Journal of Education and Health Promotion

Abstract CONTEXT: Payment mechanisms are one of the effective tools for achieving optimal results in
health system. Pay for performance (P4P) is one of the best programs to enhance the quality of
health services through financial incentives. Considering of implementing family physician program
in Iran and the P4P system, it is essential to address the challenges of implementing P4P system
in the family physician program.
AIMS: This study aimed to investigate the challenges of implementation of P4P system in family
physician program.
SETTINGS AND DESIGN: The qualitative study was carried out at areas covered by Iran University
of Medical Sciences in Tehran, Iran.
MATERIALS AND METHODS: The semi‑structured interview was conducted on 32 key informants
in 2019. The sampling method was determined based on purposeful sampling. The topic guide
of interviews was experiences in implementing of family physician program and challenges of
implementing P4P system. Participants had least 5‑year experience in the family physician program.
STATISTICAL ANALYSIS USED: A framework analysis was used to analyze the data using the
software MAXQDA 10.
RESULTS: The current study identified 7 themes, 14 subthemes, and 46 items related to the
challenges to successful implementation of P4P systems in the family physician program including
family physicians’ workload, family physician training, promoting family physician program, paying
to the family physician team, assessment and monitoring systems, information management, and
the level of authority of family physicians.
CONCLUSION: The study results demonstrated notable challenges for successful implementation
of P4P system which can helpful to managers and policymakers.

Abstract INTRODUCTION: The performance of the emergency department (ED) as one of the main parts of
hospitals, have a great impact on the performance of the whole‑hospital. In Iran, the official education
program of this discipline was started in 2001 and has expanded in most medical universities. Given
the unprecedentedness of emergency medicine (EM), there are limited studies about this specialty.
Thus, this study aims to explore the status, role, and performance of Iranian EM specialists.
MATERIALS AND METHODS: This qualitative study was conducted using content analysis of 19
semi‑structured interviews with EM specialists and key informant. Purposive sampling was conducted,
and some teaching and nonstate hospitals in different geographic regions of Tehran city were selected.
Conducting interviews continued until reaching the data saturation. Thematic analysis was employed.
Extracted themes were reviewed and confirmed by some of the participants.
RESULTS: The study results were categorized within five main themes; included the role of ED
from EM specialists’ viewpoint, EM specialists’ viewpoint on their discipline, performance of EM
specialists (including medical, managerial, and economic performance), and role of EM specialists
in patient satisfaction; and opportunities and challenges of EM specialists.
CONCLUSION: Overall, the study findings highlighted the effectiveness and positive medical,
managerial and economic impacts of EM in Iran, inside and beyond hospitals. However, the
study addressed significant opportunities some solvable challenges in educational, professional
and economic domains, and interdisciplinary relationships. Further studies are recommended for
comprehensive exploring viewpoint of other disciplines and stakeholders.

Abstract BACKGROUND: Cardiovascular disease accounts for 40% of the world’s fatality and after
accidents and traumas, is the second leading cause of death in Iran. Given the role of psychological
characteristics such as hostility and anger in the development of certain behaviors and habits affecting
heart problems, this study aimed to investigate the relationship between hostility and anger with
coronary artery disease.
METHODOLOGY: In this cross‑sectional study, 320 patients referring to the hospital with coronary
artery stenosis enrolled in the study and were available for angiography. Data collection tools
included demographic and disease status questionnaires and aggression questionnaire. The data
were analyzed by SPSS software version 16, and Spearman’s correlation coefficient, Student’s t‑,
and one‑way analysis of variance tests was used for the statistical analysis.
RESULTS: In this case, we have the following. Out of 302 cases, 183 were males and 119 were
females. One hundred and ninety‑seven patients with coronary artery disease and 105 patients with
angiography had no coronary artery disease.
CONCLUSION: People with coronary artery disease and healthy controls had no significant
differences in demographic characteristics, history of illness, and education. Furthermore, there was
no statistically significant relationship between hostility and anger with vasoconstriction. Since there is
no relationship between hostility and anger with coronary artery disease, further studies are needed
to investigate the presence of mediating variables to design appropriate and preventive interventions.

Abstract INTRODUCTION: Families, especially parents, play an important role in identifying their children’s
talents and directing their educational journey. The role of parents in their children career applies
both to collectivist and to noncollectivist culture.
AIM: To examine the correlation between parental influences on medical students’ self‑efficacy and
career exploration in collectivist culture.
METHODS: This research was a quantitative study. The study involved 1017 medical students of
medical faculties in four faculties of medicine in Indonesia. All data were collected online in August
2018. The study was conducted using an online survey questionnaire and analyzed to finally form a
model that displays the determinants of career exploration behavior. The data were analyzed using
the maximum likelihood estimation in IBM AMOS 24.
RESULTS: The results found a model that has various routes toward career exploration in collectivist
culture. Path analysis revealed both direct and direct effect toward the variable studied. Parents’
expectations had influence on self‑efficacy.
CONCLUSION: The findings show the important role between the influence of parents expectations
for self‑efficacy and career exploration in children.

