Journal of Education and Health Promotion

Abstract

Abstract INTRODUCTION: A person with colostomy or ileostomy undergoes a comprehensive treatment
with a wide range of adjustments which affect the individual’s social and psychological functioning.
Quality of life (QOL) is a subjective feeling which includes physical, social, psychological, and spiritual
domains of an individual that can be affected by a stoma.
AIM: This study is aimed at identifying the QOL and impact of stoma on their lifestyle pattern among
ostomates attending stoma outpatient department of gastroenterology department of a government
tertiary care center in South India during 2018.
METHODS: A descriptive study using a cross‑sectional survey design was conducted among 55
ostomates, following consecutive sampling technique. The data were collected using a City of Hope
QOL Questionnaire for Ostomy patients which had QOL Assessment Questions from four subdomains
including physical, psychological, social, and spiritual aspects. This tool also had open‑ended
questions on lifestyle assessment components.
RESULTS: 63.6% of the participants had colostomy; 72.7% of the stomas were due to cancer. The
mean QOL score of the participants was 4.13 ± 1.07. The ostomates scored relatively well in both
physical (5.68 ± 1.76) and spiritual (4.32 ± 1.36) domains, but the sociological (2.85 ± 1.3) domain score
was very low. Permanent ostomates scored significantly higher than the temporary ostomates (P = 0.04).
CONCLUSION: The QOL score of ostomates was less than the scores reported in the Western
population and living with stoma significantly alters their lifestyle. Therefore, follow‑up services and
counseling services to the ostomates by the health‑care professionals are needed.

Abstract BACKGROUND AND AIM: Arthritis is the most common type of arthritis in people over 40 years.
This study aimed to determine the effect of an educational intervention on the prevention of arthritis
among middle‑aged women using the health belief model.
MATERIALS AND METHODS: This was a randomized controlled field trial. The study population
was women aged 29–59 years who referred to health centers in Birjand. Seventy‑three women were
selected by a systematic random sampling method and were randomly divided into intervention (n = 36)
and control (n = 37) groups. The data collection tool was a researcher‑made questionnaire. Data
were analyzed using the Chi‑square test, Fisher’s exact test, t‑test, repeated‑measures ANOVA, and
Bonferroni post hoc test. As for the cases where the data were not normally distributed, the Friedman
nonparametric test, Mann–Whitney U‑test, and Wilcoxon post hoc tests were used.
RESULTS: In the intervention group, the mean score of knowledge, perceived susceptibility, severity,
benefits, self–efficacy, and behavior significantly increased, and the mean score of perceived barriers
significantly decreased after the intervention (≤0.001). In the control group, there were significant
differences in the mean scores of perceived susceptibility, perceived severity, perceived self‑efficacy,
and performance after an intervention (P ≤ 0.001). However, this increase was significantly higher
in the intervention group than in the control group.
CONCLUSION: Based on the present study and according to the positive impact of the educational
intervention based on the health belief model on the prevention of arthritis, it is recommended to use
this theory in educational programs to prevent arthritis.

Abstract BACKGROUND: Undergraduate dental students have to do multiple tasks as part of their extensive
curriculum in order to achieve the proficiencies expected of them. During the course of their study, a
tendency to procrastinate and question their self‑efficacy is detrimental for the students. The aim of
this study was to evaluate the level of procrastination and self‑efficacy and its related factors among
dental undergraduate students.
SUBJECTS AND METHODS: This cross‑sectional study was conducted among all (n = 361)
consented dental undergraduate students of our dental school. A twenty‑item Lay’s Procrastination
Scale for student population and a ten‑item General Self‑Efficacy Scale were used for the study after
getting institutional ethical approval. The quantitative data were explained using descriptive statistics.
Independent sample t‑test and ANOVA were used to determine the association between self‑efficacy,
academic procrastination, and genders and academic years. Pearson correlation coefficient was used
to determine the association between self‑efficacy and procrastination. Multiple linear regression
analysis was performed to determine the related factors to academic procrastination.
RESULTS: High procrastination (score ≥62) was seen among 28.5% of students. The mean
self‑efficacy score was 29.5. There was no significant difference between genders for procrastination
scores (P = 0.835) and between academic years (P = 0.226). Males showed significantly more
self‑efficacy (P < 0.001), and self‑efficacy did not show any significant difference (P = 0.204) between
academic years though a tendency for year 5 students to have lower self‑efficacy scores was observed.
Academic procrastination was negatively correlated with self‑efficacy (r = −0.238 and P < 0.001).
CONCLUSIONS: For dental undergraduates who have cognitive load as well as work associated
with patients, procrastination and self‑efficacy are negatively correlated.

Abstract INTRODUCTION: Evaluation of students’ clinical performance is an essential part of nursing
education. Mobile technology is one of the new methods of evaluation that has opened a new horizon
for nursing professors. Therefore, this study aimed to design, implement, and evaluate mobile health
technology in critical care nursing department in four‑phase intervention.
METHODS: This study was a four‑stage educational intervention in which all postgraduate students
of intensive care nursing in Isfahan University of Medical Sciences participated in the study. The four
steps were designing and developing a logbook, needs assessment, designing and implementing
an Android app, and evaluating users (students) of the Android app. Subjects' satisfaction scores
were collected using a researcher-made questionnaire with 14 questions. Data were analyzed using
SPSS 14 software.
RESULTS: In this study, a clinical practice evaluation app was designed at four levels of
access (student, professor, department manager, and faculty dean). The results showed that more
than half of app users reported this technology in terms of an overall response to the tool (87.5%),
tool specificity (100%), the amount of information displayed (75%), page layout (62.5%), information
rate (75%), recall information (87.5%), and ease of doing instructions (100%) were positive.
CONCLUSION: Evaluation of clinical practice using technology was associated with increasing
students’ satisfaction with evaluation method. In addition, this application enabled the simultaneous
interaction between the professor with the higher and lower ranks, including the department manager
and student and vice versa and the simultaneous recording of this interaction.

