Journal of Education and Health Promotion

Abstract

Abstract

Abstract BACKGROUND: Evidence‑based medicine (EBM) plays an important and dominant role in
promoting effective decision‑making in the health system. This study was aimed to evaluate the
EBM performance among health‑care workers (HCWs) in hospitals in Iran.
METHODS: In this study (a cross‑sectional study), participants were 2800 HCWs in hospitals.
A researcher‑made questionnaire was designed, and judgments of 10 experts were used for the
improvement of content validity. The reliability of the questionnaire was assessed by the test‑retest
method (α = 0.85). Data were analyzed using the descriptive statistics, t‑test, and one‑way ANOVA,
in SPSS.16 software.
RESULTS: Eventually, 1524 questionnaires were completed (response rate: 54.4%). The results
of the study show that 62%of participants have not accessed scientific journals, 52% of them have
difficulties using the Internet at work, guidelines were not reachable for 76% of them, and about 80%
have not access to databases. About 39% of participants were not well informed about databases
of EBM, and 15.8% of them were immensely knowledgeable about EBM terminology. The most
important problems to increase HCWs information about EBM include research methodology‑ related
problems, lack of resources and motivation, and coordination problems. The most prominent facilitators
include: providing training courses in EBM and increased facilities. Only work experience showed
a significant correlation with barriers and facilitators, and gender revealed a significant correlation
with barriers (P < 0.05).
CONCLUSION: It seems that prioritizing the increased access to information resources and
databases, considering the research skills of the HCWs, extending the opportunities and increasing
the facilities such as workforce, equipment, physical environment, and accessibility can have a great
impact on the improvement of the activities associated with EBM.

Abstract INTRODUCTION: Iran’s Health System Reform Plan (HSRP) were initiated in public and hospitals
affiliated to Medical Sciences Universities in June 2015. The purpose of the present paper is to
provide a critical analyse of the HSRP and its outcomes.
METHODS: The study was carried out as a review critical analyse in 2019. The pertinent articles
were searched for in Science Direct, PubMed, Ovid, and Google Scholar using keywords “health
sector,” “reform plan,” “health system reform,” “health services,” “health care system,” and “Iran.”
Published articles in scientific national and international journals in Persian and English language,
of which the full‑texts were available, were entered into the study. Finally, from a total of 75 articles
obtained, 45 studies were carefully reviewed.
RESULTS: Several factors, which impact in the success of Iran’s HSRP such as social‑economic and
political outlooks, lack of official information and a comprehensive management system, in addition
to failure to extend continuous performance control, economic sanctions against Iran. Other factors
are limitations on financial transactions between Iran and the rest of the world due to the sanctions,
relying merely on a few instructions, and negligence of the required infrastructures. In terms of
advantages of the plan, relative decrease in patient’s share in medical expenses, improvement of
emergency wards, and relative decrease in the rate of C‑section operations are notable.
CONCLUSION: Better implementation of Iran’s HSRP entails the provision of resources and facilities
such as stable and adequate resources, proper management of available resources, payment
mechanisms reform, attracting, and facilitating private sector’s participation.

Abstract Negative psychological outcomes have been consistently associated with quarantine measure and
lockdown. This article tries to look at the psychological implications of quarantine and lockdown
and then touches upon how social aspects lead to psychological effects unaddressed for various
communities of the people surviving in vulnerable conditions. The objective of this study was to
review the psychosocial implication of quarantine and lockdown among Indian community who
are facing a double burden of mental and economic crisis. Databases for relevant studies were
searched in PubMed and Google Scholar with key term “quarantine,” “mental health,” “lockdown,” and
“psychosocial.” Few newspaper reports related to quarantine and psychosocial implication have also
incorporated. Home and facility quarantine were imposed on people in order to control and check the
spread of this infectious disease. This strict imposition not just led to various other counter effects that
were negative in nature, but it is predicted to have long‑lasting social, economic, and psychological
effects too. As social diversities lead to varied mental health adversities, a broader umbrella needs
to be created in order to protect every community dealing with mental health issues due to the
pandemic. In order to address the mental issues of the vulnerable classes, the issue still remains
untouched, and this leaves us with a question of are we doing enough for each individual. A team of
clinical psychologist, psychiatrist, and sociologist come forward to combat this mental health impact
of COVID‑19 outbreaks and make this quarantine tolerable for the public with appropriate solutions.

Abstract BACKGROUND: Microteaching is a teacher training technique where a teachers get a constructive
feedback from peer or faculty in order to improve their teaching skills. Microteaching is conducted
at the departmental level. By evaluating the components of microteaching, better teaching skills can
be developed in postgraduate (PG) students.
OBJECTIVES: The objectives of this study were to determine the pattern of teaching skills and to
evaluate the components of teaching skills of microteaching in PG students.
MATERIALS AND METHODS: It was a retrospective record‑based study done over a period of
1 month. Microteaching assessment records of 34 PG students of the department of community
medicine were analyzed.
RESULTS: Teaching skills including setting induction during the class, lesson planning, presentation,
and use of audio‑visual aids were found to be satisfactory. Students lacked the skills of interaction
and summarization of the topic.
CONCLUSION: PG students’ performance with many components was satisfactory, but still, there is
a scope for improvement. Internalization of microteaching skills can make doctors a better teacher,
a better learner, and a better health educator.

Abstract BACKGROUND: Although using time management skills is a major component of nursing professional
practice, they have not received much attention. Time management training can improve the
psychological and communication aspects of nursing care quality. Therefore, this study aimed to
evaluate the effect of time management skills training on the psychosocial and communication
aspects of nursing care quality.
MATERIALS AND METHODS: This semi‑experimental study was conducted at Valiasr Hospital of
Shahr Babak City, Kerman Province, in the Southeast of Iran, during 2018. The study population
consisted of 100 nurses who were randomly assigned to one of the two groups: an intervention
group or a control group. To identify and measure the outcomes, nurses’ perceptions of the
psychosocial and communication aspects of care quality were first assessed by the Quality Patient
Care Scale (Qualpacs) at pretest. Then, the intervention group received the 2 days of training on
time management skills for 12 h. The posttest outcome data were collected from both the groups 1
month after the intervention.
RESULTS: No statistically significant differences were observed between the two groups with respect
to the total mean scores of nursing care quality and its psychosocial and communication aspects
before the intervention (t = 1.96, P = 0.09). However, there was a statistically significant difference
between the two groups in this regard after the intervention, and the mean nursing care quality scores
and its related aspects were improved in the intervention group (t = 5.76, P < 0.0001).
CONCLUSIONS: The time management skills training could significantly improve psychosocial and
communication aspects of nursing care quality. Health‑care managers should allocate facilities to
clinical training programs so that health‑care professionals can acquire the time management skills.
The higher effectiveness of time management training can be determined by its application in diverse
domains of health care.