Abstract BACKGROUND: Osteoporosis is one of the major problems associated with aging and is more
common among women than men. This study was designed to modify osteoporosis‑related behaviors
in female students based on the transtheoretical model (TTM).
MATERIALS AND METHODS: This quasi‑experimental study was conducted on female
secondary school students. The sample size was determined 100 by using Altman’s nomogram,
including 50 cases and 50 controls. Participants were completed the Demographic Information and
Osteoporosis‑Related Behavior Questionnaire based on TTM. Evaluation of the data showed that
each participant was at what stage of change in physical activity and preventive dietary behavior
of osteoporosis. The content of the training package was designed, and for the intervention group,
2‑h training sessions were held weekly by the instructor in accordance with the stage of change
for 2 months, and the booklet was provided with the appropriate contents of the stage of change.
Three months after the completion of training, the questionnaires were completed by intervention
and control groups. Statistical analysis was performed using SPSS 23 software.
RESULTS: Concerning the stages of change in physical activity and nutrition, a significant difference
was before and after the intervention in the intervention group (P < 0.001), while no significant
difference was observed in the control group. After the intervention, there was a significant difference
in the self‑efficacy and some subconstruct of processes of change, but there wasnot a significant
difference in the decisional balance.
CONCLUSION: Educational intervention based on TTM has been successful in achieving the goal of
modifying osteoporosis‑related behaviors in female students. The results of this study can be used
by health planners to plan and implement health promotion interventions that will undoubtedly help
reduce the burden of disease.

Abstract BACKGROUND: One of the most important responsibilities of today’s university libraries is supporting
research activities. The present research is aimed at explaining the librarians’ competencies in
providing research services for researchers of Isfahan University of Medical Sciences.
MATERIALS AND METHODS: This study was performed in 2018 with a qualitative approach and
conventional content analysis. The participants were 18 faculty members, students, and librarians
selected by purposive sampling. Data collection was done by 18 semi‑structured interviews.
Continuous data analysis was performed by conventional content analysis.
RESULTS: According to the participants’ experiences, two major categories were recognized,
including “general competencies” and “specialized competencies.” The general competencies
category included three subcategories of communication skill, professional ethics, and basic abilities.
The specialized competencies category included six subcategories of information resource retrieval
and evaluation, using research software, research assistance, intellectual property literacy, scientific
publication literacy, scientometrics, and altmetrics.
CONCLUSION: According to the participants’ experiences, university librarians need specialized
competencies in addition to basic and transdisciplinary abilities. It is suggested for research managers
and policymakers to plan for empowering librarians regarding the results of the present study.

Abstract BACKGROUND: Breastfeeding is not only a perfect food for the infant but also is a living fluid with
many features. It provides the infant’s physical growth and is responsive to its emotional needs.
Since determining the knowledge and attitude of girls in this period and promoting, it is considered
as the main principle in motivating them for choosing this method in future.
MATERIALS AND METHODS: This descriptive‑correlational study was conducted to determine
the knowledge and attitude of 630 high‑school students on breastfeeding at a selected public high
school in Tehran, Iran in 2018. A researcher‑made questionnaire was administered to collect the
data, to determine the validity of the tool; content validity was used and to determine its reliability,
a test re‑test method was applied. Data were analyzed by the nonparametric tests of Chi‑square,
multiple comparisons, and Spearman correlation coefficient.
RESULTS: The results showed that 80.3% had moderate knowledge. The mean score of knowledge
in the human sciences group was significantly higher than others. Furthermore, the attitude of
22.5% of girls was positive, 77.5% had no idea, none of them had negative attitudes. There was a
statistically significant difference between the mean score of attitude of the students in groups of
knowledge (good, moderate, and weak) (P < 0.01), and multiple comparison tests showed that the
positive attitude score in the moderate knowledge group was more than the attitude score in weak
and good knowledge.
CONCLUSION: The results indicate that there is an unbiased attitude about the moderate knowledge
of different aspects of breastfeeding among pre university students, although they have a moderate
knowledge on a complete and successful breast feeding.

Abstract BACKGROUND: Assessing the effectiveness of in‑service training courses in order to achieve
the desired goals and reduce the waste of costs and opportunities in the system is necessary. The
purpose of this study was to determine the effectiveness of the “pharmacopeia home health” course
considering its importance in different aspects using the Kirkpatrick model.
MATERIALS AND METHODS: The present study was a quasi‑experimental conducted at community
health workers (CHWs) on three levels of reaction, learning, and behavior. In each phase, a valid
questionnaire was used to measure the outcome according to the Ministry of Health guidelines with
pretest and posttest measurements. The data were analyzed through SPSS 23, using descriptive
statistics and repeated measures test and general linear model.
RESULTS: The results of the study showed that at the level of reaction in terms of content and
holding, conditions of implementation were favorable. Findings at the level of learning showed
that the training course was only effective in enhancing the knowledge and awareness about drug
maintenance and had no significant effect on other areas. In the third level, the results of the CHWs’
performance showed that in some areas, the results were influenced by the demographic variables.
CONCLUSION: The present study showed the effectiveness of education in different areas using
on the Kirkpatrick model. Given the lack of impact of education in some areas in the present study
and on the other, it is necessary to consider cooperative learning methods in order to develop the
effectiveness of the courses.