Abstract INTRODUCTION: Children are among the most vulnerable groups in society, whose health is of
prominent significance. Moreover, as a group of clients with special needs in the health care system,
they require special attention. Therefore, the present study aimed to investigate the 0–14‑year‑old
children’s access to health centers in rural areas of Kermanshah Province, Iran.
MATERIALS AND METHODS: In the present cross‑sectional study, both the latest published
demographic statistics related to the Population and Housing Census, announced by the Statistical
Center of Iran in 2011, and the information about the public and private hospitals in the province,
collected by Kermanshah University of Medical Sciences, were used as the basis for the analyses.
In addition, given the importance of the spatial nature of the research, geographic information system
was used for data analysis, and a buffer model was also applied.
RESULTS: The results revealed that out of the total population of 0–14‑year‑old children residing in
rural areas within 15,000 and 30,000‑km radii of Kermanshah Province, 87.94% and 75.11% of girls
versus 88.15% and 75.38% of boys lacked access to health centers, respectively.
CONCLUSION: It was found out that the 0–14‑year‑old children’s access to health centers was in poor
condition in rural areas of Kermanshah Province, which would endanger the health of this age group.

Abstract CONTEXT: Immersing students studying health promotion and disease prevention into community
settings facing health disparities is an essential supplement to their academic experience. As part
of many public health professions, these students will likely need to understand the values and
beliefs of different cultures so that decisions of appropriate health promotion and treatment can be
made equitably. This paper evaluates an education immersion program that was part of a National
Cancer Institute funded collaboration supporting the recruitment and training of university students in
cancer research. The primary aim of the Health Disparities Field Experience (HDFE) was to facilitate
an experience for students pursuing a health‑related degree to understand the conceptual issues
in border/rural health and the cultural contexts related to health disparities among medically and
financially indigent populations in the region.
SUBJECTS AND METHODS: This study was conducted using qualitative research methods using
a variation of the content analysis approach using open codes to categorize the data. Six students
were selected to participate in the HDFE (five graduate students and one undergraduate) and all six
of the participants completed pre‑ and post‑test surveys.
RESULTS: From the analysis of the data, posttest qualitative responses indicated that three
participants saw racism as a primary cause of cancer‑related disparities, a change from their
pretest responses. When asked about the personal impact of the HDFE, respondents mentioned
the importance of the experiential component.
CONCLUSIONS: Participants learned about health disparities from the HDFE and expressed high
satisfaction with this approach to education.

Abstract The present study aimed at identifying the prerequisites, facilitators, and barriers to adolescent
mental health literacy interventions. To that end, databases PsycINFO, Science Direct, Scopus,
Emerald, PubMed, Web of Science, and Google Scholar were systematically searched, out of which
39 articles that had the inclusion criteria were analyzed by the content analysis. Databases searched
from September 30, 2018, to October 10, 2018, with the keywords “health literacy,” “mental health
literacy,” “mental disorders,” adolescents, students, and more. Seven themes were identified as the
prerequisites for interventions to improve adolescents’ mental health literacy including education at the
school level, parents’ education, training of trainers and providers, cooperation and participation among
providers, intervention assessment and monitoring, provision of educational content, consideration
of the cultural and linguistic issues. Five themes were identified as facilitators: using interactive
learning and teaching methods, supplying diverse and stimulating educational content, employing
trainers with different backgrounds, having direct contact with people with mental illness, and utilizing
technological advancements in education. Finally, short‑time intervention, the collaboration between
school administrators and researchers, lack of valid information sources were identified as barriers.

Abstract BACKGROUND: There is growing recognition of the role of mobile learning (M‑learning) for
undergraduate (UG) academic education and teaching purposes, but teacher attitudes toward it
can be variable.
OBJECTIVE: To determine the attitudes toward the incorporation of M‑learning methods for UG
medical education among resident doctors at a government medical college in Delhi, India.
METHODS: A cross‑sectional study was conducted for 3‑months duration (2019) among 60 final
year junior and senior resident doctors. The participants were selected from all the preclinical and
paraclinical department, and one clinical department selected randomly based on the probability
proportion to size method. The data was collected using self‑administered instruments including the
modified 20‑item M‑learning Perception Scale (MLPS).
RESULTS: Social media (36.7%) and instant messaging platforms (85%) were routinely used by the
participants for exchanging academic (medical) and health‑related information. The mean score for all
the MLPS item responses was >3, indicating positive attitudes toward M‑Learning. The participants
expressed maximum agreement with the views stating M‑Learning can “supplement traditional
teaching,” was “reliable for personal use,” and “improves the quality of lessons.” The responses of
those participants having preexisting familiarity with health information and education portals, and
those aware of massive open online courses correlated significantly with higher MLPS scores.
CONCLUSION: M‑learning is visualized as an increasingly relevant teaching and learning medium
by early‑career resident doctors involved in UG medical education in India.

Abstract INTRODUCTION: The ultimate goal of education at all levels is the ability to generate and foster
students’ creativity. This study aimed at determining and comparing creativity and its influencing
factors among medical students.
SUBJECTS AND METHODS: In this cross‑sectional study conducted in 2019, 720 medical students
in Shahroud public and private universities were selected and studied through stratified cluster
random sampling. Data were collected using the Guilford Creativity Questionnaire. The data were
analyzed using Chi‑square, Pearson correlation coefficient, t‑test, and multiple logistic regression
with a significance level of 0.05.
RESULTS: The mean creativity score of the students was 131.4 ± 13.8. The mean creativity scores on
the fluency, elaboration, originality, and flexibility dimensions were 49.2 ± 5.3, 22.1 ± 3.4, 34.8 ± 4.7,
and 25.4 ± 3.5, respectively. In terms of creativity levels, 75.2% of the students (n = 542) had
moderate creativity and 23.8% (n = 171) had high creativity. A significant relationship was observed
between creativity and educational level (P = 0.006). Multiple logistic regression results showed that
educational level with an odds ratio of 0.59 was associated with a decreased chance of creativity.
CONCLUSION: Most of the students had moderate creativity. Moreover, among the factors examined
in this study, variables other than the field of the study and educational level had no significant effect
on students’ creativity. Therefore, using collaborative and cooperative learning and problem‑based
learning strategies, teachers’ critical thinking styles, establishing teamwork groups, concept mapping,
and using innovative and creative teaching methods can help to enhance students’ creativity.

