Journal of Education and Health Promotion

Abstract

Abstract Clinical informationist (CI) is one of the current trends in the field of medical librarianship and
information science. CIs are members of clinical care teams, and their main duty is to fill the gap in
the information needs of health‑care workers and patients using information sources. They need an
official and standard education. This study aims to identify the educational goals and needs of CIs.
To this end, a scoping review was conducted using the Preferred Reporting Item for Systematic
Reviews and Meta‑analyses guidelines. The ISI Web of Science, Scopus, Proquest (MEDLINE),
Science Direct, Emerald, ERIC, Cochrane, and Library, Information Science and Technology Abstracts
were searched. The Journal of the European Association for Health Information and Libraries was
hand searched for relevant studies. A total of 1026 studies were extracted, and 38 studies were
selected for the final review. The review resulted in identifying 18 goals in cognitive, emotional, and
psychomotor areas. Furthermore, the educational needs were identified in eight educational needs
including research method and statistics, education, medical knowledge, information and librarianship
science, clinical environment knowledge, evidence‑based knowledge, information technologies and
systems, management, and leadership. Although part of these educational needs can be met through
general medical librarianship and information science education, further specialized education for
CIs requires specific aims and curriculum. Thus, the results of this study can be the basis for future
studies regarding the competencies of CI in order to provide a more precise and detailed curriculum
based on these educational needs.

Abstract INTRODUCTION: Novel coronavirus is believed to be tiny enough (0.08–0.14 μm) to penetrate
through face mask, thus protection offered by cloth mask may be too low. However, the use of cloth
face mask in community has been recommended by the United States Centre for Disease Control
and Prevention and regulatory bodies of other countries. There is paucity of literature on efficacy of
cloth face mask in preventing SARS‑CoV‑2 infection transmission; thus, this review aims to update
the available most recent evidences on efficacy of cloth face masks in prevention of viral infection
transmission.
METHODS: We searched MEDLINE, EMBASE, and Clinical Trials Register for identifying studies
related to this review using free‑text terms and MeSH terms. Both experimental and observational
studies on efficacy of cloth masks which were published in English language have been included
in this review except expert opinions, commentaries, editorials, and review articles. Twelve studies
were eligible to be included in review for data extraction and qualitative synthesis was carried out
from extracted data but quantitative analysis (meta‑analysis) could not be performed because of
serious heterogeneity between the studies.
RESULTS: Cloth face masks show minimum efficacy in source control than the medical grade mask.
The efficacy of cloth face masks filtration varies and depends on the type of material used, number
of layers, and degree of moisture in mask and fitting of mask on face.
CONCLUSION: Cloth face masks have limited efficacy in combating viral infection transmission.
However, it may be used in closed, crowded indoor, and outdoor public spaces involving physical
proximity to prevent spread of SARS‑CoV‑2 infection.

Abstract BACKGROUND: In chronic diseases such as osteoporosis, understanding the factors that improve
prevention, such as health literacy (HL), is essential in reducing the incidence of these diseases.
This study aimed to determine the association between HL and adoption of osteoporosis‑preventive
behaviors among students in Qazvin.
SUBJECTS AND METHODS: This is a cross-sectional study in which 375 female students
(aged 15–18 years) at high schools (grades 10th, 11th, and 12th) in Qazvin city were selected, in
2019. Sampling method was multistage. To collect data, the standardized questionnaire for measuring
HL in adolescents (health literacy measure in adolescents), in addition to another questionnaire for
assessing osteoporosis‑preventive behaviors, was used. Data were analyzed using SPSS 22 by
descriptive statistics and logistic regression. The association considered significant when P < 0.05.
RESULTS: The mean scores of adoption of osteoporosis‑preventive behaviors and HL were
22.43 ± 5.60 and 70.84 ± 12.58, respectively. Logistic regression showed that there was a significant
association between the adoption of osteoporosis‑preventive behaviors and HL (P = 0.001). In
addition, the association between the adoption of osteoporosis‑preventive behaviors and age was
also significant (P = 0.048 and odds ratio = 3.35).
CONCLUSIONS: Young students and those of low HL showed less adoption of osteoporosis‑preventive
behaviors. Therefore, it is necessary to pay more attention to design educational programs that may
raise the knowledge and awareness of those students about such these diseases, mainly prevention.

Abstract Although telemedicine has been used spottily in Indian health care so far, the 2020 Covid‑19 pandemic
provided the nation’s health systems an unprecedented opportunity to make a concerted effort to
increase access and coverage. Health‑care providers can incorporate telemedicine systems to reduce
doctor‑patient visits and help in breaking the chain of transmission of infections. Anticipating the
increased need of telemedicine by health‑care providers, the Medical Council of India released practice
guidelines in March 2020. In this article, the literature pertinent to telemedicine and its applications
with special reference to recently released practice guidelines were reviewed and summarized in a
historical and current context. Telemedicine is bound to grow and be adopted by more health‑care
practitioners and patients in a wide variety of forms due to ease and availability. At the same time,
it cannot replace in‑person consultation or emergency medicine.