Abstract BACKGROUND: The current novel coronavirus pandemic started as a simple outbreak in
December 2019 from Wuhan, China, and it has now become a global threat. The governments from
most of the countries including India have already taken strict precautionary measures to reduce
the coronavirus spread such as social distancing, closure of schools, colleges, airports, restaurants,
shopping malls, and other places where the people might gather. An increase in the levels of anxiety,
aggression, depression, forgetfulness, and hallucinations are possible psychological effects of
isolation. Too little is understood of the social impact of the pandemic.
AIM: To study the social impact of post‑COVID‑19 lockdown in Kerala from a community perspective.
MATERIALS AND METHODS: This cross‑sectional survey was conducted among 700 families
(50 families from each district) from all the 14 districts of Kerala from during April‑May 2020 using
respondent‑driven sampling. The data were analyzed and the categorical variables have been
presented as percentages and proportions.
RESULTS: Anxiety (44%) and fear (44.3%) were reported by many of the study participants. The
survey also picked up an increase in the prevalence of domestic violence (13.7%) during the period.
The most common social change brought about by the lockdown was an improvement in the hygiene
practices among the study population.
CONCLUSION: The present study highlights the positive social changes brought about as a result
of the COVID‑19 lockdown. Further studies need to be conducted on a larger scale to assess the
psycho‑behavioural impact of COVID‑19 on the wider population.

Abstract BACKGROUND AND OBJECTIVES: The ongoing coronavirus disease pandemic caused by a
novel genetically‑mutated strain of coronavirus has posed a tremendous challenge to healthcare
professionals, worldwide. This study aimed to explore the healthcare professionals’ knowledge,
attitudes, and practices (KAP) related to coronavirus disease in Western Uttar Pradesh and provide
data to improve awareness about this disease and remove the knowledge gap, if any, by disseminating
the updated information to the corona warriors.
MATERIALS AND METHODS: A cross‑sectional survey was conducted in the form of a structured
28‑item online questionnaire using SurveyMonkey software. The qualitative data were coded
numerically, and the KAP score was calculated. Pearson Chi‑square test was used to study the
association, among variables.
RESULTS: Of 509 respondents, 296 (58.19%) were males and 213 (41.81%) were females. The
median age bracket of the sample was 20–40 years. By profession, 255 (50.10%) were doctors,
167 (32.74%) were medical students, 80 (15.78%) were other healthcare workers, and a minority 7
(1.38%) were the nursing staff. Educational status covered a range from secondary (2.01%) to senior
secondary (17.51%) to bachelors and equivalent (29.18%) to masters and equivalent (51.31%). The
average KAP scores were 54%, and the score was highest among doctors as compared to other
healthcare professionals (P < 0.001).
CONCLUSIONS: In light of these study findings, we conclude that healthcare professionals are aware
of coronavirus disease. However, the overall KAP score regarding its clinical course, preventive
strategies, and judicious use of personal protective equipment was less than expected. There is
a need to address all misconceptions and empower the corona warriors with the right information
through effective mass media communication and reinforcement through seminars and workshops
in the medical institutes and hospitals. The healthcare professionals are a cornerstone to prevent
the nosocomial and community spread of this pandemic.

Abstract BACKGROUND: The goal of treating cancer patients is to cure the patients and improve their quality
of life (QoL) during their illness. The aim of this research was to assess the QoL in Iranian patients
with head‑and‑neck cancer by European Organization for Research and Treatment of Cancer Quality
of Life Questionnaire‑Head and Neck 35 (EORTC QLQ‑H&N35) and University of Washington Quality
of Life Questionnaire (UW‑QoL).
MATERIALS AND METHODS: In this cross‑sectional study, Iranian variation of EORTC QLQ‑H&N35
and UW‑QoL questionnaires was administered to 210 patients with head‑and‑neck cancer. Patients
who visited the Department of Oncology at Omid Hospital in Isfahan, Shafa Hospital in Kerman,
and Emam Khomeini Hospital in Tehran were selected. Kruskal–Wallis test, general linear model
multivariate of variance, multiple regression models, and SPSS version 21 were used for statistical
analysis.
RESULTS: In the present research work, 210 patients with cancer in head and neck were under
investigation, such that 128 patients (61%) were male and 82 patients (39%) were female. Only
the patients with laryngeal cancer scored worse for dyspnea according to the scores from UW‑QoL
questionnaires. There were statistically significant differences for pain, swallowing, social eating,
social contact, speech, taste/smell, and trismus based on the QLQ‑H&N35. Lower QoL was observed
in patients with advanced (Stage III + IV) tumors and treated with radiotherapy plus surgical method.
CONCLUSION: The study showed that quality of life differs due to location of tumor, stage of cancer,
and treatment type.

Abstract BACKGROUND: The novel coronavirus (CoV) has resulted in a global pandemic despite drastic
measures to avoid contagious spread. On April 3, 2020, there were around 1 million reported cases
and 51,515 deaths due to CoV disease 2019. The disease presents with flu‑like symptoms such as
fever, dry cough, and fatigue. India being a resource‑limited country, it is very important to differentiate
the suspected cases clinically.
AIM: The aim was to know the correlation of various clinical features of severe acute respiratory
syndrome CoV 2 (SARS‑CoV‑2)‑infected cases in selected districts of UP.
SETTING AND DESIGN: This was a retrospective cross‑sectional hospital‑based study.
MATERIALS AND METHODS: This was a retrospective cross‑sectional study performed on 1243
suspected cases of SARS‑CoV‑2 infection from March 25, 2020 to April 17, 2020 in the department
of microbiology of our institute to know the incidence of SARS‑CoV‑2 infection in selected districts
of Uttar Pradesh. These cases were analyzed to see the association of various clinical symptoms
with SARS‑CoV‑2 infection. For statistical analysis, Pearson’s Chi‑square test was performed using
SPSS version 23.
RESULTS: Out of total suspected cases, 4.5% were positive. Travel history was present in 80.4%
of positive cases. About 83.9% had fever, 28.6% had shortness of breath, 35.7% had dry cough,
17.9% had either Type I or II diabetes mellitus, 12.5% had chronic kidney disease, and 7.1% had
obstructive pulmonary diseases.
CONCLUSION: Negative clinical history is very important in ruling out the suspected cases who
came out to be free from the infection.