Abstract BACKGROUND: Changing human behavior for the purposes of improving the way people work
is an integral part of most educational interventions. This study aimed to evaluate the effect of a
model based on the theory of planned behavior (TPB) on correct principles of manual material
handling (MMH) among male soldiers.
SUBJECTS AND METHODS: This study was a quasi‑experimental, pretest‑posttest research with
a control group. Furthermore, 140 soldiers, from an area located in the city of Bandar Abbas, Iran,
were selected through a simple random sampling and they were divided into two groups: intervention
and control (70 subjects in each group). The data were collected using a three‑part questionnaire
including demographic information, the theory constructs, and MMH behavior. The intervention group
was given the relevant education, and after 2 months, the both groups were evaluated.
RESULTS: Based on regression analysis, attitude toward behavior and perceived behavioral control
were predictors for correct principles of MMH. There were significant differences between the mean
scores of the theory constructs before and after the education in intervention group (P < 0.001);
however, no significant differences were observed in the theory constructs in the control group
after the intervention. Before the education, the mean score of MMH of the intervention group
was 38.30 ± 6.45; but after, the education, this changed into 44.20 ± 6.01, and significantly
increased (P < 0.001).
CONCLUSIONS: Educational intervention based on the TPB was effective in improving behavior for
correct MMH in soldiers. Thus, the use of such educational programs according to the constructs of
the planned behavior theory is recommended.

Abstract INTRODUCTION: One of the most critical stages of women’s lives is menopause. Meanwhile,
group training can have a significant effect on reducing menopausal symptoms. The aim of this
study was to investigate the effectiveness of group training on reducing menopausal symptoms in
postmenopausal women.
METHODS: This study was a randomized controlled trial. The study population was 96 postmenopausal
women visiting health centers in the city of Shazand (Markazi Province, Iran). Data collection tools
in this study were the Menopausal Rating Scale Questionnaire and the Beck Depression Inventory.
Group training intervention consisted of four training sessions. The duration of each session was
2 h. The questionnaires were completed in two stages of pre‑ and post‑test (8 weeks later) for the
intervention and control groups. Data were analyzed using descriptive statistics (absolute and relative
frequency, mean and standard deviation) and analytical statistics (independent t‑test, paired t‑test,
and analysis of covariance).
RESULTS: The mean age in the intervention group and the control group was 49.93 ± 3.44
and 51.66 ± 2.93 years, respectively. In the intervention group, the mean menstrual time was
2.37 ± 167 years and in the control group, the mean time elapsed from the last menstrual
period was 3.91 ± 2.68 years. The mean scores of menopausal physical symptoms (F = 58.69),
menopausal symptoms (F = 43.45), menopausal urinary and genital symptoms (F = 33.50), and
depression (F = 58.25) had a significant decrease in intervention group, while in the control group,
these changes were not significant (P < 0.001).
CONCLUSION: Regarding the findings of this study, which indicates the effect of group training
program on the improvement of physical, psychological, urinary and genital symptoms, and
menopausal depression, it seems that group training in menopause can be an effective method.

Abstract BACKGROUND: Adherence to treatment is one of the major challenges in patients with HIV/ADIS. If
the patients do not adhere, they will face recurrent consequences, such as disease progression. The
aim of this study was to investigate the effect of information, motivation, and behavioral Skills (IMB)
model on medication adherence, diet adherence, and physical activity in HIV/ADIS patients.
MATERIALS AND METHODS: This interventional study was conducted on 122 patients with 20 years
of age and over with HIV/AIDS in Kerman City, Iran, in 2018. A total of patients were selected by
census method and categorized into the intervention and control groups. Later, a researcher‑made
questionnaire on IMB was used before and 3 months after the intervention to assess medication
adherence, diet adherence, and physical activity .The intervention study consisted of at least 8
training sessions (90 min) over a 12‑week period.
RESULTS: In adherence to medication, information (P = 0.034) and personal motivation (P = 0.003)
constructs and in adherence to diet, information (P = 0.025), personal motivation (P = 0.001),
self‑efficacy (P = 0.010), and skills (P = 0.011) were significantly different between the two groups
after the intervention (P = 0.011). However, regarding the adherence to physical activity, no significant
difference was found between the two groups after the intervention.
CONCLUSIONS: The IMB model can be effective in promoting the diet adherence in HIV/AIDS
patients. In this regard, more qualitative and quantitative studies are recommended on the adherence
to medication and physical activity.

Abstract INTRODUCTION: Physical therapists provide important services to improve physical health for
the general population; however, physical therapy interventions are less utilized with underserved
populations such as those with severe mental illness (SMI). The quality of services for these
populations is impacted in part by negative provider attitudes and lack of preparation to work with
the SMI population. This study examined the impact of structured educational field experience on the
physical therapist’s attitudes and knowledge about working with the SMI population. This will inform
future educational practices to best prepare students to provide quality of healthcare to the population.
MATERIALS AND METHODS: Seven graduates of a doctor of physical therapy (DPT) program
from a Mid‑Atlantic University in the United States who participated in an SMI service‑learning (SL)
experience completed a semi‑structured qualitative interview in 2016. Questions about how the
experience impacted their current work were asked. Interviews were digitally recorded, transcribed,
and examined using interpretive phenomenological analysis. Coding and investigator triangulation
were conducted. All interviews reached thematic saturation.
RESULTS: The graduated DPT students reported attitudinal changes toward people with SMI through
qualitative interviews. They reported an improvement in their skills, greater competence to work with
the SMI population, and an increased focus in the use of person‑centered services.
CONCLUSIONS: The results of this study suggest that DPT students gain an understanding of both
the SMI population and themselves during SL. Using SL as part of the DPT educational curriculum
can offer students and the opportunity to build confidence in working with the SMI population. SL
can also improve their skills and attitudes toward the population, key areas that are identified as
barriers to receiving quality physical healthcare among the SMI population.