Abstract INTRODUCTION: Occupational accidents have many undesirable and irreparable effects on labor
forces, assets, environment, and credibility of organizations. Human errors are one of the most
important causes of occupational accidents. Human errors have different causes, but in all cases,
human cognitive abilities and limitations play important roles; in this research, the relationship between
occupational cognitive failures and work-related accidents in heavy equipment operators of Shahid
Rajaee Port Complex has been investigated.
METHODS: This research was done through the field method. A sample of 332 people was selected
by a stratified sampling method among all heavy equipment operators. The data gathering tool
contained a 30-item occupational cognitive failure questionnaire. Furthermore, regression analysis
method was used to test the hypotheses.
RESULTS: The results of this study showed that cognitive failures of occupational accidents on
direct work-related accidents in heavy equipment operators of Shahid Rajaee Port complex have a
direct effect (P < 0.00). Further more, variables that modify the research are age, work experience,
working hours, educational level, type of occupation, and marital status of the operators.
CONCLUSION: Regarding the direct relation between cognitive occupational failures and occupational
accidents, one can predictive this result that the occupational cognitive failure questionnaire can be
used as a predictive tool in accidents of Shahid Rajaee Port Complex.

Abstract BACKGROUND: Iran has experienced an increasing number of earthquake disasters in the past
three decades. Due to nurses’ unique role as professional and volunteer responders in times of
disaster, more information is required regarding the capabilities they need to provide more effective
care during the crisis. The aim of this study was to identify professional capabilities needed by nurses
to provide care to the injured of earthquake.
MATERIALS AND METHODS: The present study was conducted as a qualitative conventional content
analysis, and data collection was carried out through 16 semi‑structured and in‑depth interviews with
the nurses involved in providing care to the injured in the Kermanshah earthquake. The data were
analyzed following Graneheim and Lundman’s approach.
RESULTS: Data analysis led to the emergence of 427 primary codes, 10 subcategories, and four
categories. The four categories included clinical competence (professional knowledge and clinical
skills), personal competences (communication skills, resiliency, and creativity and innovation
in providing care), ethical competence (commitment to ethics and professional responsibility),
and essential skills in caring for the injured (skills in triage, psychological care skills, and skills in
observation and monitoring)
CONCLUSION: The present study identified a wide range of professional capabilities required by
nurses in disasters. Given that nurses do not acquire some of these specialized and technical skills
during their education, it is recommended to enhance the professional capacity of nurses in disasters.
In addition, special training programs in this field can be incorporated into the curriculum of nursing
programs and in-service nursing education.

Abstract INTRODUCTION: Many women refuse to exercise during pregnancy due to lack of awareness and
not receiving training. The aim of this study was to investigate and compare the effect of group and
telemedicine education on exercise during pregnancy by using the health belief model (HBM).
MATERIALS AND METHODS: This quasi-experimental study was carried out in 2019 in Zahedan,
and a total of 135 pregnant women participated in it. Samples were randomly assigned to the following
three groups: group training (n = 45), telemedicine (n = 45), and control (n = 45). Group training was
presented in three sessions, and the telemedicine group received the educational content through
mobile applications. The samples completed the HBM questionnaire before and 6 weeks after the
intervention. In addition, within 6 weeks after the intervention, they completed the exercise activity
schedule. SPSS software Ver. 16 (IBM Corp, Armonk, NY, USA) was used for analysis, and data
were analyzed by ANOVA, Tukey’s post-hoc test, Kruskal–Wallis test, and Mann–Whitney test.
RESULTS: After intervention, the scores of HBM constructs and exercise levels in group training,
telemedicine group, and control group, respectively, were as follows: perceived susceptibility
25.91 ± 3.24, 25.51 ± 1.97, and 22.55 ± 3.78; perceived severity 27.48 ± 2.27, 25.13 ± 2.29, and
22.51  ±  3.88; perceived benefits 27.28  ±  2.97, 25.68  ±  3, and 22.8  ±  3.05; perceived barriers
10.69 ± 2.69, 10.66 ± 3.19, and 14.17 ± 3.14; cues to action 24.71 ± 4.35, 23.9 ± 2.48, and
22.84  ±  3.02; self-efficacy 26.17  ±  3.05, 25.2  ±  2.82, and 22.51  ±  3.38; and exercise levels
70.99 ± 20.43, 56.51 ± 21.99, and 37.62 ± 29.66. Group training and telemedicine led to significant
improvement in all HBM constructs and exercise levels (P < 0.05, P < 0.0001, and P = 0.003,
respectively). Group training provided more improvement than telemedicine in the scores of perceived
severity (P < 0.0001), perceived benefits (P = 0.001), cues to action (P = 0.02), and mean exercise
time (P = 0.001).
CONCLUSION: The results of this study showed that the HBM is a proper model for exercise
education in pregnant women. It is recommended to use HBM as a group training and telehealth in
promoting the rate of exercise in pregnant women.

Abstract BACKGROUND: Teenagers are increasingly interested in computer games, and the adverse effects
of these games are dependent on the execution of these games. The theory of planned behavior
(TPB) is one of the most important theories in behavior change. This study aimed to determine the
effect of educational planning based on TPB on the level of dependence on computer games in high
school male students in Gonabad, Iran.
MATERIALS AND METHODS: This was a randomized controlled trial. The study population was
students of computer games in Gonabad. Sixty-four students were selected by a multistage random
sampling method and were randomly divided into intervention (n = 32) and control (n = 32) groups.
Data-gathering tool was the standard questionnaire of computer game dependency and researchermade questionnaire according to TPB constructs that were completed before, immediately, and
3 months after the intervention. The intervention consisted of eight 90-min training sessions. Data
were analyzed using the Chi-square test, Fisher’s, t-test, repeated measures ANOVA, and Bonferroni
post hoc test.
RESULTS: Before the intervention, the intervention and control groups were matched for the mean
score of model constructs. However, after the intervention, the mean score of computer game
addiction significantly decreased (≤0.001). However, the mean score of knowledge, attitude,
perceived behavioral control, and behavioral intention increased, which was statistically significant.
Furthermore, the mean changes of model structures were statistically significant (P < 0.05).
CONCLUSION: The findings revealed that TPB can be used as a good theoretical framework for
designing and implementing educational programs to reduce the dependency of computer games
on students.