Abstract OBJECTIVE: It is common among medical students to falsely attribute bodily sensations/symptoms
and holds a belief of having a medical illness with varying level of conviction. We studied and compared
this condition known as “medical student syndrome", a type of hypochondriasis, between preclinical
and clinical years students.
METHODOLOGY: This research was a descriptive study where a total of 100 students were
approached and were asked to complete a short form of health anxiety inventory (SHAI) which
has Cronbach’s alpha 0.855. No personal identifiers were included in the study questionnaires. All
statistical analyses were performed using the SPSS statistical software package (IBM SPSS Statistics
Version 23, SPSS Inc., Chicago, IL, USA).
RESULTS: The response rate among participants was 88% (42 from preclinical and 48 from clinical
years of training). Health‑related anxiety (SHAI main section score ≥ 18) was found in 14.77%
of students with a higher proportion in preclinical than clinical, 16.66% and 13.04%, respectively.
The difference was not significant between the two groups (2 = 0.429 [1], P = 0.766). Students
having medical professional in family had lower rate of health‑related anxiety, 2 (1, n = 88) = 0.228,
P = 0.633. The association between family or personal history of psychiatry or medical illness was not
significant with SHAI scores. No relation was noted between current health anxiety (SHAI score) and
the number of visits to the doctor per year before entering the medical course ( = 0.174, P = 0.112).
CONCLUSION: Every seventh medical student was found to have health‑related anxiety. It was not
affected by personal and family history of either psychiatric or medical illness.

Abstract CONTEXT: At time of epidemics, fear and rumors in the community are the main obstacles to the
success of prevention programs.
AIMS: The aim of the study was to investigate the fear and rumors of coronavirus disease
2019 (COVID‑19) among the Iranian population.
SETTINGS AND DESIGN: This nationwide cross‑sectional study was conducted on residents of six
cities of Iran via street‑based multistage sampling in March 2020.
SUBJECTS AND METHODS: The eligible participants completed a self‑administered questionnaire
about rumor and fear related to COVID‑19 epidemy.
STATISTICAL ANALYSIS USED: Data were analyzed through linear regression and survey analysis
using Stata (version 11).
RESULTS: A total of 2249 (49.3% women) were included. The main source of information was Iranian
broadcasting (68.5%). The overall mean (standard deviation) score of fear and rumor among the
Iranian population was 15.68 (0.46) and 39.24 (1.27), respectively. Educational level was associated
with fear of COVID‑19 (P = 0.001). Trusting to the rumors was affected by age (<0.0001), education
level (P < 0.0001), underlying disease (P = 0.017), and workplace situation (P < 0.001).
CONCLUSIONS: The fear and rumor surrounding the epidemic of COVID‑19 were common in
society that could make an epidemic of COVID‑19 difficult to control. Increasing public awareness
via reliable mass media is recommended.

Abstract INTRODUCTION: Emotional intelligence (EI) is the ability to understand and manage our own feelings
and of others. It has emerged as one of the vital elements of success and interpersonal relations in
everyday life. There are individual differences of EI depending on characteristics and behaviors of
an individual, which determines their personality.
AIMS AND OBJECTIVES: The present study assesses the EI and personality traits of medical
students and determines the relationship of EI with personality traits of the medical students.
MATERIALS AND METHODS: This was a cross‑sectional study and was conducted among students
of a government medical college, located in New Delhi. A total of 210 participants were included in
the study. After obtaining written informed consent from all participants, a questionnaire consisting of
demographic information, Ten‑Item Personality Inventory and Schutte EI Scale, was administered.
The means and proportions were calculated. Chi‑square test and Pearson’s correlation test were
used to test significance. P < 0.05 was considered statistically significant.
RESULTS: The mean (standard deviation) age of the study participants was 21.54 (±1.98) years.
The majority (65.7%) of the students were male. 51% of the students had moderate EI, and high EI
was seen in 49% of the students. A positive and significant relationship between personality traits
and EI was found in the study.
CONCLUSION: Personality traits and EI are related to one another and could influence student
academic achievement. Since EI influences academic performance so personality trait assessment
and empathic perceptions exploration can facilitate to aid the academic performance of the students.

Abstract INTRODUCTION: The pandemic caused by novel coronavirus (severe acute respiratory syndrome
coronavirus 2) in Wuhan, China, in December 2019 is a highly contagious disease. The World Health
Organization has declared the outbreak of coronavirus diseases (COVID‑19) as a global public health
emergency. Currently, the research on novel coronavirus is still in the primary stage. The aim of this
study is to assess the knowledge and awareness on COVID‑19 disease and related infection control
measures among the dental fraternity in Visakhapatnam – the smart city.
METHODS: A total of 808 dentists from the Visakhapatnam region completed a questionnaire‑based
survey on the knowledge, awareness, and infection control measures related to COVID‑19 infection.
The questionnaire was tailored from the guidance and information for health‑care workers issued
by the US Centers for Disease Control and Prevention. Suitable sampling method was used for the
collection of data and the distribution of responses was presented as percentages. Explanatory
statistics were performed for all groups and subgroups based on the percentage of correct responses.
Individual pair‑wise comparisons were done using the Chi‑square test for the percentage of correct
responses.
RESULTS: A total of 825 participated in the survey, of which 808 dentists completely answered the
survey, and the response rate was 98%. Among the respondents, males and females are 46.8%
and 53.2%, respectively. There was a statistically significant difference for all the questions solicited,
among age groups (P = 0.001, 0.001) and occupation (P = 0.001, 0.001, 0.004). Private practitioners
seem to more awareness compared to teaching faculty, undergraduates, and postgraduates, as they
have answered correctly (>70%) for almost all the questions.
CONCLUSION: The inputs from the survey help us throw some light and fill up lacunae where required.
There is a strong need to implement periodic educational interventions and training programs on
infection control practices for COVID‑19 among dentists in particular. The information from this survey
helps us to make necessary changes in implementing periodic educational webinars and stress on
areas where necessary, which is important for the dental fraternity for protecting themselves and
shielding our society from COVID‑19.

Abstract INTRODUCTION: Spiritual health is considered one of the important dimensions of health and has
been given serious attention by the scientific community, World Health Organization, health discourse,
and medical education. However, despite these considerations, there is a controversy in defining
the nature of this category and its dimensions and indicators. The purpose of this study is to identify
the indicators and dimensions of spiritual health for medical students.
MATERIALS AND METHODS: This qualitative study with exploratory approach utilized conventional
content analysis and individual in‑depth interviews with experts in the area of spiritual health and
spirituality in medical sciences selected through purposeful sampling. The study was conducted at
Aja University of Medical Sciences in Tehran in 2018. The semi‑structured interview was a tool used
to achieve data saturation, that interviewed with 19 experts. Member check, credibility, and reliability
were measured to increase the validity and reliability of the results. Inductive content analysis was
used for the analysis of data in three main phases: preparation, organization, and categories and
creating categories.
RESULTS: Based on the findings of the interviews, 52 indicators were identified.Then, the indicators
of spiritual health were identified in the following four categories) relationship with God, relationship
with himself, relationship with others, relation with the environment (and these categories were divided
inthree dimentions (cognitive, attitudes and emotions, behavioral)
CONCLUSION: The findings of the present study showed that in order to have spiritual health, it is
important to pay attention to one’s relationship with God and one’s relationship with oneself, one’s
relationship with others, and one’s relationship with the environment, and it is necessary to pay
attention to it in medical science curricula.