Abstract INTRODUCTION: In social cognitive theory, self‑efficacy and self‑concept (SC) have been introduced
as important constructs that associate with adolescents’ achievements. The aim of this study was
to investigate the determinant factors of academic self‑efficacy (ASE) and SC in Iranian high school
students based on the multilevel analysis.
MATERIALS AND METHODS: In this descriptive‑analytical cross‑sectional study, 1740 students
from 53 high schools selected with stratified random sampling method in 2018 in Qazvin,
Iran. Data collection tools were the Morgan and Jinks Self‑Efficacy Scale and the Piers‑Harris
Children’s  SC Scale‑Second Edition. The association between some of the students and school
variables with ASE and SC was analyzed by hierarchical linear regression models.
RESULTS: The score of the students’ standardized ASE was lower than SC. ASE and SC had a
strong positive significant association with economic status, grade point average, and the educational
period of high school. Sex had no association with any of them. Physical activity had a positive
significant association with SC but was no found association by ASE.
CONCLUSION:  These findings revealed that for improving the adolescents’ ASE and SC should be
attention to the adolescents’ family condition and school‑related factors. Proper educational, sports,
and supportive programs can be effective on the adolescents’ self‑efficacy and SC.

Abstract INTRODUCTION: After graduation, public health students should be able to work as health care
givers providing first‑level health care services. Therefore, the educational objectives of public health
bachelor’s programs should ensure that they acquire the capabilities necessary for this purpose.
This study identified the educational objectives that are essential for these students and compared
them with the current curriculum in Isfahan, Iran.
METHODS: This needs assessment study was conducted in two phases. In the first phase, the
essential educational objectives were identified using a qualitative approach, which involved eight
focus group discussions held by a group consisting of experts of the public health headquarters and
public health network administration offices of Isfahan province and the public health graduates
working in the province’s comprehensive health service centers, who were chosen using the purposive
sampling method (n = 59). In the second phase, a comparative study was performed by turning the
list of essential educational objectives into a checklist and using it to compare these objectives with
the objectives in the current course plan in the examined curriculum. In the end, a list of educational
objectives not included in the current curriculum of the public health bachelor’s program was created.
RESULTS: The focus group discussions produced 433 educational objectives in the cognitive
domain, 79 objectives in the affective domain, and 179 objectives in the psychomotor domain, which
were arranged in eight competency categories. Comparison of the essential educational objectives
with the current curriculum showed that the current curriculum does not cover any of the essential
objectives regarding care for the age groups of 18–29 and 30–59 and the first aid and only partially
covers essential objectives in other competency categories.
CONCLUSION: This study found that considering the requirements of first‑level health services
and the tasks expected from public health graduates to be providing these services, the current
curriculum does not cover all essential learning objectives and should be revised to meet additional
essential educational objectives.

Abstract BACKGROUND: Menstruation is a normal physiological process among reproductive age group
females. Although some of them show the abnormal menstrual pattern, which is influenced by
several factors, including sociodemographic status, psychosocial stress, improper sleep level,
etc. The identification of these risk factors associated with abnormal menstrual patterns may permit
risk stratification among adolescent girls. This study was planned to determine various factors which
depict menstrual cycle pattern among adolescent girls in urban India.
MATERIALS AND METHODS: A school‑based case–control study was carried out in urban India
from May to December 2019. Urban locality and schools were randomly selected, and data were
collected in two phases. Adolescent girls in the age group of 10–19 years studying in government
and private (both Hindi medium and English medium) schools of urban India were screened for the
abnormal menstrual pattern. Equal numbers of age‑matched controls were also enrolled. Data were
collected with the help of self‑administered predesigned pretested semi‑structured questionnaire.
Chi‑square test, Fisher’s exact test, unpaired t‑test, and McNemar tests were used to analyze data
using SPSS version 23.0.
RESULTS: A total of 100 cases and 100 age‑matched controls (mean age 14.8 ± 1.5 years) were
included in the study, almost half of the cases and controls have normative menarche. Improper
sleep patterns increased stress levels, and low education status of mothers show statistically
significant (P = 0.047) association with abnormal menstrual patterns.
CONCLUSION: More stress, improper sleep levels, and low education status of mothers among
school‑going adolescent girls were strongly associated with abnormal menstrual patterns with more
symptoms during menstruation.

Abstract BACKGROUND: Mobile app education is one of the new educational models. Hence, the purpose
of this study was to determine the effectiveness of mobile app intervention on knowledge, attitude,
and practice of youth for a healthy marriage.
MATERIALS AND METHODS: This quasi‑experimental study was conducted in 2019 on 88 young
people who were selected by simple random sampling in premarital counseling center of Falavarjan
city (Isfahan). Then, participants were randomly allocated to an intervention and a control group.
Mobile application intervention was installed on the intervention group’s mobiles. Data were collected
by questionnaire in two times. Data were analyzed using paired t‑test and independent t‑test.
RESULTS: The mean (Standard deviation) of couples’ age was 21.11 (5.06) years. The results
showed that after the installation of educational consulting app in the intervention group, the mean
score of knowledge (P = 0.001), attitude (P = 0.001), and practice (P = 0.001) after intervention were
significantly higher than before the intervention.
CONCLUSION: Mobile‑based educational and counseling app increases couples’ knowledge,
attitude, and practice in premarital education. Therefore, it is recommended that this type of
education (mobile app) be used to promote premarriage education classes.

