increased (P = 0.001), and the difference
between the two groups was significant (P < 0.001). The mean scores of sexual quality of life and
psychological well‑being had no significant differences before, immediately after, and 1 month after
the intervention in the control group. However, in the intervention group, over time, the mean scores
of sexual quality of life and psychological well‑being firstly increased and then decreased (P < 0.001),
and the difference between the two groups was significant (P < 0.001).
CONCLUSIONS: Training the components of emotional intelligence can be effective on enhancing
marital satisfaction, sexual quality of life, and psychological well‑being of women.

Abstract BACKGROUND: Latinos in the U.S., one of the fastest growing minority population, have low
health‑related knowledge and higher rates of diabetes and obesity.
AIM: The study aims (1) to assess health‑related knowledge levels and change in knowledge levels
after brief educational intervention and (2) to assess undiagnosed diabetes, hypertension, and
hypercholesterolemia in adult Latinos residing in Immokalee, Florida. A total of 164 participants
completed pre–posttests while 161 participants took part in health screenings comprising blood
pressure (BP), total cholesterol (TC), blood glucose (BG), and body mass index (BMI).
METHODS: Health‑related knowledge levels were assessed using 10 questions before and
after the educational intervention via face‑to face interviews. BP was measured using automated
sphygmomanometer, BG and TC were measured using lipid and glucose analyzer, waist
circumference using inch tape and BMI using digital scale. T test and Chi square were used to
examine the differences in knowledge levels and distribution of screening results across demographic
characteristics and self‑reports respectively.
RESULTS: Mean age was 40.1 ± 13.3 years; there were 77 males and 87 females. The knowledge
levels based on 10 questions increased by 1.43 (0.42) after educational sessions (P < 0.001).
Participants with college degree had statistically significantly higher pre–posttest scores than those
with no formal or less than high school education (P = 0.041). More males than females had high BP
in the age groups of 18–44 and ≥45 years (P < 0.001). More males in the age group of 18–44 years
had high TC (P = 0.024). Differences between screening results and self‑reports for diabetes and BP
were statistically significant (P < 0.001 and P = 0.01, respectively). Mean BMI was 28.5 ± 5.1 and
waist circumference was 38.6 ± 4.8 inch. Mean random and fasting BG levels and TC were higher
in females than in males (P = 0.003, P = 0.022, and P = 0.004, respectively).
CONCLUSIONS: The study highlights undiagnosed diabetes and hypertension in Latinos and more
Latino males than females to have hypertension and hypercholesterolemia. Latinos’ vulnerability to
chronic diseases and associated complications is further confounded by limited health knowledge.
However, the results of the brief educational program were encouraging and have implications in
setting up structured educational interventions in health clinics and migrant education programs.

Abstract BACKGROUND: Medical students face a variety of challenges during their years of medical education
that can affect their quality of life (QOL). This study aimed to investigate the association of QOL
with physical activity (PA), depression, and demographic characteristics, as well as to determine its
predictors among medical students in different stages of education.
METHODS: A cross‑sectional descriptive‑correlational study was conducted on 186 medical students
of Tabriz University of Medical Sciences in different educational stages including basic sciences,
physiopathology, externship, and internship using stratified random sampling method. Data were
collected using demographic questionnaire, International PA Questionnaire, World Health Organization
QOL Questionnaire, and Beck depression inventory‑2. Data analysis was performed using SPSS/Ver 23
through descriptive and analytic statistics including one‑way analysis of variance, independent t‑test,
Pearson and Spearman correlation coefficient, and multivariate linear regression model.
RESULTS: There were significant differences in total score of QOL among students in different
stages (P < 0.05). There were indirect significant correlations between total score of QOL (β [confidence
interval 95%]:−0.85 [−1.11–−0.59]) and its all subdomains with Beck depression score but direct
significant correlations with total PA (P < 0.05) except for social relationship. Educational stage,
employment status, family income, inhabitant, moderate PA, and depression were the predictors of
QOL and altogether explained 63% of its variance.
CONCLUSIONS: To pay attention to the predictors of QOL, life among medical students seems
necessary for increasing their QOL to provide high‑quality care for people with disabilities as well
as for the whole community.