Abstract INTRODUCTION: Disasters occur almost everywhere in the world, and preparation is essential.
Preparedness is an effective approach for disaster management, and it is crucial for the health
systems, especially the Emergency Medical Service (EMS) agencies. This systematic review will
be conducted to assess the preparedness levels of EMS agencies in the world for the response to
disasters and explore the key dimensions and strategies to enhance it.
METHODOLOGY: This systematic literature review will be conducted to search comprehensively the
articles published between 2000 and 2019 to explore the disaster preparedness of EMS Agencies. To
this end, PubMed, Scopus, Web of Science, and Google Scholar will be thoroughly assessed. The
following terms and expression will be used for searching the databases: “EMS” and other keywords
“Disaster Preparedness,” “Mass Casualty Incident,” “Mass Gathering,” “Terrorist incident,” “Weapons
of Mass Destruction,” and CBRNE, Disaster, included: ‘Emergency Preparedness, Preparedness,
Readiness.
DISCUSSION: To the best of our knowledge, no systematic review study has been conducted on
disaster preparedness of EMS agencies in the world. This is the first study to address this gape. It
will also explore the key dimensions of disaster preparedness in EMS services and the strategies
to enhance their preparedness.
CONCLUSION: Identifying the key dimensions of disaster preparedness is the first step in designing
valid assessment tools to evaluate disaster preparedness of EMS service. This study will provide
valuable guides for EMS administrators and researchers in an attempt to enhance of preparedness
of EMS systems in disasters.

Abstract BACKGROUND: Communication apprehension (CA) is the fear or anxiety about communicating.
This study was designed to investigate the CA and its related factors in the medical students at
Rafsanjan University of Medical Sciences (RUMS).
MATERIALS AND METHODS: In this cross‑sectional study, personal report of CA (PRCA‑24) was
administered to 340 medical and paramedical students to measure anxiety in four domains of large
groups, small groups, public speaking, and dyadic interaction. Pearson’s correlation and linear
regression analysis were used to investigate the relationship between CA and the variables of birth
order, number of siblings, and university entrance score. Data were analyzed using descriptive and
inferential statistics (Chi‑square and Kruskal–Wallis Test).
RESULTS: CA in the dimension of public speaking was higher than the other dimensions. Evaluation
of the economic stability and its relationship to CA indicated a significant difference among all the
domains of the PRCA‑24. There was a significant relationship between the scores of CA and the
number of siblings (P = 0.001). Linear regression and Pearson’s correlation tests indicated a significant
correlation between the variables of birth order, number of siblings, and university entrance score.
The correlation between the CA with dimensions of group discussion, interpersonal, speaking, and
meeting was weak but significant (P < 0.01).
CONCLUSION: Without communication, the materialization and development of the human
community are not possible. This aspect is more evident and crucial in the healthcare industry. Based
on the results of this study, the medical and paramedical students at RUMS have a medium‑to‑high
level of CA. Therefore, it is of utmost importance to detect students with high CA to prevent further
communication problems after graduation.

Abstract INTRODUCTION: It is vital importance to observe standard precautions (SPs) in dentistry to prevent
the transfer and spread of blood‑borne diseases in the community. The aim of the present study was
to evaluate the effect of educational intervention using health belief model (HBM) on the observation
of SPs by dental students in 2019.
MATERIALS AND METHODS: Eighty‑seven dental preclinical students were included in the present
quasi‑experimental study. The students were randomly assigned to two groups, and data were
collected using a questionnaire designed based on HBM. Educational intervention was carried out
after the pretest analysis in four 60‑min sessions. Data were analyzed with independent t‑test and
paired t‑test using SPSS 16 at a significance level of P < 0.05.
RESULTS: After the educational intervention, the mean score of awareness (P = 0.001), perceived
susceptibility (P = 0.01), perceived severity (P = 0.02), perceived benefits (P < 0.001), cues to
action (P = 0.006), self‑efficacy (P = 0.002), and behavior (0.03) in the intervention group was
significantly increased.
CONCLUSION: Despite the effect of education on increasing the students’ scores in HBM constructs
and observation of SPs, the most important barriers to the adoption of precautionary behaviors were
deficiencies in protective tools and aids.

Abstract BACKGROUND: Saudi Arabia aims to achieve Universal Health Coverage (UHC) by a combination
of free public healthcare and mandatory cooperative health insurance. To ensure the effectiveness
of UHC policies, every individual should have a strong knowledge of their health‑care rights and the
system that guarantees it.
OBJECTIVES: The aim of this study is to measure the knowledge of Alfaisal students and record
their perceptions and attitudes about Saudi Arabia’s basic health‑care coverage structure and UHC
policies.
MATERIALS AND METHODS: A cross‑sectional survey was developed with 22 items measuring
knowledge and 7 items evaluating perception and attitudes and distributed through E‑mail with a
consecutive sampling method at Alfaisal University to achieve the required calculated sample size
for March–April of 2020. The accumulated data were organized, tabulated, and statistically analyzed
using SPSS software. Comparison between two groups and more was made using the Chi‑square test.
RESULTS: Students’ self‑reported knowledge on the three main knowledge questions ranged from
30.6% to 57.7%, with medical students admitting to similar or worse knowledge compared to their
colleagues from other colleges. About 57.3% of our respondents believe the Saudi system provides
effective and sufficient healthcare to all, but only 42.7% believe that the system provides financial
protection to all.
CONCLUSION: The study showed a low level of knowledge about Saudi Arabia’s UHC policies
among Alfaisal students, especially among medical students, with a generally positive perception
and attitudes toward them, although with some serious misconceptions that should be addressed.

