فهرست مطالب

Journal of Education and Health Promotion
Volume:10 Issue: 9, Sep 2020

  • تاریخ انتشار: 1399/09/12
  • تعداد عناوین: 34
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  • Shubhi Goel, Byalakere Rudraiah Chandrashekar* Page 226
    BACKGROUND

    Washing of hands and maintenance of appropriate hand hygiene plays a significant role in preventing the spread of many communicable diseases. However, literature demonstrating the efficacy of the World Health Organization (WHO) recommended handwashing procedure among schoolchildren in India is scanty.

    AIM

    The aim of this study was to assess hand hygiene efficacy through graphical assessment technique utilizing ultraviolet (UV)‑sensitive fluorescent lotion before and after handwashing demonstration among students aged 12–18 years.

    MATERIALS AND METHODS

    This was an interventional study carried out over a period of 5 days among 21 schoolchildren aged 12–18 years in their respective school premises. Participants were requested to rub their hands with an UV‑sensitive fluorescent lotion and then wash them. Hands were air‑dried and examined under UV rays for blue light emission in a dark room. Emission of blue light highlighted parts of hand where lotion is still present and area not washed properly. Such areas were painted with nontoxic skin‑friendly paints. Painted hands were imprinted over graph papers. Hand hygiene demonstration was provided to the participants as per the WHO guidelines by qualified public health dentists using audiovisual aids. Postintervention, the procedure followed at baseline was adopted to obtain imprints of uncovered (not covered during hand hygiene process) parts of hands. The mean percentage of uncovered parts of hand was assessed and compared between baseline and postintervention.

    RESULTS

    The overall mean percentage score of uncovered hand area significantly reduced from 73.90 ± 19.81 mm2 at baseline to 20.05 ± 17.0 mm2 after demonstration of proper hand hygiene guidelines (P < 0.001).

    CONCLUSION

    Hand hygiene demonstration by qualified public health dentists using audio‑visual aids has significantly contributed to improving their hand hygiene practice.

    Keywords: Graphical assessment technique, hand hygiene, hand hygiene maintenance, hand rubbing, handwashing
  • Tahereh Moghadas‑Dastjerdi, Athar Omid*, Nikoo Yamani Page 227
    BACKGROUND AND OBJECTIVES

    This study was conducted to evaluate the health experts and professionals’ education program in order to become multiprofessionals regarding health system transformation plan by a descriptive and educational evaluation method based on the context, input, process, and product (CIPP) evaluation model in 2018.

    MATERIALS AND METHODS

    The statistical population included managers and experts of health deputy (13 people), managers and authorities in health networks (32 people), teachers (251 people), and learners (1914 people). Data were collected by four researcher‑made questionnaires based on the CIPP model and evaluation checklist of facilities and equipment. The view of experts was used to measure the face validity and content validity of the questionnaire, and Cronbach’s alpha coefficient was used to determine reliability. Data were entered into SPSS 23 software, and data were provided using descriptive statistics (frequency, mean, and standard deviation).

    RESULTS

    The evaluation indicators of the educational course in the field of context were evaluated desirable by province’s managers and experts (95% questions), city managers (100% questions), teachers (95% questions), and health caregivers (80% questions). In the field of input, it was evaluated desirable by managers and experts’ input of province (60% questions) and city managers (70% questions) and it was evaluated semi‑desirable by teachers (78.95% questions) and health caregivers (88.24% questions). In the field of process, it was evaluated desirable by province’s managers and experts (73.68% questions) and city managers (66.67% questions) and it was evaluated semi‑desirable by teachers (66.67% questions) and health caregivers (94.4% questions). In the field of product, it was evaluated semi‑desirable by managers and experts of province (63.63% questions), teachers (81.81% questions), and health caregivers (100% questions) and it was evaluated desirable by city managers (72.72% questions).

    CONCLUSION

    Holding initial service education course of health caregivers has been necessary, and the public health, family, and midwifery disciplines needed to be educated in a university appropriate to the description of tasks of health caregivers.

    Keywords: Context, health caregiver, input, process, product
  • Farideh Moradi, Razie Toghroli, Jaffari Abbas, Arash Ziapour, Javad Yoosefi Lebni, Amin Aghili, Nadya Baharirad, Mohammad Mohseni, Ali Soroush* Page 228
    INTRODUCTION

    The qualification of managers in terms of management skills is one of the most important factors in the continuous success of each organization, and utilizing such skills can have a positive contribution in the effectiveness of the organization while improving the performance of the employees in line with the objectives and goals of the organization. The study's primary objective was to examine the necessary skills of the hospital managers and their capabilities to manage the challenges in providing health care facilities to their patients and employees.