Abstract BACKGROUND: Depression is a disorder of the brain, a state of low mood and aversion to activity
that can affect a person’s thoughts, behavior, feelings, and sense of well‑being and can cause
alteration in sympathetic activity of the body, thus affecting heart rate variability (HRV).
AIM: The study was conducted to determine the effects of depression on HRV parameters in clinically
known cases of depression.
MATERIALS AND METHODS: A cross‑sectional (observational) study was conducted on fifty known
patients of depression, aged 18–65 years, and fifty healthy, age‑matched, normal controls. HRV test
was conducted, and the results were analyzed statistically using Student’s “t”‑test for equal variance,
for various parameters.
RESULTS: The study showed that the differences in mean R‑R interval(s), mean HR (beats/min),
very low frequency (VLF) power (milliseconds squared [ms2
]), and low frequency/high frequency
(LF/HF) power (%) (LF/HF ratio) among controls and cases were statistically highly significant, while
the differences in LF power (ms2
) in controls and cases were statistically significant. However, the
differences in basic anthropometric parameters, STD (standard deviation of the normal to normal)(s),
root mean square successive difference (ms), NN50 (count), pNN50 (%), VLF peak (Hz), LF peak (Hz),
HF peak (Hz), HF power (ms2
), VLF power (%), LF power (%), HF power (%), LF power (nu), and
HF power (nu) were found to be statistically insignificant.
CONCLUSION: Depression leads to changes in autonomic control of the body and changes the
autonomic balance in favor of an increased sympathetic tone, which can be detected with fair
accuracy with HRV analysis.

Abstract Clinical education requires creating a supportive atmosphere for learners and nursing students, who
need support to be prepared for their future profession. The purpose of this study is to investigate
the challenges of supporting the nursing students in clinical education. This article reviewed studies
conducted between 2009 and 2019 with the keywords including support, challenge, students,
education, and nursing using SID, Magiran, IranMedex, Google Scholar, Elsevier, and PubMed as
databases. Among the 926 articles obtained during the two review stages, which were based on the
inclusion and exclusion criteria and the first one analyzed the title and the abstract and the second
one analyzed the whole article, ultimately 32 articles were selected for the study. The types of articles
used in this study are as follows: qualitative (16 articles), descriptive analytical and cross‑sectional (12
articles), review (3 articles), and mixed‑methods (1 article). The focus of all studies was on the
students’ clinical education environment. The participants of the studies were undergraduate nursing
students (in 22 articles), graduate students (in 2 articles), nursing instructors and students (in 4
articles), and nursing instructors and managers (in 1 article). Most of the challenges of supporting the
students included violence, fear, and anxiety; socio‑cultural challenges, environmental‑organizational
stresses; and ineffective clinical education. The findings of this study showed that nursing students
face many challenges in the clinical setting. Therefore, the managers of educational and health‑care
centers should give a high priority to their students’ support programs.

Abstract BACKGROUND: Dynamic aging depends on providing opportunities to improve the quality of life
of the elderly. The objective of this study was to investigate the relationship between social support
and quality of life in the elderly in Guilan.
MATERIALS AND METHODS: This descriptive‑correlational study was conducted in the elderly
who visited urban public places in the East of Guilan (mosques, parks, weekly markets, and clubs).
A total of 168 elderly who met the inclusion criteria were selected through two‑stage, cluster, and
convenience sampling. Data were collected using Phillips Standard 23‑item social support scale
and 12‑item quality of life scale‑short form. Data were analyzed through descriptive and inferential
statistics (Pearson correlation coefficient).
RESULTS: The mean score of social support in the elderly in Guilan was 73.25 ± 9.18 and the mean
quality of life was obtained at 24.67 ± 7.06. Data analysis showed that there was a significant and
positive correlation between social support and quality of life (r = 0.29, P < 0.0001).
CONCLUSIONS: Increased social support leads to a higher quality of life in the elderly. Thus, it is
necessary to timely identify the needs and promote comprehensive social support to improve the
quality of life in the elderly.