Abstract INTRODUCTION: The clinical environment is an essential and irreplaceable resource in preparing
nursing students for their professional role. Despite many changes that occur in the clinical learning
environment (CLE), these environments remain important to nurse training. With regard to the
importance of students’ viewpoints in the evaluation of CLE, this study was performed to the
determination of nursing students’ viewpoint of the actual and preferred CLE at Bushehr University
of Medical Sciences in Iran 2013.
MATERIALS AND METHODS: In this cross‑sectional analytic study, due to the small size of the
research population, all nursing students (86 students) of Bushehr University of Medical Sciences
in Iran who had passed at least one clinical course were selected through the census. Participants
were invited to complete anonymously the actual and preferred Farsi versions of the CLE Inventory
consisting of 42 items originally developed by Professor Chan (2001). Data were analyzed using
frequency distribution, mean, standard deviation, and paired t‑test.
RESULTS: The results indicated that there were significant differences between students’ perceptions
of the actual and the preferred CLE (P < 0.001). The highest and lowest mean scores of actual CLE
belonged to student involvement and individualization, respectively, and the highest and lowest mean
scores of preferred CLE belonged to task orientation and individualization, respectively.
CONCLUSION: In general, students prefer a more positive CLE than what they actually have
experience and would prefer an environment with higher levels of clarification of personalization,
student Involvement, satisfaction, task orientation, innovation, and individualization.

Abstract A valid tool is of paramount importance in determining women’s sexual and reproductive health
status, meeting their health needs, and recognizing the effectiveness of some interventions. This
review study aimed to assess sexual and reproductive health dimensions tools in women with type
1 diabetes mellitus with regard to Consensus‑based Standards for the selection of health status
Measurement Instruments (COSMIN) checklist. In this review study, in addition to Iranian databases
(MagIran, Sid, Irandoc), non‑Iranian databases (PubMed, Scopus, Embase, and Web of Science)
and Google Scholar search engine were considered. The mentioned databases were searched
for articles in English and Persian published within 2000–2019, using the search strategy for each
database and Boolean operators along with appropriate keywords according to the MESH term.
Articles with nonresearcher‑made tools measuring the sexual and reproductive health concepts
and dimensions were included in the present study. Afterward, the psychometric properties of the
tools were assessed according to the COSMIN checklist. In the selected articles, there were 14
psychometrically valid tools to be assessed from 151 articles containing the sexual and reproductive
health dimensions; among which, seven tools were evaluated with regard to COSMIN. None of
the tools also had all the features noted in COSMIN. Moreover, all the concerned scales were not
interpretable and accountable; however, a majority of them had internal consistency and construct
validity. In this study, there was no valid and specific tool for measuring sexual‑reproductive health
status in this population group. Therefore, it is necessary to develop a valid tool according to the
dimensions and needs of specific reproductive health in type 1 diabetes.

Abstract CONTEXT: Inappropriate self‑medication can increase chances of adverse drug reactions, disease
aggravation, or drug interactions. Analgesics are most commonly used as self‑medication.
AIMS: The aim of this study was to evaluate and compare analgesic self‑medication practices among
medical and paramedical undergraduate students of a tertiary care teaching institute in Central India.
MATERIALS AND METHODS: A cross‑sectional, observational study was conducted in 216
undergraduate medical (MBBS and BDS) and paramedical (occupational therapy/physiotherapy
and BSc nursing) students. A predesigned, self‑developed, semi‑structured questionnaire was used.
STATISTICAL ANALYSIS: The Chi‑square test was used for testing statistical significance.
RESULTS: The overall prevalence of self‑medication with analgesics was 83.33%. Self‑medication
was significantly high among medical students as compared to paramedical students (P = 0.003).
Significantly more medical students were aware about adverse drug reactions of analgesics as
compared to paramedical students (P = 0.019). The most common source of information about
drugs was previous prescription (58.33%), followed by media including the Internet (53.70%). The
most dominant symptom compelling self‑medication was found to be muscular pain (42.12%),
followed by headache (36.57%). 54.16% of the students revealed that self‑medication provides
quick relief from pain. The most commonly used analgesic was paracetamol (82.40%), followed
by diclofenac (22.68%). A significant number of paramedical students do not know exactly what
precautions should be taken while taking analgesics (P = 0.002).
CONCLUSIONS: Medical students are more indulged in self‑medication practices with analgesics.
Paramedical students need to be educated regarding safe use of analgesics.

Abstract INTRODUCTION: Providing information based on truth is very important in patients’ treatment‑related
decisions and reduces emotional and physical sufferings as well as patient costs. The aim of this
study was to design a model that is based on the culture and health‑care context of Iran in order to
establish a truth‑based communication and provide accurate information to patient.
MATERIALS AND METHODS: This qualitative study was conducted in 2019. Data were collected
through semi‑structured interviews with 18 nurses who had been selected by purposeful sampling
method. Data analysis was performed in two steps. In the first step, the participants’ experiences were
determined using the grounded theory approach. In the next step, using Walker and Evant’s (2011)
method, the concepts and statements were combined and presented in a central concept.
RESULTS: The central concept in this study was “an attempt to establish a truth‑based communication
with patient,” and then, a truth‑based communication model was presented. The components of the
model were presented in three parts: improving patient communication skills, managing the situation
in which the truth is presented, and the patient’s participation in decision‑making.
CONCLUSION: To present the truth of the treatment, which can sometimes be unpleasant and
bitter, it is very important to improve communication skills and choose an effective communication
strategy. To establish a truth‑based communication, it is necessary to create a suitable ground for
communication, which should be provided in clinical setting and community.

Abstract BACKGROUND: Disordered eating attitude may lead to full‑blown eating disorders. Recent
longitudinal studies show that disordered eating attitudes either remain stable or even increase from
childhood to adulthood. The current study was done to determine the psychometric properties of the
Eating Attitudes Test‑8 (EAT‑8) and introduce the suitable measure for researchers and therapist in
the field of clinical psychology and psychiatrist.
MATERIALS AND METHODS: The Persian version of the EAT‑8 was produced through forward
translation, reconciliation, and back translation. A sample of 302 students were selected through
convenience sampling method and completed a set of questionnaires, including the EAT‑8,
Eating Attitudes Test‑16 (EAT‑16), Eating Beliefs Questionnaire‑18 (EBQ‑18), self‑esteem scale,
and self‑compassion scale short‑form. The construct validity of the EAT‑8 was assessed using
confirmatory factor analysis and divergent and convergent validity. Internal consistency and test–retest
reliability (2 weeks’ interval) were conducted to evaluate the reliability. Data analysis was conducted
using SPSS (version 22) software and LISREL (version 8.8).
RESULTS: EAT‑8 was found to be valid and reliable measures, with good internal consistency and
good test–retest reliability among students. In terms of convergent validity, EAT‑8 showed a significant
positive correlation with self‑report measures of EAT‑16 and EBQ‑18. EAT‑8 showed a negative
correlation with self‑compassion and self‑esteem, thus demonstrated a good divergent validity. The
results of this study also provide support for the one‑factor model of the EAT‑8.
CONCLUSION: The EAT‑8 showed good validity and reliability and could be useful in assessing
disordered eating in Iranian population. The EAT‑8 shows notable promise as a measure for use in
disordered eating research and clinical settings.