Abstract INTRODUCTION: Abortion is one of the most common complications of early pregnancy, which
emerges as a physically and mentally devastating experience. Due to the prevalence and importance
of postabortion mental health problems and their adverse effects on subsequent pregnancies, some
interventions should be made to reduce the resultant anxiety and depression. The present study
aimed to determine the effect of self‑care education on anxiety and depression among pregnant
women with a history of spontaneous abortion.
METHODS: This randomized quasi‑experimental study was performed on ninety pregnant women
with a history of spontaneous abortion who referred to health centers in Zahedan in 2019. The
samples were selected by convenience sampling method and randomly assigned to two intervention
and control groups. Between 6 and 16 weeks of gestation, the participants in the intervention group
received four sessions of 60‑min self‑care training over 2 weeks. On the other hand, the control
group received routine pregnancy care. Data collection tools included a demographic and fertility
evaluation questionnaire, a 6‑item short‑form of the state scale of the Spielberger State‑Trait Anxiety
Inventory, and a short form of Beck Depression Inventory. Posttest was performed 4 weeks after
the end of the intervention. The data were analyzed in SPSS software (version 21) using statistical
tests of independent t‑pair, paired t‑pair, Chi‑square, and Fisher’s exact test.
RESULTS: Based on the obtained results, there was no significant difference between the two
groups in terms of anxiety and depression scores before the intervention. Nonetheless, after the
intervention, the mean scores of anxiety and depression in the intervention group were calculated
at 7.31 ± 1.31 and 4.71 ± 1.90, respectively. However, these scores were reported as 1.87 ± 13.46
and 9.31 ± 1.59 in the control group, respectively (P = 0.0001).
CONCLUSION: As evidenced by the obtained results, self‑care education is effective in the reduction
of anxiety and depression in pregnant women with a history of spontaneous abortion. Therefore,
health professionals and health‑care providers should enrich prenatal care programs with these
training sessions and provide women with peace of mind and comfort during pregnancy.

Abstract BACKGROUND: Risk perception is an important predictor to mitigate climate change effects which
can produce mental health consequences such as anxiety and depression. For developing policies
of climate risk adaptation, awareness of public attitudes, beliefs, and perception is essential. At this
study, researchers tried to focus on the often “unseen” psychological aspects of climate change.
MATERIALS AND METHODS: A qualitative approach was done with a consistent content analysis
method. The study consisted of 33 participants including ordinary people and experts in disasters
and climate change. Purposeful sampling was adopted until data saturation. The data collection was
performed through in‑depth and semi‑structured interviews. All interviews were transcribed after
listening again and again and reading several times to catch an overall understanding of the interviews.
RESULTS: The main theme of the study was “Complexity nature of climate change risk perception”
and related categories including “the Mental health dimension,” “the Cognitive dimension” and
“Interaction of imposed components.” The structure of the research community strongly reflected
effects of cultural and religious factors in all aspects of community life. Participants’ life experiences
of extreme events were associated to their perception of climate change.
CONCLUSIONS: Risk perception is multifactorial and complicate and should clearly be understood to
improve community participation to manage climate change‑related risks. We propose that authorities
and related managers should pay attention to it as a priority. This may assist in developing research
on public mental health practices.

Abstract BACKGROUND: Today, marked by advanced scientific approach, urbanism, and changing life style,
there is an ever‑growing rate of fast‑food consumption, which has significantly affected public health.
Hence, the present research aimed to predict factors involved in fast‑food consumption in light of
the prototype/willingness model among the students of Rafsanjan University of Medical Sciences.
MATERIALS AND METHODS: In the present descriptive/analytical research conducted in 2018–2019,
350 students in Rafsanjan University of Medical Sciences were selected through proportionate
stratified random sampling. The required data were collected using a self‑administrated questionnaire
in light of the constructs within the prototype/willingness model and fast‑food consumption behavior.
The data were analyzed in SPSS version 16.0 using descriptive and inferential statistics including
mean scores, standard deviation, correlation coefficient, and linear regression.
RESULTS: Behavioral intention of fast‑food consumption showed to be positively correlated with
positive willingness, positive prototype, positive subjective norms, and positive attitude toward fast‑food
consumption. Furthermore, the correlation between positive behavioral intention of consuming fast
food and positive subjective norms and positive attitude toward fast‑food consumption was statistically
significant (P < 0.05). The underlying constructs of prototype/willingness model altogether managed
to explain 13% of the total variance of fast‑food consumption behavior. Behavioral intention showed
to be the strongest predictor of the behavior (β = 1.613).
CONCLUSION: It is suggested that the preventive measures aimed to reduce fast‑food consumption
among the youth focus more on strengthening negative attitudes and subjective norms concerning
fast‑food consumption.

Abstract Background: In health care, the rapid proliferation of health information on the internet has resulted
in more patients turning to the digital media as their first source of health information and acquiring
knowledge. The present study was conducted to assess use of the digital medium as a medical
information resource in health-related states and to determine their experience and perceptions about
the quality and reliability of the information available among the participants.
Methodology: The study was done in an urban settlement of Delhi among adults who use any digital
media. A sample of 321 were selected though convenient sampling. The information was collected
through a semi-structured, self-administered, pre-tested questionnaire which contained questions
on socio-demographic profile, internet usage and awareness about Digital India. Bivariate analysis
was done to determine the association between various socio-demographic variables associated
with internet usage for health information.
Results: In the present study, 88.2% (283/321) were using the internet for health information
through digital media. This study found out that younger age group (18-30 years), literate and
higher socioeconomic group (upper middle and above) population were more likely to access health
information via digital media which was found out to be statistically significant.
Conclusion: Access to health information through digitization can improve health literacy among
the population and help in promoting a preventive aspect to health problems and disease. They can
be the building blocks to build “Swasth Bharat (Healthy India)”.

Abstract BACKGROUND: Approximately one third of the food produced in the world for human consumption
was wasted.
OBJECTIVES: This study aimed to determine the effect of intervention on behavior of food
consumption and waste production in the restaurants of Shahid Beheshti University of Medical
Sciences.
MATERIALS AND METHODS: In this quasi‑experimental study, 233 students of public health school
were selected as intervention group, and 233 students of medical school were selected as control
group. The food wastage was weighed in both “Sabz” and “Medical” restaurants for a week. Based on
training needs of the samples, teaching methods and programs were implemented in the intervention
group for a month. The clients of both restaurants were followed 4 weeks after the intervention. The
food waste was weighed after 4 weeks. Data were analyzed using SPSS software version 16 and
statistical tests (Wilcoxon, Chi‑squared, McNemar, and Mann–Whitney tests).
RESULTS: The results obtained from Wilcoxon test showed that, the means of awareness, attitude,
and behavior were significantly improved after the intervention in the intervention and control
groups (P < 0.001). After the intervention, according to the number of served foods, it was expected
that the weight of food wastage to be 341.37 kg/week, but this figure was reduced to 224.98 kg/week
after the intervention.
CONCLUSIONS: This study has confirmed the effectiveness of implementation of interventions on
enhancement of knowledge, attitude, and behavior of people about consumption of food and amount
of wastage. The authors suggest that to investigate sustainability of effect of intervention on behavior
of food consumption and wastage production, this study could be implemented in different and longer
time intervals after the end of project.