Abstract BACKGROUND: It is essential to evaluate the performance of hospitals in the health system.
Hospitals need a performance evaluation system to develop and compete in order to measure the
efficiency and effectiveness of their programs, processes, and human resources. This study aimed
to evaluate the performance of teaching hospitals using the Technique for Order of Preference by
Similarity to Ideal Solution (TOPSIS) method and hierarchical analysis.
MATERIALS AND METHODS: This was a cross‑sectional and descriptive study conducted in 2019
in all teaching hospitals affiliated to Shahid Beheshti University of Medical Sciences. The required
data were collected using a standard checklist. The collected data were analyzed using the analytic
hierarchy process (AHP) and TOPSIS. In the first phase, annual indicators of hospital evaluation
were collected. Following the AHP, key performance indicators (KPIs) were selected and prioritized
in hospitals.
RESULTS: The questionnaires were provided to 15 experts to weigh KPIs, and the most important
indicators were selected. The results of hierarchical analysis showed that three main indicators in
evaluating the performance of hospitals were bed turnover rate, emergency clients, and length of stay.
CONCLUSIONS: One of the problems in evaluating hospitals is the use of key indicators that
alone measure the quantity or quality of their performance. Multicriteria decision‑making can be
used to determine key indicators first, and then by combining these indicators into a multicriteria
decision‑making model, a better assessment of the role and performance of hospitals can be provided.

Abstract

Abstract INTRODUCTION: Professionalism is an important measure of the efficacy of the medical education.
Some studies showed that dominant values changed during clinical education, and some negative
values might replace positive ones. In this regard, this study aimed to explore barrier to professionalism
in clinical medical education.
METHODS: This was a qualitative study conducted with the content analysis method. A total of 34
interviews with 23 participants were done.
RESULTS: Two hundred forty‑eight original codes were extracted from the research data, which were
classified under the theme of “Academic Exhaustion” and the four following categories: “stressful
environment, “human conflict,” “Poor Inter professional collaboration,” and “emotional exhaustion.”
DISCUSSION: It can be admitted that having full knowledge of the factors influencing professionalism
from the viewpoint of stakeholders can improve the environmental and organizational conditions to
prevent professional misconduct.

Abstract BACKGROUND: Marital satisfaction is a complex of feelings, which includes pleasure, satisfaction,
and pleasure experienced by the husband or wife in all aspects of marriage, and it is an important
part of individual health, especially mental health. This qualitative study was conducted to understand
marital satisfaction using grounded theory on couples.
MATERIALS AND METHODS: This qualitative study was implemented using grounded theory based
on Corbin and Strauss, 2008, to investigate the process of marital satisfaction formation among
couples from 2014 to 2016. The sampling was started as purposeful and continued as theoretical. The
data were obtained using semi‑structured interviews. 28 interviews were taken from 25 participants;
MAXQDA software was used to facilitate the organization of classes and subclasses.
RESULTS: The central variable of this study was called “toward a relaxing evolution.” On that
account, the main classes included “supportive companionship” and “responsible love,” and variables
of “personality traits,” “interactive relationships,” “economic status,” “passage of time,” and “present
resources in society” provided the basis for the formation of marital satisfaction.
CONCLUSION: To achieve marital satisfaction, couples should set their family’s ultimate goal toward
achieving a relaxing evolution for the entire family, and they should accompany each other in order
to achieve that goal. This sometimes requires sacrifice and forgiveness to achieve the ultimate goal
of the family.

Abstract BACKGROUND/AIM: Adolescent girls’ concerns about their body images can negatively affect their
social and academic performance. This study aimed to determine the prevalence of body image
concern (BIC) in adolescent schoolgirls in Iran and its risk factors.
PATIENTS AND METHODS: This epidemiological study with cross‑sectional design was conducted
in 2018 on 396 middle schoolgirls aged 12–17 years (mean age = 14 years) living in Khorramabad,
Iran. For screening BIC, the Persian version of BIC inventory (BICI) was used. Their birth order,
school grade, school type, father’s education, and household income were also recorded. Collected
data were analyzed in SPSS v. 18 software using descriptive statistics and Chi‑square test.
RESULTS: Of 396 girls, 106 (26.8%) had BIC, 89 (84%) reported moderate BIC, and 17 (16%)
severe BIC. Their mean BICI score was 40.84 ± 12.93 (out of 42). Most of them reported to spend
a significant amount of time checking their appearance in the mirror (n = 81, 20.5%) and examining
flaws in their appearance (n = 74, 18.7%). A few of them were embarrassed to leave the house
because of the appearance and avoided from looking at the appearance in the mirror (n = 6, 1.5%).
There was no significant difference in BIC severity in terms of birth order, school grade, school type,
father’s education, and household income factors (P > 0.05).
CONCLUSION: The prevalence of BIC among schoolgirls in Iran is high. Appropriate therapeutic
interventions should be carried out to improve their quality of life, mental health, and self‑esteem to
reduce the BIC prevalence.

Abstract Pneumonia triggered by novel corona virus (SARS-CoV-2) in Wuhan, China, in December 2019 is
an extremely contagious disease. The WHO has stated the outbreak of COVID-19 (corona virus)
as a pandemic issue. Corona virus cases started increasing day by day in India, also from the time
the first case was diagnosed on January 30, 2020. In this regard, there are so many colleges and
universities across India which cancelled or rescheduled their academic activities such as conferences,
workshops, and other academic and sports activities. Because the universities and colleges should
protect and take care of their students and faculty in this regard. In this brief communication, I would
like to give an idea on the potential impact of the dangerous COVID-19 outbreak on the education
system and mental health of students and staff.