Abstract BACKGROUND: Experiential learning sessions as a teaching aid have been applied early in the
medical undergraduate curriculum to improve the knowledge and inculcate research interest. We
compared the ability of 1st‑year medical undergraduates to answer the molecular biology questions
among those who had attended the experiential learning sessions of molecular biology techniques
versus those who did not attend.
SUBJECTS AND METHODS: A randomized controlled trial was carried out with 200 1st‑year medical
undergraduates, among whom 69 students were selected by simple random sampling for the
demonstration of the molecular biology techniques, such as isolation of genomic DNA, polymerase
chain reaction, cell culture techniques, western blotting, and high‑performance liquid chromatography
for 1‑week duration. Student’s feedback was collected on a five‑point Likert sc ale at the end of the
session to understand how they agree or disagree with a particular statement. The content validity
rate (CVR) and content validity index (CVI) of the questionnaire were determined, and its internal
consistency was examined by Cronbach’s alpha. The internal assessment marks of these students,
valued by faculty who were blinded to their training sessions, were compared with the rest of the
131 students by independent t‑test to know the outcome of these experiential learning sessions.
RESULTS: On CVR and CVI assessment, all the questions scored more than 0.70 and 0.85,
respectively. Cronbach’s alpha for the whole questionnaire was 0.85. Student’s feedback indicated
that these sessions did complement the cognitive skills acquired for these techniques. We also
found a statistically significant improvement (P = 0.006) in the examination performance between
the students who attended versus those who did not attend the experiential learning sessions.
CONCLUSION: Experiential learning, through demonstration and hands‑on experience, enhance d
the learning of molecular biology techniques among 1st‑year medical undergraduates.

Abstract INTRODUCTION: Considering the importance of the academic level of university graduates in the
advancement of communities, it is necessary to evaluate factors affecting the academic achievements
of university students. Therefore, this study investigated the relationship between religious beliefs and
academic achievements of students in the Dental School in Qazvin University of Medical Sciences.
MATERIALS AND METHODS: In this correlational study, all the dentistry students in the last 4 years
of education were selected as the study samples. Of 109 students who had the inclusion criteria,
81 (31 males and 50 females) completed the questionnaires. The data collection tools were three
questionnaires, including Gluck–Stark’s questionnaire, two researcher‑made questionnaires on
“sympathy with and responsibility for patients,” and the “self‑satisfaction” questionnaire. Data were
analyzed with descriptive and deductive statistics (t‑test, Friedman test, and Pearson’s correlation
coefficient).
RESULTS: According to the analyses, a significant and positive correlation was found between
religiosity and students’ overall mean grades (r = 0.27, P = 0.016) or “sympathy with and responsibility
for patients” (r = 0.21, P = 0.05). No significant correlation was found between self‑satisfaction and
religious beliefs.
CONCLUSION: Based on the results of the present study, the religious beliefs of the students
were at a moderate level. On the other hand, this variable had a direct relationship with academic
achievement and responsibility. Therefore, attention has to be paid to the promotion of these beliefs
among students in colleges. Reinforcement of religious beliefs will improve the students’ academic
achievement. Based on the findings of this study, it should be considered by university professors
and educational planners that the average score of students with higher religiosity was higher, and
with the increase of religious beliefs, academic achievement is increased.

Abstract INTRODUCTION: Reporting medical errors is one of the common methods for identifying and
preventing mistakes in‑hospital care. This study was conducted to identify the status of reporting
and related factors in two groups of midwives and midwifery students.
METHODOLOGY: This research was analytic correlational; it was conducted among all the midwives
working in the midwifery and labor departments and midwifery students in Isfahan University of
Medical Sciences. The data collection tool included a checklist of errors and the researcher‑construed
questionnaires of awareness and attitude toward reporting errors. The results were examined using
descriptive and inferential statistics (ANOVA, Pearson and Spearman correlation coefficient, and
independent t‑test) by SPSS software version 20.
RESULTS: In this research, the error reporting in midwifery staff was 79.1% and the most frequent
error was related to the patient’s process of testing; the error reporting among the students was
90% and the most frequent error occurred in the labor processes. The present study also showed
that there was a direct relationship between awareness and attitude toward reporting medical
errors (P < 0.001), while there was not a significant relationship between the midwifery students’
awareness and attitude toward reporting the medical errors (P = 0.31).
CONCLUSION: According to the study, hospital midwives reporting is less than midwifery students.
Accordingly, it is recommended to focus on the error and risk management committee to strengthen
the reporting system.

Abstract BACKGROUND: Internet addiction (IA) currently is the major public health concern, especially
in adolescents, although the results of previous reports are not generally uniform. This study was
conducted to determine IA in adolescents and to examine the correlation of IA with mental health
in adolescents.
METHODS: This cross‑sectional study was conducted in 2019 in Ilam city. In this study, 362 persons
were included using stratified cluster sampling; clusters were geographical area and schools. The valid
questionnaires including Internet Addiction Test and 28‑item General Health Questionnaire (GHQ‑28)
were used to interview. The correlation statistical technique was used to determine the association
between the two variables. The significance level was considered <0.05.
RESULTS: The mean ± standard deviation age of the responders was 16.40 ± 2.47 years; the total
score of IA and mental health was 43.02 ± 16.50 and 19.27 ± 9.72, respectively. We found that
5.5% of the adolescents had a severe level of IA. The lack of control with anxiety, neglect work and
social dysfunction, and neglect social life and severe depression in internet users were found to be
statistically significant: r (365) = 0.151, P < 0.033; r (365) = 0.126, P < 0.021; and r (365) = 0.125,
P < 0.033, two‑tailed, respectively.
CONCLUSION: According to the results, the excessive use of internet, lack of control, and neglect
social life are significantly correlated with mental health in adolescents; these results could be
contribute to improve the theoretical models for IA in adolescents.