Abstract INTRODUCTION: The recent pandemic of COVID‑19 is very challenging for each and every sector
like health, economic, technology, agriculture, industries, and education. In the field of education, a
teaching institute or a university is suffering in regard to syllabus completion, clinical postings, and
examinations which eventually ends up in huge academic loss. Thus, to minimize the academic loss
and facilitate the students in distance education, online learning was the solution; in spite of various
challenges, Datta Meghe Institute of Medical Sciences (Deemed to be University) have implemented
the online learning program for the undergraduate students within a week of lockdown.
METHODOLOGY: The survey was conducted at MGACH&RC, total of 189 students have participated
in the survey. Data collected by survey with help of feedback on a 5‑point Likert scale questionnaire
with close‑ and open‑ended questions and focus group discussion (FGD) with students.
DISCUSSION: Although the program was implemented to verify the utility, accomplishment, and
lacunas of e‑learning, the survey was planned to assess the perception of students toward online
learning during the COVID‑19 pandemic. The e‑learning model has been successfully introduced;
there are more requirements from the students regarding the resource material and minimal lacunas
regarding the skill of faculty members and technical issues. Students appreciate the online learning
module for the pandemic situation and necessitated for the combination of both learning modalities
in future. Seamlessly, the running program recommended online assessment and evaluation of the
students in future.

Abstract INTRODUCTION: Professional responsibility‑acquiring process among bachelor degree nursing
students is important for their current and future performance and educational and health‑care
system, but this process has not been explored in the literature. The aim of the current study is to
explore the process of acquiring professional responsibility among bachelor degree nursing students.
METHODOLOGY: The study design was based on grounded theory (Corbin and Strauss 2015).
Purposive and theoretical sampling led to the inclusion of 18 individual interviews and a focus group
interview with bachelor degree nursing students, their instructors, and key informants in a nursing
school and university, an educational hospital, and a health comprehensive service center in Tehran
in 2019–2020.
RESULTS: After data analysis, 6 categories, 17 primary categories, 64 subcategories, and 1747 initial
codes were extracted. Trying to optimal use of the educational period was the main category of this
study and its primary categories were responsible learning and performance management strategies,
there were facilitators and inhibitors categories for applying these strategies. Personal, educational,
and professional context factors were primary categories that may lead to the main concern (uncertain
productivity of the educational period) with regard to acquiring professional responsibility. Protection
of the students and others versus irresponsibility was consequence category of this process.
CONCLUSION: Knowing the process of acquiring professional responsibility among bachelor degree
nursing students can be used to facilitate the formation, promotion, and evaluation of professional
responsible behaviors. Further researches in these areas are recommended.

Abstract INTRODUCTION: Getting pregnant care is different due to the psychological problems of pregnant
mothers. Self‑compassion and social support are the important components of mental health.
Women with higher self‑compassion and social support can take full care of their pregnancies. The
aim of this study was to determine the relationship between social support and self‑compassion with
adequate prenatal care.
METHODS: The present study is a cross‑sectional descriptive study that was performed in
2018 using the available sampling method on 500 pregnant mothers referred to Isfahan health
centers. Individuals entered the study if they had entry criteria and no exit criteria, and completed
social support, self‑compassion, and adequacy of pregnancy care questionnaires. The data were
coded and analyzed by SPSS software version 22 and Pearson’s correlation statistical test.
RESULTS: The results of data analysis with Pearson’s correlation test showed a positive and
statistically significant relationship with pregnancy care between the overall score of social support
(P < 0.001) and the dimensions of social support such as family support (P < 0.002), support of
friends (P < 0.004), and the support of other people (P < 0.001). The results also showed a positive
and statistically significant relationship between self‑compassion and prenatal care (P < 0.001). There
was a significant positive relationship between the subscales of the self‑empathy questionnaire,
including kindness to oneself, human commonalities, mindfulness and increasing replication, and
pregnancy care, but there was a significant negative relationship between subscales of isolation and
self‑judgment with pregnancy care.
CONCLUSION: According to the results of the present study, social support and self‑compassion
as two components of mental health can affect the quality of services during pregnancy. For this
reason, it is recommended that health‑care providers pay attention to these two issues in order to
increase the level of care during pregnancy and thus ensure maternal health during pregnancy and
childbirth and the health of the fetus and baby.

Abstract INTRODUCTION: Understanding adaptation is strongly influenced by the culture and beliefs of every
society. By increasing knowledge about the different dimensions which require the adaptation in
different aspects requiring the nurse adaptation in oncology, a clear definition of the problem can be
stated. Because of the lack of a standard and appropriate tool for the culture of the Iranian society,
this aimed at developing and validating the nurse adaptation tool in the oncology departments.
METHODS: This research is a methodological study and an exploratory mixed method being
conducted in three main steps of conceptualization, production of items, and field test. Inductive
conceptualization was performed through qualitative methodology and conventional content analysis
approach; in the second step, developed instrument was evaluated in terms of face validity, content
validity, and construct validity. In the third step, sampling of oncology nurses was done and exploratory
factor analysis was performed for evaluating the construct validity, adequacy of sampling, and
dimensioning. Cronbach’s alpha was calculated for checking the reliability of the instrument.
RESULTS: The oncology nurse adaptation questionnaire was formed with twenty items in four main
dimensions, including “emotional factors,” “supportive factors,” “work‑related factors in the ward,”
and “factors related to job conditions.” The reliability of the tool was confirmed by evaluating the
internal consistency with Cronbach’s alpha, which was above 0.7 for each dimension and 0.82 for
the whole instrument.
CONCLUSION: This instrument can be used as a practical tool for determining the adaptation of
oncology nurses for providing evidence to improve the work conditions of nurses by improving the
working conditions in the workplace and providing facilities with individual intervention, and the
outcome will be care of patients with high quality.

Abstract OBJECTIVES: Involving the patients in health‑related decisions requires high health literacy. Health
literacy is related to the concept of information literacy through its emphasis on information skills.
Hence, the aim of this study was to investigate the relationship between information literacy and
health literacy.
STUDY DESIGN: We carried out an original research.
MATERIALS AND METHODS: This is an applied research that is carried out in a survey method.
The statistical population of this study is MSc and PhD students at School of Health Management
and Information Science in Iran University of Medical Sciences who were selected by stratified
random sampling. A standard health literacy questionnaire including access dimensions, reading
skills, comprehension, evaluation, decision‑making, and application of health information was used to
assess the health literacy status of the students. To measure information literacy, the questionnaire
includes identifying information needs, locating information, organizing information, and evaluating
information were used. The data were analyzed by tests of one‑sample t‑test, Pearson correlation,
and simple linear regression with spss software version 18 produced by IBM located at New York.
RESULTS: The results showed that the level of information literacy among students was higher
than the average level. The average of information literacy rate in the sample is 49.09. In this
regard, the most frequent information is gained from the internet, interacting with friends, and asking
practitioners and health workers. In addition, there is a positive and significant relationship between
all dimensions of information literacy with health literacy and information literacy affects 35.4% of
health literacy changes.
CONCLUSIONS: It can be said that information literacy is a predictor of health literacy. Furthermore,
the pattern of people’s health information has moved to new information environments and to improve
health having sufficient information seeking and information literacy skills are essential.