Abstract BACKGROUND AND AIM: There is a growing interest in learning styles of undergraduate health‑care
professional students; however, the evidences about learning styles over time during undergraduate
programs are rare. In this study, the learning styles of undergraduate health‑care professional
students from the beginning to the completion of the program were examined to determine changes
in learning style over time.
METHODOLOGY: This is a longitudinal descriptive study from 2015 to 2018. A total of 101 health‑care
professional students were selected by census method. Learning styles were evaluated using the
Perceptual Learning‑Style Preference Questionnaire three times in the study at the beginning (T1),
the middle (T2), and the end of the educational course (T3). The data were analyzed using repeated
measures ANOVA.
RESULTS: In T1, auditory (mean = 13.99) and visual (mean = 13.54) styles were preferred as major
learning styles, whereas at T2, visual style (mean = 13.6) was the only preferred major learning
style. At T3, the major learning styles were kinesthetic (mean = 14.32), tactile (mean = 13.98), and
visual (mean = 13.58). There were statistically significant differences in auditory, kinesthetic, tactile
and group scale scores between the three time points (P < 0.05). Group learning style was in the
negative type at all three time points.
CONCLUSIONS: Learning styles can change depending on the context, environment, teaching
method, and the subject of learning material and are probably a flexible changing feature rather than
a fixed inherent feature a student possesses.

Abstract AIM: This study was intended to evaluate the knowledge and attitudes regarding infant’s oral health
care among graduating medical students from Kulasekaram, Tamil Nadu.
MATERIALS AND METHODS: A cross-sectional survey research design was employed in this
study. Self-administered questionnaire of the validated “Graduating medical students’ Knowledge and
Attitudes Survey Regarding Infant’s oral health care” were utilized to ascertain the baseline levels of
knowledge and attitudes of graduating medical students’ in Kulasekaram hospital. In this regard, a
preliminary study with a convenience sample of 100 medical students was conducted so as to assess
the knowledge of infant oral health care among graduating medical students in Kulasekaram. This
study, while limited in sample size, benefits the general practitioners as target readers to assess the
abnormalities in children at early stages of life.
RESULTS: The results of the study revealed that the mean percentage score overall was 65.7%.
Only 3.2% of participants obtained a passing score of 80% or greater. Widespread knowledge deficits
and poor attitudes among graduating medical students were noted in this study, particularly in the
domain of pharmacological management of pain. Positive correlations were observed between the
respondents’ score and level of education. Further analysis revealed respondents had an inaccurate
self-evaluation of their pain management knowledge.
CONCLUSION: The results of this study reveal that there is dearth of knowledge and attitudes of
graduating medical students’ regarding infant oral health care. Educational and quality improvement
initiatives in oral health care of infants could enhance medical student’s knowledge baseline in the
area of oral health care and possibly improve practices.

Abstract INTRODUCTION: Prenatal care refers to proper and principled implementation aimed at maintaining
a healthy pregnancy in terms of physical health and favorable psychological outcomes for the
mother, infant, and family. The adequacy of prenatal care is an important indicator in predicting infant
and maternal mortality. Mental health components such as hope and happiness can influence the
quality of prenatal care. The aim of this study was to determine the relationship between hope and
happiness with prenatal care.
METHODS: This is a cross‑sectional study that was performed on 200 pregnant mothers referred
to Isfahan, Iran, comprehensive health centers in 2018 using an available sampling method. The
research instrument was a questionnaire of hope, happiness, and quality of prenatal care that was
completed by qualified people. The data were analyzed by descriptive and analytical statistical
methods (Pearson correlation).
RESULTS: The results of this study showed that there is a significant relationship between the
adequacy of care and overall hope score (P = 0.032). There was also a positive and significant
relationship between the adequacy of care and the subscales of hope (thinking [P = 0.002] and
path [P = 0.004]). There was a positive and significant relationship between the adequacy of prenatal
care and overall happiness score (P = 0.03). Positive emotion subscale (P = 0.033) had a significant
positive correlation and negative emotion subscale (P = 0.001) had a significant negative relationship
with the adequacy of prenatal care.
CONCLUSION: According to the results, mental health can affect the quality of prenatal care. As a
result, health providers to pregnant mothers can improve the adequacy of prenatal care by examining
pregnant women in terms of these two issues, thereby improving the health of themselves and their
children, and ultimately, community health.