Abstract INTRODUCTION: Hypertension is one of the most critical factors for chronic diseases such as
cardiovascular disease, stroke, arrhythmias, heart failure, and renal disease. The aim of this study
was to evaluate the quality of life and its related factors in hypertensive patients.
MATERIALS AND METHODS: This study was descriptive research. The sampling method was
simple random, i.e., 137 were selected among the ten health centers of the list of the existing patients
by simple random sampling. Data were collected using a questionnaire World Health Organization
Quality of Life-BREF (Short Form-26). After collecting the questionnaires, the data analysis was
carried out using SPSS software and using statistical methods (e.g., number, percentage, mean,
standard deviation, and MANOVA tests).
RESULTS: The results showed that the mean score for the physical domain (52.82), the psychological
domain (50.26), the social domain (48.33), the environmental domain (46.1), and the total quality of life
(49.60). Among the demographic variables, the education level variable (P =0.000), job (P = 0.013),
and the duration of hypertension (P = 0.039) were significantly correlated with the quality of life of
patients. The “levels of education” variables are significantly correlated with the physical domain
(P = 0.000), psychological domain (P = 0.000), social domain (P = 0.000), and environmental domain
(P = 0.000) of the quality of life. The “job status” variable is only significantly correlated with the social
domain of the quality of life (P = 0.005). The “duration of hypertension” variable is only significantly
associated with the physical domain of the quality of life (P = 0.011).
CONCLUSION: The findings of the present study show that demographic variables such as
educational level, occupation, and duration of hypertension have a significant relationship with the
quality of life domains of hypertensive patients. It is recommended that the principled education of
patients is a step toward the improvement of the quality of life of patients.

Abstract INTRODUCTION: Conduct disorder is among the most serious and complex complications in schoolaged children. Considering severe problems in the families of children with conduct disorder, this
article aimed to investigate such problems in this group.
SUBJECTS AND METHODS: This qualitative research was conducted on 23 participants in Tehran,
Iran. The study participants were selected by purposive sampling technique. Interviewees consisted
of children with conduct disorder (8–12 years old), their parents, teachers, and relevant experts. This
study is a qualitative research which is a content analysis. The research tools included a checklist of
questions approved by experts. The content analysis method was used with the help of MAXQDA
software to analyze the obtained data.
RESULTS: The findings comprised the studied families’ issues in five categories. These classes
included the parents’ marital problems, helplessness, and inability of the family to improve conditions;
inappropriate discipline approaches; the family’s lack of interest in the treatment; and the family
members’ mental harms.
CONCLUSIONS: It is necessary to provide appropriate facilities and health-care centers for the
families to reduce the burden of their problems. In addition, a specialist and experienced work team
consisting of at least a child psychiatrist, a child psychologist, and a social worker is necessary to
serving these families.

Abstract INTRODUCTION: Adolescence is characterized by a rapid phase of growth and development
during which the requirement of nutrition and micronutrients is relatively high. Although there is a
decreasing trend in the prevalence of undernutrition among adolescents, the current prevalence
of undernutrition is still very high (41.9%). Adolescents with good nutrition knowledge are more
likely to follow healthy eating habits. In the light of this, the current study was planned to assess the
baseline nutrition‑related knowledge of adolescent girls and the effectiveness of nutrition education
material (flipchart) in increasing their nutrition‑related knowledge.
MATERIALS AND METHODS: A school‑based interventional study was conducted among adolescent
girls of class 9th of a school in an urban slum of Delhi. A structured pretested Knowledge Assessment
Questionnaire consisting of 10 multiple‑choice questions in Hindi with a maximum score of 10 was
used. The intervention was a nutrition education session conducted by doctors of Community Health
department using specially designed flipcharts covering important aspects of nutrition relevant for
adolescent girls. A demonstration of food items and charts and flex material was also given. The
total sample size was 265 adolescent girls.
RESULTS: Baseline knowledge as assessed by mean pretest score was poor (3.698 ± 1.81).
The students’ baseline knowledge was significantly associated with mother’s educational
status (P = 0.024). There was a significant increase (mean difference was 1.7890 ± 0.1434) in the
nutrition‑related knowledge of the participants after the intervention (P < 0.001). The proportion of
students who improved, i.e., 147 (55.47%) was more than proportion who deteriorated (25 [9.43%])
after the educational session. This difference was found to be statistically significant (P ≤ 0.001).
CONCLUSION: Nutrition knowledge was found poor among school‑going adolescent girls, which
significantly improved after the nutrition education session.

Abstract BACKGROUND: Health promotion of adolescents requires appropriate evidences of its determinants.
The aim of this study was to investigate predictors of self-rated health (SRH) among adolescents
in Qazvin, Iran.
MATERIALS AND METHODS: In this descriptive cross-sectional study, with a multistage sampling
method, we recruited 1740 adolescents aged 12–19 years from 53 schools in Qazvin, Iran (2018). We
used the Strengths and Difficulties Questionnaire and Adolescents’ Academic Stress Questionnaire
for data collection. The analysis was conducted using a multilevel logistic regression model. Gender,
educational period, and socioeconomic status were considered as confounders.
RESULTS: Almost 21% of the adolescents reported their SRH suboptimal. Suboptimal SRH was
higher in girls and older adolescents. Mental health disorders and academic stress had a positive
association with SRH. However, this association was negative for academic achievement and
physical activity. The interaction between mental health disorders and academic stress with SRH
had a significant association in a crud regression model.
CONCLUSION: Mental health, academic stress, academic achievement, and physical activity were
important predictors for SRH. Interventions that focus on promoting mental health, academic stress,
academic achievement, and physical activity such as physical activity for 1 h and each day for 3 days
per week can improve SRH in adolescents. Hence, policymakers should pay more attention to this
issue in health promotion programs of adolescents.