Abstract INTRODUCTION: Acquired immune deficiency syndrome (AIDS) is a pervasive disease, and
its epidemic is spreading around the world. The only way to effectively fight against human
immunodeficiency virus (HIV)/AIDS is good‑quality health. The present study aimed to investigate
the effect of an educational intervention program on HIV/AIDS preventive behaviors based on the
Health Belief Model (HBM) in vulnerable women residing in peripheral neighborhoods.
MATERIALS AND METHODS: This study was a quasi‑experimental research conducted among 200
vulnerable women, randomly selected from four community health centers in peripheral neighborhoods
in 2019 in Zahedan, Iran. The data were collected using a researcher‑made questionnaire, containing
demographic information, HIV knowledge, and the HBM constructs. Besides, the data were collected
before, immediately after, and 1 month after the intervention in both groups. Data analysis was
performed in SPSS (version 24) using descriptive statistics, Chi‑square test, independent t‑test,
repeated‑measures analysis of variance, and multivariate linear regression.
RESULTS: The findings revealed no significant difference in the mean scores of knowledge and
the HBM constructs before the educational intervention (P > 0.05). However, after the intervention,
this difference was significant in three time intervals (P < 0.05). Despite the effectiveness of
the educational intervention in the mean scores of knowledge and the HBM constructs in the
intervention group compared with the controls, the largest effect size was observed, respectively, in
knowledge (d = 0.762) and perceived barriers (d = 0.612), and the smallest effect size was reported
in cues to action (d = 0.421). As well, the F‑statistic ratio (0.847) demonstrated that the selected
demographic variables had failed to explain variations in knowledge mean scores (P = 0.497).
CONCLUSION: HBM‑based training interventions were positive for HIV/AIDS prevention behaviors.
However, training alone does not seem to have enough effect on behavior persistence. Therefore,
further research is recommended to investigate the role of predictive factors, especially social
determinants of health and their relationship to different parts of the model, to take more effective
measures for behavioral stability at the same time as training.

Abstract INTRODUCTION: Medical education is tricky to imbibe and difficult to apply. Various
teaching–learning  (TL) methods have been tried from time to time to enhance the proficiency of
students. The aim was to assess the students’ perception toward three different TL methods (pedagogy,
andragogy, and heutagogy) in medical education.
MATERIALS AND METHODS: A comparative experimentalquestionnaire‑based study was done
on population of second‑year MBBS students of SMS Medical College, Jaipur, in October 2019.
They were taught topic of anticancer drugs using pedagogy, andragogy, and heutagogy methods.
Then, their opinion regarding these methods was collected and evaluated. The reliability of the
questionnaire was ascertained by Cronbach’s alpha value which turned out to be 0.89. The data
collected were analyzed statistically using one‑way Analysis of Variance (ANOVA) and Principal
Component Analysis (PCA).
RESULTS: The results showed that all these methods differ significantly from each other as the
P < 0.05 considering 5% as level of significance. PCA revealed that andragogy and heutagogy were
found to be most effective in this study.
CONCLUSION: Competency‑based andragogy and capability‑based heutagogy are more effective
TL methods than didactic lecture‑based pedagogy for MBBS undergraduate students.

Abstract INTRODUCTION: The world’s population is aging and this trend continues. Older adults are living
healthier and longer than in the last decades and their sexual function should also be considered
along with their general health. This study aimed to examine the correlation between general health
and sexual function in elderly women.
MATERIALS AND METHODS: In this cross‑sectional correlation study, 1245 women over 60 years
old were selected in Ardabil health‑care centers by a convenient sampling method. Demographic
data of all participants were noted and general health and sexual function were evaluated by the
Goldberg General Health Questionnaire and Female Sexual Function Index (FSFI) Questionnaire.
RESULTS: The participants’ mean ± standard deviation age was 75.1 ± 7.2 years, most of the
women (40.08%) were illiterate, and the majority of them were living with their married (44.81%)
or single children (27.14%). The general health score for 380 older women (30.52%) was under
22 (healthy). About 60% of the women had engaged in sexual activity during the past 4 weeks,
and the total mean score of FSFI was 17.36 ± 1.44. In addition, 84.33% of the women had
sexual dysfunction (FSFI < 26.55). The age (P < 0.05), educational level (P < 0.001), living with
children (P < 0.01), and general health status (P < 0.01) were found to be significantly related to
sexual function. The total scores for FSFI and the scores for all domains except for satisfaction
were in positive correlation with the score for the total and all domains of general health (P < 0.001).
CONCLUSION: Sexual function in elderly women is affected by several factors, such as general
health. Therefore, to promote successful aging in women, sexual function and general health require
more attention when implementing women’s health initiatives.

Abstract CONTEXT: Quality of life is significant in all stages of life, including within pregnancy. The hormonal,
emotional, psychological, and physical factors specific to pregnancy can affect and threaten the
quality of life of pregnant mothers.
AIMS: This study sought to investigate the health‑related quality of life (HRQoL) and related factors
among pregnant women
SETTINGS AND DESIGN: This cross‑sectional study was performed on 300 pregnant women who
were in the second and third trimesters of pregnancy without any risk of high‑risk pregnancy covered
by a community health center in Yazd, Iran, between 2018 and 2019.
SUBJECTS AND METHODS: The required data were collected using demographic questionnaire
and HRQoL (SF‑12v2) questionnaire
STATISTICAL ANALYSIS USED: Data were analyzed using SPSS 18 software and ANOVA
statistical tests (P < 0.05).
RESULTS: Physical dimension of quality of life of pregnant women had the mean and standard
deviation of 43.7 ± 7.3 and that psychological dimension had the mean and standard deviation of
31.5 ± 11.8. Physical dimension of quality of life was significantly correlated with maternal age,
gestational age, body mass index before 12 weeks of pregnancy, mother’s education and job as
well as spouse’s level of education (P < 0.05). Furthermore, the psychological dimension of quality
of life was significantly correlated with gestational age, mother’s education and occupation as well
as spouse’s level of education (P < 0.05).
CONCLUSIONS: According to the findings, attention to physical and psychological aspects of quality
of life of pregnant women and demographic factors affecting it is essential for improving maternal
and child health during and after pregnancy.