    MATERIALS AND METHODS

    This study is a qualitative that deep interviews were performed with 22 managers (senior and middle managers) of educational hospitals of Kermanshah city, and the sample size was 22 individuals. The interviews were analyzed by a MAXQDA software application after transcription.

    RESULTS

    This study includes 8 themes and 23 subthemes. The strategic skill, the perceptive skill, the human relations skill, work experience, and personal characteristics were among the skills necessary for hospital managers. Some of the challenges facing the hospital managers included rapid changes in the policies, the limitations of financial resources, and lack of proportion between the educational and occupational spheres.

    CONCLUSION

    Because of their existential philosophy and differences with other service sectors, managing hospitals poses a particular sensitivity. In this regard, the role of the hospital manager is very important. Therefore, in order to meet the satisfaction of those receiving services, decision‑makers and policy‑makers must think twice when selecting and appointing hospital managers and evaluate and appraise this group in terms of abilities and skills necessary for managing such an important service section.

    Keywords: Challenges, hospital managements, qualitative study, skills
  • Behrooz Pouragha, Mahnaz Keshtkar, Mahdieh Abdolahi, Hojjat Sheikhbardsiri* Page 229
    INTRODUCTION

    Organization survival is dependent on communications and managers spend a main portion of their time to establish communications. The identification, improvement, and development of communication skills serve as the essential components of successful organizations. The present study aimed to investigate the role of communication skills in human resource (HR) productivity in North Iran and aimed to investigate the role of communication skills in health HR (HHR) productivity in North Iran.

    METHODS

    The study employed a cross‑sectional design and was conducted in six deputies supervised by the Alborz University of Medical Sciences, in 2019. The statistical population included all 302 employees were selected as the sample population according to the Cochran’s formula. Using two researcher‑made questionnaires of communication skills and HHR productivity, we assessed the role of communication skills in HHR productivity.

    RESULTS

    According to the research findings, there were significant relationships between communication skills including verbal skills, listening skills, and effectiveness skills with HHR productivity (P ≤ 0.05). There was a significant relationship between age group, gender, level of education, and travel home‑university distance with communication skills and resource productivity of employees (P ≤ 0.05).

    CONCLUSION

    This study examines the role of communication skills in the promotion of HHR productivity who work in the administrative section of the University of Medical Sciences in Iran. Findings suggest that health planners and authorities may need to examine factors that contribute to the promotion of the communication skills for increase HHR productivity of employees and improved performance of health organizations.

    Keywords: Communication skills, human resource, Iran, productivity
  • Sajad Sajadi, Ghoncheh Raheb*, Masoumeh Maarefvand, Khadijeh Abolmaali Alhosseini, Abolfazl Ghasemi Page 230
    BACKGROUND

    One of the serious issues in the field of children’s social and mental health globally, is conduct disorder. Concerning the special problems of these children, their need for appropriate education seems vital. Thus, this study aimed to identify the educational deficiencies in the Iranian education system in terms of educating children with conduct disorder. SUBJECTS AND

    METHODS

    This was a qualitative content analysis study of the directed type. The population was in Tehran City, Iran. This research was performed on 23 individuals using a triangulation sampling technique and in‑depth interviewing. The study subjects were children with conduct disorder, their parents, teachers, and social workers, and psychology experts. The study participants were selected using a purposive sampling method, and the tool used for data collection was a checklist of questions that has been approved by 4 experts. MAXQDA (version 12) software was used for data analysis in this study.

    RESULTS

    The obtained data suggested that the deficits of the educational system in Iran are classified into four categories, including the lack of knowledge and skills of school staff, the lack of necessary workforce, the lack of appropriate hardware facilities, and the lack of coordination and cooperation between individuals and systems.

    CONCLUSION

    Considering the present study results, to improve the educational status of children with conduct disorder and reduce their problems, it is necessary to resolve the identified educational deficiencies as soon as possible by the government, policymakers, and educators.

    Keywords: Children, conduct disorder, educational system, externalizing disorder, social work
  • Somdatta Patra*, Amir Maroof Khan, Madhu Kumari Upadhyay, Rahul Sharma, Om Prakash Rajoura, Sanjiv Kumar Bhasin Page 231
    CONTEXT

    Currently, self‑directed learning (SDL) is emphasized in medical institutions all over the world. The skills of SDL enable one to be a lifelong learner, a necessity to cope up with fast‑expanding medical knowledge.

    AIMS

    This study aims to develop and implement an “SDL” module for medical undergraduates and find out their perception about the same. SETTINGS AND DESIGN: A cross‑sectional study using a mixed‑method design (having both qualitative and quantitative components) was conducted in the Department of Community Medicine, UCMS, Delhi, India.