Abstract BACKGROUND AND PURPOSE: The World Health Organization has identified health literacy (HL)
as one of the most important determinants of people’s health. Therefore, this research aimed to
investigate the status of HL and its predictors.
MATERIALS AND METHODS: This research was a cross-sectional study that was performed on 600
adults in Bijar County, Iran. Cluster sampling was used to select the samples. Data were collected
using the questionnaire of HL for Iranian adults. Data were analyzed using one-way analysis of
variance, Student’s t-test, and multiple linear regression in SPSS 21.
RESULTS: The mean score of HL was 3.6 out of 5; 69% and 29% of the samples had a moderateto-high health status, respectively. Among the dimensions of HL, the highest and the lowest means
were perception (3.94) and evaluation (3.21), respectively. Based on the multiple regression results,
the variables (gender – B = −0.142, confidence interval [CI]: −0.409 to −0.011, P = 0.39; education
level – B = 0.391, CI: 0.149–0.287, P = 0.00; and income level – B = 0.203, CI: 0.00–0.00, P = 0.01)
were significantly positively associated with HL.
CONCLUSION: The results of this study can be applied to educational interventions through media
and radio-television to increase public awareness. Education is also strongly recommended in terms
of demographic variables and characteristics to promote HL in the society.

Abstract INTRODUCTION: Professionalism and medical ethics are a vital quality for doctors, which has been
taken into account seriously in recent years. Perception of the factors affecting professionalism may
help develop more efficient approaches to promote this quality in medical education. This study
was aimed to explain the role of hidden curriculum in the formation of professional ethics in Iranian
medical students.
MATERIALS AND METHODS: This qualitative study was performed on 15 medical interns of
Kermanshah University of Medical Sciences in 2019, using grounded theory. Sampling was started by
purposive sampling and continued through theoretical sampling until complete data saturation. Data
collection and analysis were done simultaneously. Data were interpreted by a constant comparative
method according to Strauss and Corbin’s approach.
RESULTS: The analysis of the participants’ interviews and reduction of findings using common
themes yielded one class and four categories as well as a number of concepts as the role of hidden
curriculum in the formation of professional ethics in medical students. The categories included the role
of modeling in the formation of professional ethics, role of education in the formation of professional
ethics, role of environmental factors in the formation of professional ethics, and role of personal and
inherent attributes in the formation of professional ethics.
CONCLUSION: Curriculum developers and medical education authorities need to proceed in line with
the findings of the present study to provide a proper learning environment, in which the modeling,
learning, and teaching conditions and supportive environmental atmosphere are taken into account
in accordance with the inherent and individual characteristics of the learners in order to guarantee
the formation of professional ethics in medical students.

Abstract CONTEXT: Pap smear test is one of the most important actions in preventing cervical cancer. This
study aimed to perform a meta-analysis on all related literature about the effects of health belief
model (HBM)-based training on Pap smear screening test performance of Iranian women.
METHODS: The search was performed in Scopus, PubMed, and Web of Science. Eligibility criteria
were limited to English and Persian language articles with experimental or semi-experimental methods
until October 2019 that evaluated the effect of HBM-based training on Iranian women’s performance
of Pap smear test. We excluded studies that used both cervical and breast cancer screening together.
RESULTS: Twelve studies were performed on totally 1605 participants. This meta-analysis showed
that all of Health Belief Model (HBM) constructs improved significantly among HBM-based trained
women, perceived susceptibility (standard mean division [SMD] =0.785; P = 0.002; confidence interval
[CI] = 0.005 to 1.56; Heterogeneity; P = 0.013; I2 = 97%)., perceived severity (SMD = 1.14; P = 0.001;
CI = 0.66–1.62; heterogeneity; P < 0.001; I2 = 92%), perceived benefits (SMD = 1.25; P = 0.001;
CI = 0.545–0.135 heterogeneity; P = 0.003; I2 = 97%), perceived barrier (SMD = 0.20; P = 0.001;
CI = 0.44–1.24; heterogeneity; P < 0.001; I2 = 92%) and perceived self-efficacy (SMD = 0.638;
P < 0.001; CI =1.76–0.426; heterogeneity; P < 0.001; I2 = 97%).
CONCLUSION: Cervical screening education program based on the HBM can be effective on Iranian
women’s performance in their perceived susceptibility, perceived severity, perceived barrier, and
perceived self-efficacy about Pap smear test.