Abstract BACKGROUND: There is a growing global movement toward quality and safety in healthcare
and quality improvement (QI) in general surgery. The first step in any QI initiative is identifying the
challenges and barriers to achieve such goals and then to define appropriate actions. This study
aims to provide an overview of the QI challenges in Iranian hospitals’ surgery‑related processes and
suggest applied solutions accordingly.
METHODS: This is a sequential (qual‑quant) mixed‑method study from November 2019 to January
2020, involving 21 face‑to‑face interviews with hospital managers, quality officers, and surgery‑related
clinicians and staff, followed by a Delphi consensus‑seeking stage to finalize solutions. MAXQDA
software was applied for organizing the concepts, and thematic content analysis was used for
analyzing the data as an inductive approach to extract the emerging themes and sub‑themes.
RESULTS: The managerial problems were classified into four groups of (I) defects and delays in
completing patient medical records, (II) irregularity and the lack of transparency in the direction of
processes in the hospital, (III) inappropriate and unrealistic operating scheduling, and (IV) poor
safety considerations. The proposed solutions included imposing stricter regulations for competing
for medical records, such as reduction of payments, development of guiding brochures or protocols
for patients on their arrival, assigning a certain number of experienced nurses and surgeons for
schedule management, rewarding the report of medical and surgical error cases, and developing a
regular monitoring program for the proper implementation of surgical safety guidelines.
CONCLUSION: There are various managerial barriers that hamper QI in hospitals’ surgery‑related
processes. Implementing simple but agreed solutions can lead to saving patients’ lives, reduction of
the unnecessary use of resources, and enhance of patient and staff satisfaction.

Abstract Schools are considered as a first community, which plays an essential role in developing the child’s
life skills; thus, it is important to provide safety and health in these places. Accordingly, health, safety,
and environmental (HSE) issues in schools are among the important issues that should be considered.
Therefore, the purpose of this study was to review the studies conducted on the HSE status of Iranian
schools. A systematic search of databases, including Google Scholar, SID, PubMed, IRANDOC,
MEDLIB, and Science Direct, was performed using keywords by March 2020. The reference lists
of key studies were also scanned to find additional articles that are suitable to include in this study.
Twenty‑five studies met the inclusion criteria. The results of the studies showed that the surveyed
schools had favorable status in terms of HSE indicators, and only 12% of the studies reported poor
status. About 88% of schools had favorable or average condition. Some cases, such as lack of safe
emergency exit and inadequate ergonomic seats, have been reported, and some differences have
been observed in schools in rural and urban areas. The results showed that the health and safety
situation in most of the urban schools in Iran is good and relatively favorable. However, there have
also been some problems; hence, the implementation of integrated HSE management is imperative to
improve the status of schools. Personal health education and safety education are also recommended.

Abstract BACKGROUND: There are various instructional methods worldwide and virtual instruction is one
of them. This widely used method involves online instruction and e‑learning. The present study
compares the effects of lecture‑based and virtual instruction on student learning, satisfaction, and
content retention among surgical technology students at Isfahan University of Medical Sciences.
MATERIALS AND METHODS: The population of this two‑stage, quasi‑experimental study consisted
of 40 surgical technology students at the School of Nursing and Midwifery. After fulfilling inclusion
criteria, they were randomly assigned to the virtual instruction group (VG, n = 20) and the traditional,
lecture‑based instruction group (TG, n = 20). Data were collected via a researcher‑made student
satisfaction questionnaire and two learning examinations. Their validity and reliability had been
confirmed. The data were analyzed using SPSS 13 and analytical and descriptive tests (P < 0.05).
RESULTS: There was no statistically significant difference between the TG and the VG with respect
to the mean score in the first examination (P = 0.89). However, the two groups were significantly
different in terms of the mean score in the second examination (P = 0.03). Regarding content retention
and recall performance, the VG outperformed the TG. Furthermore, the mean satisfaction score of
the VG (132.24 ± 17.92) was higher than that of the TG (115.56 ± 17.57) (P < 0.05).
CONCLUSION: Virtual instruction and lecture‑based instruction had comparable short‑term learning
outcomes. Nevertheless, with the passage of time, it was revealed that virtual instruction could result
in better learning performance and higher content retention and satisfaction.

Abstract BACKGROUND: Child abuse (CA) is prevalent in every segment of society and is witnessed in all
social, ethnic, religious, and professional strata. In this situation, dentists are in an ideal position to
help detect signs of CA and should be able to recognize those signs.
AIM: To assess the perspectives toward CA and neglect among dental practitioners of Belagavi city.
MATERIALS AND METHODS: A cross‑sectional survey was conducted among 102 dental
practitioners. The data were collected by self‑administered structured questionnaire. Data were
analyzed using descriptive analyses for responses to each question, and Chi‑square test was applied
to test the association.
RESULTS: 59.8% had learned the topic of CA and neglect as a student. Overall, 16 participants
have recognized suspicious case of CA and neglect in their dental office. Only 34.3% had knowledge
regarding the findings pointing to CA and neglect, and 96% had reported that there are barriers
regarding reporting the same. 93% are of opinion that the topic is of utmost importance and more
training is required in this aspect.
CONCLUSION: Training and continuing dental education programs should be tailored to the specific
needs of all professionals to diagnose, report, and prevent CA.