Abstract OBJECTIVE AND AIM: Chronic obstructive pulmonary disease (COPD) is one of the most common
chronic diseases. The patient’s fear and anxiety of shortness of breath and coughing during exercise
may lead to a decrease in patients’ daily activities. Therefore, the present study aimed to determine
the effect of empowerment program based on the social cognitive theory (SCT) on the daily activity
of patients with COPD.
METHODS: This quasi‑experimental study was performed on 70 patients with COPD referred to
Kashani and Hajar centers in 2019. Samples were randomly divided into two groups of experimental
and control. Data collection tools included demographic information questionnaire and activity of daily
living questionnaire, specific for COPD, and a researcher‑made questionnaire for measuring SCT
constructs. For the experimental group, the training program consisted of four theoretical and practical
sessions of 40 min/week. The data were collected at three time points, before, immediately and 3
months after the training are 3 time. The data were analyzed by SPSS software using descriptive
and inferential statistics.
RESULTS: The difference between the mean scores of behavioral ability, self‑efficacy, and
empowerment in the three stages was significant only in the experimental group (P < 0.001). The
mean daily activity score of patients before, immediately, and 3 months after intervention showed
a statistically significant difference between the two groups (52.46 ± 21.98, 63.36 ± 21.95, and
71.34 ± 19.02), respectively, in the intervention group, and (51.79 ± 19.29, 53.70 ± 19.28, and
53.82 ± 19.26), respectively, in the control group (P < 0.001).
CONCLUSION: The results of this study showed that empowerment of patients through interventions
based on SCT can increase the daily activity of patients with COPD. Because nurses play an important
role in patient education and improvement, it is hoped that the findings of this study will be used as
a strategy to increase the daily activity and ultimately improve the quality of life in these patients.

Abstract INTRODUCTION: Investigating severe maternal morbidity and near‑miss cases are applied
internationally as a new indicator to examine the quality of maternal care and as an effective strategy
to reduce maternal mortality. This study aimed to determine the root causes of severe maternal
morbidity in order to improve maternal health.
MATERIALS AND METHODS: The present research is a descriptive case series study. The data was
obtained from the hospital and health records of mothers admitted to hospitals affiliated to Isfahan
University of Medical Sciences due to severe morbidity in the first 6 months of 2018, which were
selected randomly. The data collection was completed by interviews with the mentioned mothers and
14 related health‑care staffs and that led to the development of the morbidity story. The compiled
story of each case was evaluated by the root analysis team’s opinion. Causes of morbidity were
determined according to a root cause analysis checklist composing of factors such as health‑care
services (human and structural factors), family‑social status, and disease status of maternal morbidity.
RESULTS: The findings indicated that human factors related to the health system led to severe
maternal morbidity more than any cause. Inadequate knowledge and skills of service providers,
disregard for guidelines and protocols, lack of teamworking, and lack of considering competency
were the most important human factors. Disease condition, family, and social status were the other
related factors, respectively.
CONCLUSION: Human factors are the most important cause of maternal morbidity based on the
results of this study. Therefore, modifying the health structure can be one of the most important
reducing factors for maternal mortality in order to improve the services for these individuals.

Abstract INTRODUCTION: Social media is becoming a new tool for developing health knowledge management.
However, despite the rapid growth of research in this area, few attempts have been made to review
previous research. This study tried to summarize the opportunities and challenges of using social
media to managing health knowledge.
METHODOLOGY: This article used a narrative approach to collect and review studies. In this
review, published documents during 2010–2019 were retrieved by search in the following three
electronic scientific databases: Web of Knowledge, PubMed, and Google Scholar search engine
using keywords including social media, public health, health knowledge, knowledge management,
and health promotion.
RESULTS: Social media by overcoming geographical barriers, developing health promotion,
facilitating decision‑making, and providing public health education has been able to enhancing health
awareness and improving health behavior. Doctors’ unwillingness to interact with the public, lack of
compliance with the principles of medical ethics, users’ privacy concerns, and difficulty of managing
negative comments are the four challenges to health knowledge management in social media.
CONCLUSION: Social media can be a suitable tool for developing health knowledge management
processes if medical professional ethics and users’ privacy managed properly.

Abstract

Abstract AIM: This study aimed to investigate the effect of school‑based interventions on mental health among
adolescents in the southeast of Iran.
METHODS: This interventional quasi‑experimental study included a total of 420 adolescent girls
studying 10th grade in the public schools of Zahedan, Iran. Data were collected using general health
questionnaire‑28 questionnaire. After pretest, multidimensional interventions (individual education,
group education, individual consultations, modern education, and parents’ educational packages)
were given to the intervention group from October 2015 to June 2016. After a 3‑month interval, the
posttest was conducted in October 2016. Data were analyzed by covariance analysis.
RESULTS: There was a significant statistical difference between the changes in the mental
health scores after the intervention among the two study groups (P < 0.05). Furthermore, after the
intervention, moderate‑to‑severe mental health problems decreased considerably among the students
in the intervention group compared to controls. The greatest impact was on individual psychological
counseling.
CONCLUSIONS: The results of the study showed that by applying group training and individual
counseling in the schools improves mental health. Therefore, identifying student problems and
parent–teacher cooperation as well as consulting with specialist counselors can be effective in
providing practical and effective solutions in this regard. Therefore, findings suggest that prioritizing
mental health and taking action on the field are of utmost importance.