Abstract INTRODUCTION: Use of technology and ICT tools is ubiquitous among college students including
medical students. However overuse or misuse may lead to many physical and psychological problems
including the risk of harming professional standing in the long term. The purpose of this study was
to explore techno stress among freshmen at a medical institute and to suggest measures to reduce
problematic use of technology pertaining to internet.
OBJECTIVES: (i) To explore the extent of technology use including internet among medical
freshmen, (ii) To identify the content of usage (iii) To quantify the extent of techno stress and iv. To
suggest measures to reduce problematic use of technology.
MATERIALS AND METHODS: The sample comprised all the freshmen at a medical institute (n = 61).
A semi structured questionnaire was used to collect socio demographic details of students and their
patterns of technology usage. Perceived Stress Scale was used to measure stress.
RESULTS: The mean age of the sample was 18.34 (±0.58) years comprising 68% males and 32%
females. Students spent a mean time of 3.96 h/day on the technology tools (standard deviation = 4.99).
Ninety-two percent of the students used technology for educational purposes followed by
entertainment (89%), social networking (77.78%), watching films (70.37%), communication (66.67%)
and watching pornography (46.3%). 11.47% had symptoms suggestive of problematic internet use.
One percent had craving suggestive of addiction. All these had stress out of which 43% had high
and 57% had moderate levels of stress.
DISCUSSION: Considering the students’ present usage of social media, it can serve as a potent
academic tool. However, awareness is required to be raised with regard to its use as a medical
professional.
CONCLUSION: Use of technology is crucial in the current academic world and restrictions on usage
may neither be practical nor feasible. However, understanding patterns of usage among students is a
preliminary step that can enable educators and administrators to formulate guidelines to channelise
their usage in more productive ways.

Abstract BACKGROUND: Recently, the Iranian Ministry of Health estimated about 750,000 deaths are
attributed smoking complications. The aim of this study was to apply the transtheoretical model
(TTM) on general population of Mashhad city to evaluate the stages of change and possible cultural
factors regarding smoking cessation.
METHODS: This descriptive, cross-sectional population-based study was conducted in Mashhad, Iran.
A total number of 562 participants selected by multistage sampling. They were asked about stages of
change for smoking cessation for both hookah and cigarette smoking. Stages of change refer to an
orderly sequence of changes in smoking behavior that people progress through according to the TTM.
Its six stages are as follows: precontemplation (PC) (no intention to quit smoking within 6 months),
contemplation (planning to quit smoking in the following 6 months), preparation (planning to stop
smoking within 1 month), action (quit smoking for <6 months), maintenance (stopped smoking for
6 months or more), and termination (will never smoke again). Data were analyzed using tests such
as Chi-square, Kruskal–Wallis, and logistic regression by SPSS 11.5.
RESULTS: About 18% and 19% of people in this study were regular hookah and cigarette smokers,
respectively. There was significant difference between cigarette smoking and sex (P < 0.001) and
marital status (P = 0.01). There was a statistically significant difference between stages of change
in men and women from the point of cigarette smoking (P < 0.001). Male sex, hookah smoking,
and alcohol abuse were predictors of PC, and age was the only predictor of termination stage for
cigarette smoking. Sex did not have any role in hookah smoking.
CONCLUSION: Targeted education based on gender and marital status warrant attention.
Community-wide education and interventions such as increasing the price of cigarettes are desired.

Abstract INTRODUCTION: To design instructions in health sciences education, it is highly relevant to heed
the working memory and the approaches for managing cognitive load. In this article, we tried to
mention the implications of cognitive load theory (CLT) for optimizing teaching-learning in health
sciences education and discussing cognitive load from the perspective of cognitive neurosciences
as brain-aware medical education.
MATERIALS AND METHODS: We searched databases of Pubmed, Proquest, SCOPUS, and ISI
Web of Science for relevant literature in September 1, 2018.
RESULTS: The 27 articles out of a total of 46 records, along with 23 papers from snowballing and
hand searching were included in this study. Main items encompassed; “Various types of cognitive
loads,” “Aim of cognitive load theory,” “Strategies to managing Cognitive Load,” “Cognitive Load Theory
in novice and experienced learners and “expertise reversal effect,” Medical and Health Sciences
Curriculums and Cognitive Load Theory,” “Challenges of Cognitive Load Theory.”
CONCLUSIONS: We discussed six important themes for CLT in health sciences education according
to the literature. Mental imagery (visualization) as one of the useful techniques to optimize germane
load was suggested, as it processes further gain access to neural circuits that are engaged in sensory,
motor, executive, and decision-making pathways in the brain.

Abstract BACKGROUND: The concept of electronic health literacy has become a main focus of health-care
professionals along with the increasing use of the Internet. In Iran, the Internet not yet has much
impact on providing health services, and the physicians’ and patients’ community are now more
willing to use the traditional method for diagnosing disease and prescribing medicines. This study
aimed to determine the correlation between electronic health literacy, quality of life (QoL), and selfefficacy among Tehran citizens.
MATERIALS AND METHODS: The present study is a descriptive, cross-sectional study with a
correlation approach that was conducted on 400 clients of community health centers of Shahid
Beheshti University of Medical Sciences in 2019. Samples were selected by stratified random sampling
method. Data were collected using E-Health Literacy Questionnaire (α = 0.88), 12-item Short-Form
Health Survey (α = 0.73), and General Self-Efficacy Scale (α = 0.87). Analytic statistics were using
by descriptive statistics (mean and standard deviation) and inferential statistics (Pearson correlation
coefficient and regression analysis) at the significant level (P < 0.05).
RESULTS: Correlation between electronic health literacy and QoL was 0.14 and with self-efficacy was
0.10, which was positive and statistically significant (P < 0.05). In addition, the correlation between
QoL and self-efficacy was 0.33, which was positive, statistically significant, and moderate (P < 0.05).
CONCLUSION: According to the findings of this study, it is possible to improve the QoL through the
promotion of electronic health literacy and self-efficacy. The results of this study can be used as a
basis for health service providers and policymakers in designing and implementing health-related
interventions.