Abstract INTRODUCTION: The Internet has drastically affected human behavior, and it has positive and
negative effects; however, its excessive usage exposes users to internet addiction. The diagnosis of
students’ mental dysfunction is vital to monitor their academic progress and success by preventing
this technology through proper handling of the usage addiction.
MATERIALS AND METHODS: This descriptive‑analytical study selected 447 students (232 females
and 215 males) of the first and second semesters enrolled at Kermanshah University of Medical
Sciences, Iran, in 2018 by using Cochrane’s sample size formula and stratified random sampling.
The study applied Young’s Internet Addiction Test and Goldberg General Health Questionnaire 28
for data collection. The study screened the data received and analyzed valid data set through the
t‑test and Pearson’s correlation coefficient by incorporating SPSS Statistics software version 23.0.
RESULTS: The results of the current study specified that the total mean score of the students for
internet addiction and mental health was 3.81 ± 0.88 and 2.56 ± 0.33, correspondingly. The results
revealed that internet addiction positively correlated with depression and mental health, which
indicated a negative relationship (P > 0.001). The multiple regression analysis results showed students’
five significant vulnerability predictors toward internet addiction, such as the critical reason for using
the Internet, faculty, depression, the central place for using the Internet, and somatic symptoms.
CONCLUSIONS: The study findings specified that students’ excessive internet usage leads to
anxiety, depression, and adverse mental health, which affect their academic performance. Monitoring
and controlling students’ internet addiction through informative sessions on how to use the Internet
adequately is useful.

Abstract INTRODUCTION: Unusual impacts of disasters on normal living conditions pose challenges to the
health system. Nurses who take care of disaster victims may face situations that make decision‑making
difficult; hereon, the use of new technologies can be a useful solution. The study aimed to identify
the telenursing care during incidents and disasters.
METHODS: The study was conducted at a medical science university in Iran from 2018 to 2019. This
was a semi‑structured interview‑based qualitative study using content analysis. Eighteen nurses,
nursing teachers, and emergency medical technicians were included in the study. Data analysis
was performed using inductive content analysis and coding with MAXQDA (2010) software. The
Lincoln and Guba (1985) trustworthiness criteria were used for the reliability and validity of the data.
RESULTS: Telenursing in critical and supportive care was the main theme identified from data
analysis. This theme included six main categories: (1) management of trauma, (2) technical skills, (3)
care and decision‑making in stressful situations, (4) management of patients with special needs, (5)
life‑saving intervention, and (6) psychological and emotional supports.
CONCLUSIONS: Telenursing in disasters is the turning point of the care management of victims.
In order to achieve this goal, nurses should acquire the relevant knowledge, skills, and abilities.

Abstract INTRODUCTION: The 2019 coronavirus disease (COVID‑19) is a major global health concern. Joint
efforts for effective surveillance of COVID‑19 require immediate transmission of reliable data. In this
regard, a standardized and interoperable reporting framework is essential in a consistent and timely
manner. Thus, this research aimed at to determine data requirements towards interoperability.
MATERIALS AND METHODS: In this cross‑sectional and descriptive study, a combination of
literature study and expert consensus approach was used to design COVID‑19 Minimum Data
Set (MDS). A MDS checklist was extracted and validated. The definitive data elements of the MDS
were determined by applying the Delphi technique. Then, the existing messaging and data standard
templates (Health Level Seven‑Clinical Document Architecture [HL7‑CDA] and SNOMED‑CT) were
used to design the surveillance interoperable framework.
RESULTS: The proposed MDS was divided into administrative and clinical sections with three and
eight data classes and 29 and 40 data fields, respectively. Then, for each data field, structured data
values along with SNOMED‑CT codes were defined and structured according HL7‑CDA standard.
DISCUSSION AND CONCLUSION: The absence of effective and integrated system for COVID‑19
surveillance can delay critical public health measures, leading to increased disease prevalence and
mortality. The heterogeneity of reporting templates and lack of uniform data sets hamper the optimal
information exchange among multiple systems. Thus, developing a unified and interoperable reporting
framework is more effective to prompt reaction to the COVID‑19 outbreak.

Abstract BACKGROUND: Today’s Bachelor in Medicine, Bachelor in Surgery (MBBS) students will become
Indian Medical Graduates in future. Emotional intelligence (EI) is an essential component in the
making of an Indian Medical Graduate. There is increasing stress during medical training. The study
was conducted to compare the association of EI score and perceived stress scale (PSS) among
average and excellent undergraduate medical students. The secondary objective was to find the
predictors of excellent academic performance.
MATERIALS AND METHODS: This descriptive cross‑sectional study was conducted after institutional
ethics committee approval. All 522 consented students studying in 2nd, 4th, 7th, and 9th semesters filled
up established pre‑validated questionnaires ; Schutteself report EI test and Cohen’s perceived stress
scale. Sociodemographic details of the respondents were collected. Average attendance and marks
of previous semester examinations of all included students were collected from academic cell of the
institution. All students were grouped into three groups: average, good, and excellent performers
from the marks collected. Comparison of EI scores and PSS scores was done between students in
excellent and average groups using unpaired t‑test.
RESULTS: Of the 94.9% of respondents, 78.2% of the students were included in the study. The mean
EI and PSS scores were 123 ± 14.5 and 22.8 ± 13.9, respectively. There was no statistically significant
difference in EI scores between average and excellent performers ([123.8 ± 18.7] vs. [127.7 ± 16];
P – 0.089). Perceived stress was lower in excellent performers ([20.9 ± 11.1] vs. [24.8 ± 15.0];
P – 0.01). EI was associated with better performance in clinical year students. EI was negatively
correlated to perceived stress.
CONCLUSION. Our study provides predictors of excellent academic performances among Indian
medical undergraduates. This study suggests introduction of extracurricular activities in ongoing
undergraduate curricular syllabus. It imparts awareness among students about the importance of
attending classes. This study bestows higher EI and lower perceived stress to better academic
performance.