Abstract BACKGROUND AND AIM: Given the absence of a scale specially designed to measure willingness
to mobile learning (m‑learning) in medical sciences students, the present study was conducted to
design and evaluate the psychometric properties of “willingness to m‑learning” scale for medical
sciences students.
METHODOLOGY: The study was carried out as a mixed‑method study in two phases at Saveh
University of Medical Sciences in 2019. Phase one was a qualitative study to elaborate on the students’
perception of m‑learning. Then, the statements were extracted, and statement pool was completed
through reviewing the text. In the second phase, the psychometric properties including face, content,
and construct validities (using explorative factor analysis), internal consistency (Cronbach’s alpha),
and test–retest reliability (intercluster correlation test) were measured. A total of 482 students who
were selected randomly participated in the second phase. Data analysis was done with MAXQDA
software (VERBI Software 2019, Berlin, Germany) for qualitative data and SPSS 19 software
(SPSS Inc., Chicago, IL, USA) for quantitative data.
RESULTS: Based on qualitative content analysis and literature review, 92 statements were extracted.
After checking face and content validity, 55 statements remained in the study. Construct validity of the
questionnaire based on explorative factor analysis removed 10 more statements and the remaining 45
statements were categorized into nine factors, namely technophilia, perceived attraction, perceived
ease, perceived conflict, self‑management, attitude, behavioral intention to use, educational use,
and efficacy of m‑learning. Reliability of the scale was obtained as 0.95 based on Cronbach’s alpha
and stability was checked using test–retest method (intercluster correlation coefficient; r = 0.92).
CONCLUSION: Willingness to m‑learning scale had an acceptable reliability and validity in medical
sciences students. Therefore, it can be used for medical sciences students for improve learning
and education.

Abstract BACKGROUND AND AIM: Measuring child abuse and adverse experiences is a critical task with
regard to its long‑term impact on the health of individuals and communities. The purpose of this
study was to validate the Persian version of the International Adverse Childhood Experiences Abuse
Short Form (ACE‑ASF) in Iranian society.
MATERIALS AND METHODS: This cross‑sectional study was conducted in Kerman, southeast of
Iran, in 2019, on 494 students from Kerman University of Medical Sciences, selected by convenience
sampling method. Psychometric properties of the questionnaire were examined after the forward
and backward translation processes. The factor structure of the questionnaire was evaluated using
exploratory factor analysis (EFA) and confirmatory factor analysis (CFA). The concurrent validity of
the questionnaire was assessed using the childhood trauma questionnaire (CTQ). Cronbach’s alpha
and corrected item‑total correlation were used to measure reliability.
RESULTS: The mean age of participants was 24.3 ± 5.3 years. Based on EFA, two physical–emotional
abuse and sexual abuse factors were obtained. The CFA fit indices well supported two extracted
factors. The CFA showed acceptable factor loadings. The internal consistency coefficient of
Cronbach’s alpha was 0.75 for the physical–emotional abuse factor and 0.77 for the sexual abuse
factor. The correlation coefficient of ACE‑ASF and CTQ was r = 0.56. The reliability index of intraclass
correlation coefficient was 0.73 (95% confidence interval: 0.60–0.84).
CONCLUSION: The Persian version of the ACE‑ASF questionnaire has acceptable psychometric
properties.

Abstract BACKGROUND: University health coverage gives everyone accesses to health services focused
on the most important causes of illness and death and ensures that the quality of services is high
enough to improve the health of those receiving services. Nurses as the largest group of staff in the
health system play an important role in achieving UHC. This study aimed to determine the training
needs of nursing managers in universities of medical sciences of Iran in achieving UHC.
MATERIALS AND METHODS: This study was a qualitative study conducted in 2019 using the
framework method. There were 15 experts in nursing management, health management, and nursing
authorities at the national level using the purposive random sampling. Data were collected from the
expert panel. We used the Atlas.ti software version 7.2 and using the framework method for the
analysis of qualitative data. A set of codes organized into categories that were jointly developed by
the researchers involved in the analysis. The UHC framework used to summarize data in a way that
could support answering research questions.
RESULTS: This study showed that three educational modules leadership and strategic thinking,
management, and decision‑making, achieving excellence in nursing management to capacity building
of nursing managers in the country.
CONCLUSION: Training leadership skills and strategic thinking in the nursing empowerment modules
illuminate global and national health roadmaps and policies and change attitudes to the model of
nursing service delivery. Since nurses are the largest group of professionals in the health system, it
facilitated by changes in the role and functions of the hospital and nurses to reach UHC.