Abstract BACKGROUND: Postpartum depression is a significant common health problem that has negative
effects on mental and physical health of mothers and their infants. The main purpose of this study
was to investigate the relationship between spiritual well-being (SWB) and perceived social support
with postpartum depression in new mothers.
MATERIALS AND METHODS: Using a descriptive survey design, 200 mothers in the 4th–8th weeks
after delivery, who referred to selected therapeutic centers in Qom Province, were selected by a
convenience sampling method. They were asked to answer the question of the Edinburgh Postnatal
Depression Scale, Multidimensional Scale of Perceived Social Support, SWB Scale, and Farhangestan
Spiritual Health Questionnaire. Data were analyzed using Pearson correlation and Chi-square.
RESULTS: The prevalence of postpartum depression in this group was 22%. Pearson correlation
test showed that there was a negative correlation between high level of perceived social support
and SWB with postpartum depression.
CONCLUSION: The findings of this study suggest that perceived social support and SWB have an
important role in low depressive symptom in mothers during postpartum. This result can help healthcare professionals to pay much attention to social support and SWB as a protective factor against
postpartum depression in postpartum or pregnancy care programs.

Abstract INTRODUCTION: Regular training in the blood transfusion process is crucial for transfusion safety.
Hospital transfusion committees have an obligation to provide this education to hospital employees
through training activities. E-learning is positioning itself as a valid alternative to physical-presence
courses.
MATERIALS AND METHODS: We describe a training course on blood transfusion to members of
our hospital who are involved in the transfusion process, including technicians, nurses, and doctors.
The course uses Moodle as the e-learning platform; it is evaluated using a satisfaction survey along
with a knowledge-transfer and impact survey a year after taking the course.
RESULTS: From 2015 to 2018, seven editions of the online transfusion course were developed.
Six hundred and eighty students enrolled; of these, 124 did not take the final examination (18.2%);
60 never began the course (8.8%). Of the 556 students who completed the course, 546 passed
(98.2%). The average score from the initial self-assessment was 7.3 while the average score from
the final self-assessment was 9.2; the mean improvement was 1.9 (out of 10). The level of general
course satisfaction was 9.27 (an average out of 10). More than 90% of the students stated that they
were able to apply the acquired knowledge in the workplace after a year.
CONCLUSIONS: E-learning has demonstrated itself as an affordable solution that could help in
the training of all staff involved in the transfusion process at our hospital, with the advantage that it
includes general knowledge and particular skills in local transfusion medical practice.

Abstract INTRODUCTION: Disciplinary-based information literacy (DIL) or professional-related information
literacy has not been widely studied in the academic context, including medical sciences. This study
aimed at investigating the status of DIL among medical students in an Iranian medical university.
MATERIALS AND METHODS: This study was a cross-sectional survey. A random sample consisting
of 298 students majoring in general medicine at Tehran University of Medical Science, Tehran, Iran,
in the academic year of 2018–2019 completed a valid and reliable 20-item questionnaire on DIL.
Data were analyzed using SPSS statistical software.
RESULTS: Participants’ DIL was less than expected, especially in the skills related to professional
information access and evaluation. The majority of them had low DIL level. However, medical students
in their last 2 years of study had significantly high scores in DIL than those in their first 2 years of study.
CONCLUSION: Information literacy has not been seriously considered in health-related higher
education in Iran. It is needed to consider DIL in the medical curriculum for training students to be
proficient specialists in medical practice.

Abstract INTRODUCTION: Despite the progress of health care and the application of new technology in the
care of patients, the need to train highly skilled and specialized nurses is inevitable. Given that a
master’s degree in neonatal intensive care nursing has been recently established in Iran, the aim of
the study was to explain the educational challenges of neonatal intensive care postgraduate nursing
students in their perspective.
MATERIALS AND METHODS: This conventional content analysis was performed by conducting
semi-structured interviews with 18 students of neonatal intensive care in X University of Medical
Sciences from 2018 to 2019. Data were analyzed using conventional content analysis. To establish
the reliability and validity of findings, Graneheim and Landman criteria were considered.
RESULTS: Following the data analysis, two main categories were extracted: “theoretical education
challenges” and “clinical education challenges.” The first main category was comprised of the following
subcategories: “detachment of nursing department and hospital,” “defects in weekly scheduling,”
“combination of care and treatment approaches in education,” “inconsistency between the content
of theoretical courses,” “limited collaboration between basic science and medical departments,” “low
number of lecturers,” “lecturers’ unrealistic expectations,” and “the importance of the scoring system.”
“Extended work shifts,” “a large number of students,” “lack of opportunity to do clinical practices,”
“lack of training classes,” and “limited amenities in the hospital” were recognized as subcategories
of the second category.
CONCLUSION: Managers can address some of the students’ challenges and provide the opportunity
to enhance the quality of education through being familiar with, considering and meetings the needs
and expectations of these students.

Abstract INTRODUCTION: Diet adherence may cause diabetes complications to be diminished.
OBJECTIVES: This study aimed at identifying determinants of diet adherence among patients with
Type 2 diabetes based on the health action process approach (HAPA).
METHODS: In this cross-sectional study, 734 patients with Type 2 diabetes, attending to South Tehran
health centers, were recruited during June–December 2018. The dietary regimen scale (nine items)
and a researcher-designed questionnaire consisting of HAPA constructs were used to gather the
data. Data were analyzed using the Mann–Whitney test, Pearson Chi-squared test, Fisher’s exact
test, and linear regression test. All statistical tests were assessed using SPSS (IBM Corp. Released
2017. IBM SPSS Statistics for Windows, Version 25.0. Armonk, NY, USA: IBM Corp.).
RESULTS: The level of nonadherence to diet was 91.1%. Diet adherence was significantly associated
with family income (P = 0.005), level of education (P < 0.001), and age (P = 0.009). The linear
regression showed that 55% of the variance of diet adherence was determined by HAPA variables.
Diet adherence was associated with intention (P < 0.001), action planning (P = 0.005), and barriers
(P = 0.003).
CONCLUSION: Most of the patients did not adhere to their diet. Appropriate programs should be
designed to promote diet adherence among the patients, especially those with low literacy and
patients living in poor communities.