Abstract INTRODUCTION: Many infertile people have heard about adoption, but little is known about the true
meaning of adoption and how it is accepted. Giving the right information about adoption is effective
in making the right decision for couples. As a result, there is a need to intervene and provide training
to improve community attitudes and increase adoption among infertile people. Therefore, the present
study aimed to determine the effect of two counseling methods (face‑to‑face and telephone) on
awareness and attitude toward adoption in infertile couples.
MATERIALS AND METHODS: The present study is a randomized quasi‑experimental study of two
groups in the Milad Infertility Center of Mashhad on 34 (each group of 17 couples) infertile couples
with the criteria to enter the study. Couples were randomly assigned to two telephone and face‑to‑face
counseling groups, and each individual’s awareness and attitudes toward adoption were completed
separately before and after counseling. The average number of face‑to‑face sessions for face‑to‑face
counseling was three 60‑min sessions and six 30‑min sessions for telephone counseling.
RESULTS: Based on the results of t‑test, there was a statistically significant difference between
the average score of awareness of adoption before and after the intervention (2 weeks after the
last counseling session), in infertile couples in face‑to‑face training group and in telephone training
group (P < 0.0001). The score of the attitude toward adoption before counseling in the face‑to‑face
counseling group was 60.55 ± 5.5, which reached 66.76 ± 4.7 after counseling. Based on the results
of the T‑pair test, this difference was significant (P < 0.0001). In addition, in the telephone counseling
group, the score of attitude toward adoption increased from 59.53. 7.4 to 67.73 ± 7.5, which was a
significant difference in terms of t‑pair test. The mean score of attitudes toward adoption was not
statistically significant in the two groups (P = 0.653).
CONCLUSION: The results of this study showed that both counseling methods (face to face and
telephone) increase the level of awareness and attitude of couples about adoption, but neither
method was superior to the other.

Abstract BACKGROUND: Adolescence is a vital stage of growth and development; however, many adolescents
do die prematurely due to accidents, suicide, violence, poor mental stability, depression, and other
illnesses that are either preventable or treatable. Life skills are important for the promotion of well‑being
of adolescents and to develop positive attitude and values to lead a healthy life.
OBJECTIVES: The study was conducted to assess the change in life skills postintervention and
study the association between different variables and the postintervention life skills score.
MATERIALS AND METHODS: A quasi‑experimental study was conducted among 137 adolescents
each in urban and rural schools. Life skills training module based on ten domains of life skills given
by the World Health Organization was implemented using interactive teaching–learning methods.
After 6 months of implementation of life skills training sessions, a postintervention assessment was
done using the life skills assessment scale, and the differences in the scores were measured.
RESULTS: Higher life skills score was observed postintervention, and this difference was statistically
significant  (P  <  0.001). Higher postintervention mean score  (above 15) was seen in critical
thinking (19.58), self‑awareness (18.03), creative thinking (15.78), and interpersonal thinking (15.15).
CONCLUSION: Increase in the postintervention scores using an educational intervention module
and interactive teaching–learning methods suggests effectiveness of the life skills education program.
Implementing this health promotion module on life skills in the school curriculum will address the
overall development of the personality of the school students.

Abstract INTRODUCTION: Considering the trend of reducing fertility in recent decades, the level of awareness
and attitude of health workers to fertility has an important role in achieving the country’s demographic
goals. Improving attitudes and improving the scientific level and skills of health workers are the basic
pillars to improve the quality and quantity of health‑care services. Therefore, this study was conducted
with the aim of improving the level of awareness and attitude toward fertility and fertility counseling
skills of health workers with both face‑to‑face and virtual training methods.
MATERIALS AND METHODS: This study was a randomized controlled trial of three groups and
pre‑test‑posttest experiments performed on 108 midwives and health‑care workers working in
Mashhad Health Center and Community Health Centers and Health Centers in 2015. The tools
used in this study were four researcher‑made questionnaires that were validated and reliable. Data
analysis was performed by Chi‑square test, one‑way, and independent t‑analysis of variance using
SPSS software version 16.
RESULTS: The results showed a significant increase in awareness level, attitude toward fertility,
and counseling skills in the studied groups after the implementation of interventions (P < 0.001).
Furthermore, there was a significant inverse relationship between the attitude score of the research
units at the beginning of the study and the demographic variables with only the average work
experience.
CONCLUSION: Training is effective in raising the level of awareness and changing the attitude of
health workers. The use of group discussion methods in person as well as through a webinar in
which learners think, interact, and gain experience in promoting healthy fertility counseling promotes
awareness, attitudes toward fertility, and their counseling skills in providing healthy reproductive
counseling.

Abstract BACKGROUND: Despite the multitude of studies comparing teacher burnout with an ample of
variables, a need for seeking what English language teachers think about their job and the interfering
variables regarding the context seems essential. The aim of this study was primarily to investigate the
relationship between teacher burnout and job satisfaction of English language teachers and, then,
to find out the impact of teaching experience and gender on teacher burnout and job satisfaction.
MATERIALS AND METHODS: It was a mixed‑methods study conducted on 103 teachers who were
conveniently sampled and were investigated through questionnaires and interviews among high
school English language teachers in Sistan and Baluchestan province. The sampling method was
purposive, and data were collected through questionnaires and semi‑structured interviews. Data
analyses were performed using mixed–methods approach.
RESULTS: The results revealed a moderate negative correlation between the first two elements
of teacher burnout (emotional exhaustion and depersonalization) and job satisfaction (P < 0.01),
whereas a positive correlation was found between the next element, i.e., personal accomplishments
and job satisfaction (P < 0.05). Afterward, no statistically significant difference was detected between
demographic characteristics (i.e., gender and teaching experience) (P < 0.01). Then, 15 teachers
voluntarily participated in the interview sessions and expressed their opinions about the way teachers
see the environment they work in.
CONCLUSIONS: There are factors that influence on the quality of teaching and learning processes
and lead to burnout and job dissatisfaction; therefore, it seems advisable to remove them to reduce
their negative effects.