Abstract BACKGROUND: Ethnic minorities are underrepresented in health sciences programs in various
nations. Furthermore, there is no known research studying the occurrence of physical inactivity (PI)
and insufficient sleep (IS), and their effects on academic achievement (AA) in ethnic minority
students (EMS) in higher education.
OBJECTIVE: The objective of this study is to explore the occurrence of PI and IS, and their
independent and mixed effects on AA in EMS of a dental school.
MATERIALS AND METHODS: Thirty EMS and sixty non‑EMSs were matched (1:2) in this
case–control study. It was utilized as an administrative dataset that stores register related to the
students. Moreover, the grade point average was considered an indicator of AA. Logistic regressions
models were run, expressed in odds ratios, complemented by confidence intervals (CIs) of 95%.
RESULTS: A total of 73% and 60% EMS were PI and slept insufficiently, respectively. The groups
presented statistically significant differences (P < 0.0001) in physical activity, sleep, and AA, with
inferior values for EMS. All unadjusted models showed that PS, IS, and low AA were strongly
associated with EMS, demonstrating their independent effect. After controlling for PI and IS, the
multivariate model for AA and EMS increased odds by 6.5 times (95%CI: 1.8–23;), indicating
that EMS is strongly associated with low AA. Besides, PI and IS were also statistically significant
higher (<0.0001) in the model, demonstrating their mixed effect.
CONCLUSIONS: This study found a higher occurrence of PI and IS in EMS. Besides, independent
and mixed effects of these variables on low AA in EMS were very significant.

Abstract INTRODUCTION: Gifted students are superior to their peers in terms of cognitive, educational,
scientific, creativity, and artistic abilities. There are also gifted students who struggle with cognitive,
educational, social, emotional, and behavioral development, especially academic performance. They
are called underachieving students. One of the main problems of these students is the low level
of academic engagement in educational settings. Thus, this study investigated the effectiveness
of Martin’s educational program on academic engagement (behavioral, emotional, cognitive, and
agency) of underachieving gifted students.
MATERIALS AND METHODS: Thirty underachieving gifted students were selected by purposeful
sampling from a high school in Isfahan, Iran, and were divided randomly into the experimental (n = 15)
and the control (n = 15) groups. All participants completed the students’ academic engagement
questionnaire (behavioral engagement, emotional engagement, cognitive engagement, and agency
engagement) at pre/post‑test.
RESULTS: The findings showed that Martin’s cognitive‑behavioral program had a significant effect on
academic engagement and its subscales, including behavioral engagement, emotional engagement,
cognitive engagement, and agency engagement.
CONCLUSION: School counselors could benefit Martin’s cognitive‑behavioral program to promote
the academic engagement of underachieving gifted students.

Abstract BACKGROUND: Improving the learning process in education will empower medical students, and
also formative assessment helps improve the teaching–learning process by providing ongoing
reflective information about learning gaps.
OBJECTIVE: The aim of this study was to explore the effect of student‑centered formative assessment
by weekly reflective self‑correction quizzes on medical laboratory students’ performance on the final
examination of hematology course in 2018.
MATERIALS AND METHODS: A semi‑experimental study was conducted on fifty students divided
randomly into intervention (n = 25) and control groups (n = 25) using convenience sampling in 2018
from Torbat Heydariyeh University of Medical Sciences, Iran. Data analysis was performed using
SPSS software version 16, two‑sample t‑test, Chi‑square test, and analysis of covariance.
RESULTS: The intervention had positive effects on students’ mean test scores in hematology
II so that the intervention and control groups managed to obtain 18.45 ± 1.46 and 14.57 ± 2.64,
respectively (P < 0.01).
CONCLUSIONS: The results suggested that weekly formative assessments along with reflective
self‑correction activity and active participation of students in the learning process by designing
questions could improve student learning.

Abstract

Abstract BACKGROUND: Hypertension (HTN) has become a major public health problem which can cause
serious complications when it is not well-controlled. Prevention and effective care of HTN require
a population-based registry. Thus, establishing this registry can be used to collect comprehensive,
timely, and reliable data on epidemiology cases. The aim is to create a registry for the collection of
highly required prospective data that will present an in-depth analysis of the characteristics of all
individuals with HTN and track them over a particular chronological interval.
MATERIALS AND METHODS: The study was divided into three phases: At first, a comprehensive
literature review was conducted to determine the proposed data classes and data fields. Then, the
final minimum data set was designed by a two-round Delphi consensus approach of 20 experts of
cardiologists, nephrologists, nutritionist, and health information management. Finally, a web-based
registry system was developed by a Structured Query Language environment.
RESULTS: A total of two clinical and nonclinical data categories with nine data classes and 68 data
fields were selected for their inclusion in the registry following the consensus phase. A web-based
registry was designed with a modular and layered architecture.
CONCLUSIONS: This study provides an appropriate information infrastructure for active tracing and
monitoring of individuals with HTN. It has provided a practical information system allowing quality
improvement, aggregate reporting for planning, and research purposes.