Abstract BACKGROUND AND OBJECTIVES: Because the performance assessment of the health system
is used as the basis for decision‑making and demonstrates progress or failure in achieving the goals
of the health system, promoting the health system performance assessment can play a major role
in improving and enhancing the health system. Therefore, the main aim of the study was to identify
and prioritize the challenges of promoting the health system performance assessment.
MATERIALS AND METHODS: There were two approaches in both qualitative and cross‑sectional
studies. At first, using semi‑structured interviews with 52 performance appraisers, data related
to the challenges of promoting the health system performance assessment were collected and
thematically analyzed. Then, in cross‑sectional terms, the performance appraisers were provided
with researcher‑made checklists which contained a list of challenges to determine the priority of
challenges by scoring. The data were handled and analyzed using MAXQDA Plus version 12 and
Microsoft Excel.
RESULTS: Our results revealed five themes and ten subthemes on the challenges of promoting
the health system performance assessment. Themes (subthemes) included infrastructures (cultural
and technological), implementation (organizational support, process, and responsibilities), human
resources (motivation and training), assessment (performance monitoring), and content of
measures (reliability and validity). We also prioritized 31 listed challenges in three priority groups,
including below average, average, and above average.
CONCLUSION: Our findings suggest that promoting the health system performance assessment
in Iran can be accomplished by allocating financial and nonfinancial motives to the performance
assessment staffs, using performance assessment results in policymaking, clarifying tasks of
assessment process executors, and reviewing and adapting the performance assessment indices
according to contingencies in the health system.

Abstract BACKGROUND: Better preventive care is a prerequisite to foster community health and in reducing
the unnecessary burden on the health‑care system. The Unani System of Medicine has given due
emphasis on preventive care. This article aims to discuss the health promotion and disease prevention
approaches in Unani Medicine.
MATERIALS AND METHODS: A manual literature survey of classical Unani texts such as
Firdaus‑al‑hikmat, Al Qanoon‑fit‑tib, Kitab‑al‑mansoori, Kitab‑al‑kulliyat, and Kitab‑al‑taisir was
conducted to collect the information available on the strategic approaches of health promotion and
disease prevention in Unani Medicine. To obtain the appropriate English equivalent words for Unani
terms and the scientific name of the drugs, “Standard Unani Medical Terminology” and “Classification
of Unani Drugs” were consulted, respectively.
RESULTS: The findings of the literature survey revealed that Unani physicians have advocated the
personalized and predictive approaches for maintaining health and preventing diseases. Personalized
approach mainly centers on the temperament of an individual. By determining an individual’s
temperament, Unani physician can tell what is adequate or not adequate for the individual. While in
the predictive approach, correct knowledge of prodromal symptoms is a prerequisite to predict the
future developments in the human body and recommending the appropriate preventive measures
accordingly.
CONCLUSION: These approaches present interesting perspectives in the field of promotive and
preventive care and are of much relevance in the present scenario. Unfortunately, the lack of efficacy
studies is a limiting factor in their application. Hence, effective protocol must be developed to provide
evidence‑based data and to give grounds for their widespread usage.

Abstract BACKGROUND AND AIM: Posttraumatic growth following traumas such as chronic illnesses can
occur in some people. The psychological factors, such as cognitive emotion regulation (CER), can
influence its formation. CER is a type of coping strategy that helps to efficiently deal with trauma.
Due to the importance of the topic and the lack of sufficient studies on posttraumatic growth and
CER in hemodialysis patients, this study aims to investigate the relationship between posttraumatic
growth and CER in hemodialysis patients.
METHODS: This is a descriptive study performed on hemodialysis patients in Bou Ali and Velayat
hospitals in Qazvin. One hundred and sixty-two patients were selected by the convenience sampling
method, and Garnefski Cognitive Emotion Regulation Questionnaire (α =0.92) and Tedeschi
Posttraumatic Growth Questionnaire (α =0.96) were used. Data were analyzed using Pearson
correlation and ANOVA tests.
RESULTS: The results showed that the majority of the hemodialysis patients experienced some
degree of posttraumatic growth. The participants achieved high scores in the domains of spiritual
development and communication with others. Moreover, posttraumatic growth was positively and
significantly correlated with CER (r = 0.67, P < 0.001).
CONCLUSIONS: Hemodialysis provides the basis for the positive mental reactions known as
posttraumatic growth in hemodialysis patients. Nurses and other authorities can use this phenomenon
to adapt to illness and care planning.