Abstract INTRODUCTION: Over the past decades, the pattern of diseases in human societies had changed
from infectious diseases to noncommunicable diseases (NCDs), and according to the report by the
World Health Organization, the highest burden of disease is attributed to NCDs. The study was
conducted to determine the status of hypertension, type‑2 diabetes, lipid disorders, and body mass
index (BMI) among the patients aged over 30 years admitted to health centers of Karaj, Iran.
MATERIALS AND METHODS: In this cross‑sectional study, the population included 2947 men and
women aged 30 years and above admitted to six health‑care centers in Karaj. The questionnaire
includes demographic characteristics and had the questions on hypertension, diabetes and their
risk factors, like lipid disorders and BMI was administered. The data were analyzed in SPSS,
version 23, software using descriptive (frequency, percentage, mean, and standard deviation) and
analytical (Chi‑square and analysis of variance) tests (P < 0.01).
RESULTS: About 10% of the participants had diabetes and 15% of the participants had hypertension.
About 32% of the participants had dyslipidemia and 87% of the participants were overweight or obese
and over 35% were obese. Furthermore, with the increase in BMI, the prevalence of lipid disorder,
hypertension, and type‑2 diabetes increased in the studied population (P < 0.01).
CONCLUSION: According to the results, a high percentage of people had hypertension, type‑2
diabetes, hyperlipidemia, and BMI in the population. Gender segregation showed that lipid disorders,
overweight, and obesity in women were more than in men and percentage of people with hypertension
among male were significantly higher than in females. In the case of type‑2 diabetes, the results
showed no statistically significant differences between men and women. The results may be helpful
in developing educational strategies and prevention and control of these diseases.

Abstract BACKGROUND: Dried Urmia Lake in the northwest of Iran is a major regional source of sodium
and toxic metal aerosols which may cause numerous health problems. The aim of this study was to
evaluate iron‑deficiency anemia (IDA) and some related risk factors among women of reproductive
age in the suburb of dried Urmia Lake to provide the information about the problem to the health‑care
providers.
METHODS: This cross‑sectional study was conducted on 278 healthy nonpregnant, nonlactating
women aged 18–45 years, living in the rural area of the Salmas city, closest to the Urmia Lake between
February and June 2017. The study participants were selected using a stratified random sampling
method with proportional allocation from seven villages. A general questionnaire was completed for
each participant to collect sociodemographic information and a 3‑day dietary recall questionnaire
to obtain daily dietary intakes. IDA was defined as a hemoglobin (Hb) level of <12 g/dl and ferritin
concentration of <15 μg/l. Spearman’s correlation coefficient and Fisher’s exact test were applied to
determine sociodemographic factors associated with the serum Hb and ferritin levels.
RESULTS: The prevalence of overall anemia (Hb <12 g/dl) was 7.9%. IDA was determined in 4.3%
and iron deficiency (ID) in 19.1% (serum ferritin <15 μg/l) of the participants. There was a significant
positive correlation between serum Hb concentrations and the mean daily intakes of protein and
iron (P < 0.001). Similarly, a significant positive correlation was observed between serum ferritin
levels and body mass index (P < 0.001). Significant inverse associations were found between Hb
concentrations and the number of pregnancies and children (P < 0.001), as well as the number of
family members (P < 0.05).
CONCLUSIONS: Results indicated a mild prevalence of IDA and a relatively high rate of ID among
studied participants. Educational programs are needed to improve nutritional habits as well as the
use of contraceptives to promote women’s health.

Abstract OBJECTIVE: The purpose of family‑centered care interventions is to enhance the abilities of family
members in certain areas that overcome the barriers to health and well‑being, The purpose of the
present research was to determine the effect of education based on family‑centered empowerment
model on health‑promoting behaviors and some serum metabolic indicators in elderly women.
MATERIALS AND METHODS: In this stratified randomized controlled trial, 60 elderly women aged
60 years and older referring to elderly‑friendly health centers in Tabriz‑East Azerbaijan were divided
randomly into intervention and control groups in 2019. Intervention group received a family‑centered
healthy lifestyle intervention once a week for 10 sessions and the control group received the routine
care. The mean score of health‑promoting behaviors using the Health Promoting Lifestyle Profile‑II
questionnaire, glycemia and serum lipid profile, liver and renal function, 25‑hydroxy Vitamin D, and
calcium serum levels were assessed before the intervention, 2 and 6 months after the intervention
through SPSS/version 23 using independent t‑test, ANCOVA, and repeated measure analysis.
RESULTS: The ANCOVA test showed a significant increase in total lifestyle score in the intervention
compared to the control group, 2 (adjusted mean difference [aMD]: 13.7; 95% confidence interval [CI]:
5.6–21.8) and 6 months (aMD: 17.2; 95% CI: 7.7–26.7) after education. The score of the nutrition and
health responsibility domains significantly increased two (P < 0.05) and 6 months (P < 0.001) after
the intervention in the intervention group compared to control. In both groups, serum levels of total
cholesterol, low‑density lipoprotein cholesterol, urea, and creatinine showed a significant decrease,
and high‑density lipoprotein cholesterol and calcium levels showed a significant increase (P < 0.05).
CONCLUSION: A healthy lifestyle education based on family‑centered empowerment model
increased the total lifestyle score. So, it is recommended as an effective educational approach to
improve the health of elderly.

Abstract INTRODUCTION: “Gender” denotes the differences in the social roles of different sexes. This
interaction results in variable health outcomes and care‑seeking behavior. The present study was
conducted to find out the attitude of school‑going adolescents regarding gender equity and also to
explore teachers’ perceptions in this context in a school of tribal belt of West Bengal.
MATERIALS AND METHODS: A cross‑sectional, mixed‑method study was conducted among the
students of classes eight to twelve, chosen by complete enumeration technique, with a predesigned,
pretested validated questionnaire. The questionnaire was based on Gender Equitable Men scale
and International Men and Gender Equality Survey questionnaire, comprising the following
domains: ‘Gender restrictions’, ‘Gender attributes’, and ‘Gender domination’. The respondents were
categorized into ‘high’, ‘moderate’, and ‘low’ groups as per their domain‑wise attitude scores. In‑depth
interviews (IDIs) were conducted among seven teachers chosen purposively. Thematic analysis was
done with the qualitative data.
RESULTS: Out of 191 students, 112 were girls (58.6%) and 47 belonged to scheduled tribe
category (24.6%). Overall, 170 (89.0%), 80 (41.9%), and 96 (50.3%) students had a high
gender‑equitable attitude regarding the domains of ‘gender restrictions’, ‘gender attributes’, and
‘gender domination’ respectively. Girls had higher percentage of high gender‑equitable attitude in all
the three domains (92.0%, 57.1%, and 50.9%, respectively). Regarding ‘gender restrictions’, 91.2%
had high gender‑equitable attitude in lower age group, compared to 81.4% in higher age group.
Among the lower and higher age groups, 52.7% and 41.9% respectively, had high gender‑equitable
attitude on ‘gender domination’. Gender inequality amidst poverty, women deprived of health care,
and gender violence were the major themes derived from the IDIs.
CONCLUSION: Girls had a better attitude toward gender equity. Laws regarding gender dominance
and violence should be focused. Conducting intensified awareness campaigns on gender equity and
addressing women’s right to health is a much‑needed timely intervention for the health of womenfolk.