Abstract BACKGROUND: The Internet of Things is a revolution in health care both in the field of patient
treatment and health information management. This technology can improve the status of patients,
providing them with healthcare, collecting, sharing, storing and analyzing their medical information.
AIMS AND OBJECTIVES: Since the use of the IOT will create a wonderful future in the field of
electronic health and the telecommunications industry, hospitals, health centers and policymakers
in the health sector in the country should not neglect to get advantage of this technology. Therefore,
this study aims to collect the necessary indicators for entering this technology and also measuring
its preparation to use it.
MATERIALS AND METHODS: This is a practical research and in terms of information gathering, a
descriptive survey type that describes and evaluates the preparation of IOT technology implementation
in hospitals affiliated to Isfahan University of Medical Sciences. In order to measure the preparation
for implementation of such technology in the treatment centers, a model based on the opinion of
the experts in this area should be designed. According to which the model of this assessment in 5
different sections in the treatment centers that require this technology are also significant and Effective
changes will be reviewed to assess their preparation.
RESULT: According to the standard coefficients obtained as a result of reviewing the opinions of
the experts in this field, the most effective factor is "training of specialist staff in the university" and
the least effective factor is "purchasing technical knowledge from universities and affiliated centers".
CONCLUSION: The results show that current hospitals are not prepared to move to this area and
the universities should be able to enter the field quickly.

Abstract BACKGROUND: Happiness is among the factors that promote mental health in mothers with
unplanned pregnancy. The present study aimed to determine the impact of attachment skills training
on happiness among women with unplanned pregnancy.
MATERIALS AND METHODS: This clinical trial was conducted on 84 women with unplanned
pregnancy referred to three prenatal clinics in Shiraz in 2018. The participants were randomly divided
into an intervention group and a control group using permutation block. At first, the participants were
requested to sign written informed consent form, demographic information form, and mental health
questionnaire. Then, they were asked to complete Oxford Happiness Questionnaire and Cranley’s
Maternal-Fetal Attachment Scale. The intervention group received attachment training through six
90-min sessions, while the control group underwent the hospital’s routine care. The two groups were
required to fill out the study questionnaires once more after 4 weeks after the intervention. After all,
the data were analyzed using Chi-square test, Fisher’s exact test, independent t-test, and ANOVA.
RESULTS: There was a significant difference between the two groups’ pretest and posttest mean
scores of happiness (P = 0.0001). The results showed that in the experimental group, pretraining and
posttraining period mean scores were 89.64 (7.2) and 93.13 (6.09), respectively; while in the control
group, pretraining and posttraining period mean scores were, respectively, 91.69 (9.96) and 91 (8.82).
The difference between the two groups was statistically significant. No significant relationship was
observed between happiness and the couples’ occupations, number of pregnancies, and number
of miscarriages in the two groups (P > 0.05).
CONCLUSION: The mean score of happiness increased after the training, being significantly different
from that in the control group. Therefore, happiness is a changeable feature that can be promoted
among pregnant women via interventional methods.

Abstract BACKGROUND: The prevalence of viral diseases is on the rise and has caused many problems
for public health. COVID‑19 is a new viral outbreak in the world. This study aimed to investigate the
trends of incidence and case fatality rate (CFR) of COVID‑19 in the world by April 30, 2020.
METHODS: This was a descriptive‑analytical study. We investigated the number of cases and deaths
in 35 selected countries and regions of the WHO that had at least 10,000 cases by the time of the
study. In addition, the incidence and CFR of COVID‑19 were investigated. Finally, time trends of the
number of cases, deaths, and CFR were investigated using ordinary least squares regression models.
RESULTS: The total number of confirmed cases of COVID‑19 was 3,090,184. The European region
had the highest number of COVID‑19 patients (1,434,649 [46.43%]). Ukraine with 10,406 and the
USA with 1,003,974 cases have reported the lowest and highest confirmed cases, respectively. In
addition, the European region and the African region with 157.13 and 2.50 patients per 100,000
population had the highest and the lowest incidence rate, respectively. India (2.44) and Spain (455.69)
had the lowest and the highest incidence rate per 100,000 population, respectively. In the world,
217,759 deaths have happened, of which 135,961 (62.44%) were reported in the European region.
Furthermore, the USA had the highest number of deaths (52,428) due to COVID‑19. CFR was 7.05%
in the world, which ranged from 3.74% in the African region and 9.48% in the European region. The
number of patients and deaths due to COVID‑19 had increasing trends in all countries, and the trend
of CFR just for Iran and Ukraine was negative.
CONCLUSION: The countries had different trends in the morbidity and mortality of COVID‑19.
However, regarding the increasing trend of the disease in the world, it will be more important to rely
on public prevention strategies. It is necessary to apply and continue public health policies at national
and global levels till the control of the disease.