Abstract INTRODUCTION: Brucellosis is one of the common diseases between humans and animals. The
purpose of this study was to investigate behavioral determinants of brucellosis incidence among
stockbreeders and their family members in a rural area based on the PRECEDE model.
MATERIALS AND METHODS: This cross-sectional study was carried out among 540 stockbreeders
and their family members in Northeastern Iran in 2019. Sampling was done in two stages including
stratified sampling and random sampling method. Data collection was conducted by a valid and
reliable questionnaire developed based on the PRECEDE model. Data were analyzed using SPSS16
through Pearson correlation coefficient, independent t-test, and ANOVA. Furthermore IBM SPSS
AMOS version 20 was used for the path analysis.
RESULTS: The mean age of the participants was 39.02 ± 16.41 years, of whom 53.1% and 46.9%
were men and women, respectively. About 23.9% of the participants had a history of brucellosis in
their families. Enabling factors were the most important determinant of self-efficacy and self-efficacy
was the most important determinants of behavior. Evaluation of the chi-square indicators, chi-square
ratio to degree of freedom, root mean square error of approximation, adjusted goodness of fit index,
parsimony comparative fit index, comparative fit index, incremental fit index, and parsimonious normed
fit index indices indicated that the model was well fitted and there was a positive and significant
relationship between the predisposing, enabling, and reinforcing factors on the one hand and behavior
on the other. chi-square indicators, chi-square ratio to degree of freedom, root mean square error
of approximation, adjusted goodness of fit index, parsimony comparative fit index, comparative fit
index, incremental fit index, and parsimonious normed fit index
CONCLUSION: Designing and implementing health plans based on the PRECEDE model with more
emphasis on self-efficacy as the most important behavioral determinants can bring about a positive
effect on enhancing the brucellosis preventing behaviors.

Abstract INTRODUCTION: The educational service is expensive and having the right financial information is
one of the most important tools for managing financial resources. Therefore, due to the importance
of this issue, this study aimed to determine the cost of educational services for medical sciences
students at Alborz University of Medical Sciences.
METHODOLOGY: A cross-sectional study was conducted between March 20, 2018, and March 20,
2019, at Alborz University of Medical Sciences. The current and capital cost data were extracted
from the university’s financial database, and the cost price of services provided was calculated using
the activity-based cost model.
RESULTS: The mean annual cost of services per student was $4778, and the mean cost of education
per hour was $113. The total cost price of services provided per student at the school was 65% for
wages and salary, 26% for depreciation of building and equipment, and 9% for consumable goods
and services. Furthermore, the share of different cost centers to the total cost price of services
provided per student was 82% for educational services, 11.9% for student welfare services, and
6.1% for research services.
CONCLUSION: Costs of personnel, especially pays to faculty members and the costs of capital
expenditures, are the most important costs in higher education institutions. It seems reducing of
pay to faculty members through novelty approach of education and evaluation, reducing capital
expenditures through use effective of buildings and equipment that can be placed higher education
institutions in the path to productivity.

Abstract INTRODUCTION: As a part of healthcare providers of the Health System Reform Program, midwives
are required to master the necessary knowledge and skills to meet the related demands of society.
This study was aimed to assess the knowledge and skills training needs of practicing midwives of
health and medical centers of Isfahan.
METHODS: This study is a descriptive cross-sectional study. The statistical target population was
midwifery experts working in Isfahan health centers and the samples were selected through simple
random sampling (sample size 250). Data were collected by two questionnaires to assess knowledge
and skill needs. The validity of the questionnaires was confirmed by experts of the province and
city health centers and medical education experts and its reliability was calculated by Cronbach’s
alpha (98%). Data were analyzed using SPSS 23 software and descriptive and analytical statistical
methods (frequency, mean, variance).
RESULTS: The first five knowledge training priorities of employed midwives in health and medical
centers, which comprise most of the means values, are pregnancy complications and abnormalities
(3.64 ± 1.21); mammography and its interpretation (64.3 ± 1.30); skills and principles of parenting
(3.59 ± 1.24); shortness of breath and palpitations during pregnancy (3.58 ± 1.16); and common
mental disorders (3.57 ± 1.16). The most important skills training needs were Excel (1.21 ± 3.59),
PowerPoint (27.1 ± 54.3), internet (3.52 ± 1.25), and parameters registration and reporting in the SIB
system (3.49 ± 1.28). Employed midwives of the health and medical centers displayed a significant
difference in feeling the need for training in some subjects.
CONCLUSION: Needs assessment is the foundation of purposeful training, and better training leads
to improved performance of personnel and organizations. Therefore, it is imperative that reliable
and documented data be utilized for promotion and improvement of in-service training programs
of employed midwives of the health and medical centers of Isfahan province and also for revising
university curriculums. Taking these measures would lead to the empowerment of personnel and
general development of society.

Abstract BACKGROUND: Health communication is a field that uses social and behavioral models to improve
health outcomes and raise awareness on major health risks that threaten human well‑being.
Low‑income countries (LICs) suffer from the effects of communicable and noncommunicable diseases
that are exacerbated by weak health‑care systems, lack of awareness campaigns, and ineffective
communication tactics. This work aims to explore health communication research in LICs to find
strategies that help improve health outcomes in the future.
MATERIALS AND METHODS: The PubMed database was explored systematically for publications
related to health communication from LICs between January 1, 1960, and January 1, 2020.
Publications were categorized according to country of origin and were analyzed with respect to
population size, gross domestic product (GDP), and primary school enrollment of each state as
obtained from the World Bank Open Data.
RESULTS: Collectively, LICs published 796 contributions, comprising 1.08% of the total biomedical
research published by LICs and 0.27% of the world’s health communication research. Malawi had
the highest number of publications per GDP, with 32.811 publications per billion US$. Uganda had
the most contributions per population, with 9.579 publications per million persons. Ethiopia had the
highest amount of contributions per primary school enrollment with a ratio of 2.461 publications per
%gross. The role of health communication in promoting HIV awareness and prevention was the most
common theme explored. Other infectious diseases, such as malaria, tuberculosis, and Ebola, were
also highlighted. Improving communication in health education was also explored.
CONCLUSION: Health communication is a rising field in LICs, with research focusing on disease
prevention. Efforts to amplify research are key to effectively utilize the health communication models
and improve health outcomes in LICs.