Abstract INTRODUCTION: Most of the neonatal and maternal deaths occur within the first 48 hours
post‑delivery. Hence, this time period is very crucial for the survival of newborns and mothers both.
As per maternal and child health program guidelines in India, it is clearly mentioned that all the
government health facilities should discharge the mother and baby only after 48 hours of delivery in
case of normal delivery and after 7 days in case of delivery conducted by cesarean sections.
AIM: The aim of the study was to find the various factors responsible for early maternity discharge
(<48 h) of normal vaginal deliveries (NVDs) conducted at government health facilities.
MATERIAL AND METHODS: The study was conducted in a rural block of Haryana, North India, from
May to June, 2015. Postnatal women with NVD within 6 months of duration from initiation of the study
were included after taking proper informed consent. A questionnaire was developed by the investigators
to interview the women. The questionnaire consists of 26 items which included the socio‑demographic
details and questions on various factors affecting postnatal stay at the health facility.
RESULTS: A total of 40 postnatal women consented and participated in the study. Their mean
age was 23.46 ± 5.63 years. Majority of them (24, 60.0%) were having their first child. Out of them,
12 delivered at primary health centers (PHCs), 18 at community health centers, and the rest at the
district hospital. A total of 24 (60%) of them were discharged early (<48 h) as per laid guidelines.
It was observed that primiparity, delivery at PHC, normal birth weight of baby, and term deliveries
were significantly associated with early discharge. Among those who had NVD and stayed beyond
48 h, most of them mentioned that the round‑the‑clock availability of doctors/nurses was the main
reason for their staying at the health facility.
CONCLUSION: The proportion of postpartum women discharged early is high and alarming. There
is a need for essential counseling to be imparted to the mothers by doctors/nurses at all the health
facilities for staying till 48 hours and by health workers during the antenatal period of the importance
of the stay at the facility post delivery .

Abstract INTRODUCTION: Health promotion through lifestyle improvement is an important topic that has
received considerable attention from the scientific community worldwide. This study aimed to
determine the effect of Pender’s health promotion model on self-efficacy and treatment adherence
behaviors of hemodialysis patients in Shahrekord, Iran, in 2018–2019.
METHODS: This quasi-experimental study was performed on 70 hemodialysis patients who were
attending routine hemodialysis sessions in Hajar hospital in Shahrekord. Individuals were selected
by simple random sampling and randomly assigned to two groups of control and intervention.
In the preintervention stage, all patients completed a questionnaire that was prepared to collect
demographic information and measure health-promoting behaviors, self-efficacy, and treatment
adherence. The intervention group participated in eight sessions of a health promotion model-based
education program. Both groups were asked to complete the questionnaire again immediately after
the intervention and also 2 months later.
RESULTS: The repeated measures analysis of variance (ANOVA) showed a significant difference
between the two groups in terms of the extent of change in mean scores over the three measurement
stages (before the intervention, after the intervention, and 2 months after the intervention) (P < 0.001).
A statistically significant difference was observed between the two groups in terms of self-efficacy
scores in the postintervention and follow-up stages (P < 0.05). The repeated measures ANOVA also
revealed a significant difference between the two groups in terms of the extent of change in mean
treatment adherence scores over the three measurement stages (P < 0.001).
CONCLUSION: Considering the positive effects of the program on patients undergoing hemodialysis,
it is recommended to use the program to promote the well-being of these patients without time
restrictions.

Abstract BACKGROUND: The health-promoting lifestyle by empowering individuals will increase control over
their health, improve quality of life, and prevent diseases. The purpose of the present study was to
determine the effect of the educational intervention based on the intervention mapping approach on
health-promoting lifestyle in Iranian college students.
METHODS: This study is a quasi-experimental control study that was conducted in two groups of
65 students of Iran University of Medical Sciences in 2018–2019. The data were collected using the
Health-Promoting Lifestyle Standard Profile II questionnaire and a researcher-made questionnaire
based on the mapping approach, whose validity and reliability were confirmed. The educational
intervention was designed according to the pretest results, including five training sessions and
performed for the intervention group. The two groups were evaluated with the same questionnaires
1 month and 3 months later, and the data were analyzed using independent t-test, Spearman,
ANCOVA, ANOVA test, and covariance.
Results: Before the intervention, no significant difference was observed between the mean scores of
health-promoting behaviors in the two groups, but after the intervention, the mean scores of attitude,
subjective norms, enabling factors, and perceived self-efficacy and mean scores of health-promoting
lifestyle and its dimensions increased significantly in the intervention group (P < 0.001) compared
to the control group.
Conclusion: The educational intervention is effective in improving behaviors related to healthpromoting lifestyle and its dimensions. Therefore, performing educational interventions are suggested
to adopt and adhere to behaviors related to health-promoting lifestyle by utilizing and reinforcing
perceived self-efficacy, subjective norms, enabling factors, and attitudinal change.

Abstract