    METHODS

    A module was developed following an extensive literature review and focus group discussions with the teaching staff of the institute. First‑semester undergraduate students were invited to participate in the study and asked for feedback using a semi‑structured questionnaire. STATISTICAL ANALYSIS: Quantitative data were expressed in mean, range, and frequency. For qualitative data, thematic analysis was performed.

    RESULTS

    The module was implemented with 160 students, in November for 10 hour distributed over 5 weeks. Feedback could be obtained from 130 students. Sixty‑seven percent of students were satisfied and 66% reported as motivated to study the allotted topic further. Qualitative analysis showed that though the students liked the learning process based on this module, they also felt facilitators could have been more active in imparting knowledge and skills.

    CONCLUSIONS

    To make learners equipped with the ability to learn throughout a professional learning course, SDL as a learning tool should be introduced in the medical undergraduate curriculum.

    Keywords: Competency, medical students, self‑directed learning
  • Nasrin Shokrpour, Leila Bazrafcan*, Amir Rezaei Ardani, Shabnam Nasiraei Page 232
    INTRODUCTION

    Academic burnout is one of the issues involving the educational systems at all levels, which wastes the human resources and expenditures. Academic burnout refers to the sense of exhaustion due to educational requirements, the sense of cynicism and indifference, and the sense of lack of competence. Considering the fact that burnout has already been studied in different professions and in cultures different from that of ours, there is a need to identify these factors among the Iranian medical students and accordingly propose some strategies to reduce burnout symptoms among these students. With this end, this study aimed to identify and quantify the importance of possible factors causing burnout among medical students in the 2nd and 4th years of their studies in Mashahd University of Medical Sciences and provide some suggestions.

    METHODS

    The present research is a cross‑sectional study conducted in 2017. The participants included medical students who had entered Mashhad University of Medical Sciences in Iran in 2013 and 2015 and were in their 4th and 2nd year of their studies in the university. A questionnaire prepared and validated by Maslach et al. was used to collect the data and distributed among 195 participants who were selected randomly as the sample.

    RESULTS

    The results showed that the mean scores given by 195 selected respondents regarding emotional exhaustion, indifference, and inefficiency were respectively 3.89, 3.87 and 4.12 out of 7.

    CONCLUSION

    Based on the results, students had the highest level of academic burnout in personal inefficiency or incompetence component and the lowest level was observed in indifference. Therefore, burnout and its components were explicitly seen among medical students; the authorities are recommended to take measures to reduce academic burnout among the students.

    Keywords: Academic burnout, emotional exhaustion, indifference, inefficiency
  • Mahla Salajegheh, John Sandars, Ali Norouzi, Azim Mirzazadeh, Roghayeh Gandomkar* Page 233
    BACKGROUND

    Organizational capacity development is an important outcome of faculty development programs, but there is a lack of an appropriate instrument for its evaluation. AIMS AND

    OBJECTIVES

    The aim of this study was to develop a questionnaire to evaluate the organizational capacity development for faculty development programs and to test its psychometrics.

    MATERIALS AND METHODS

    The initial capacity development for faculty development questionnaire (CDQ‑FD) of 26 items was developed based on a literature review and opinion of experts. Content validity ratio (CVR), content validity index (CVI), content validity index for items (I‑CVI), and the content validity index for scales (S‑CVI) were computed for content validity. Confirmatory factor analysis (CFA) and exploratory factor analysis (EFA) were performed for construct validation.

    RESULTS

    The score for CVR, CVI, I‑CVI, and S‑CVI was 0.71, 0.83, 0.87, and 0.90, respectively. EFA resulted in a three‑factor model with total variance extraction of 64%. Cronbach’s alpha and Spearman Brown coefficient were investigated for reliability assessment. The Cronbach’s alpha of overall scale was 0.8 and the test‑retest reliability of the overall scale was 0.78. The final CDQ‑FD contained 21 items and three categories.

    CONCLUSIONS

    The CDQ‑FD questionnaire appears to be a valid and reliable instrument for the evaluation of organizational capacity development for faculty development in the medical education.

    Keywords: Capacity building, empowerment, faculty, medical education, program evaluations, psychometric, questionnaire, staff development
  • Leila Shahmoradi, Sohrab Almasi, Nastaran Ghotbi*, Marsa Gholamzadeh Page 234
    INTRODUCTION

    The virtual reality‑based (VR) game can be considered as a new approach to education and to enhance the skills of health‑care students.

    AIMS

    The purposes of this research were to design a VR game and to apply it to teach physiotherapy in neurological diseases.

    METHODOLOGY

    In this study, at first, a VR game was designed for upper limb rehabilitation in brain‑injured patients based on the literature and the opinions of physiotherapy experts and game designers. Then, the designed game was used for teaching physiotherapy in neurological diseases. Thereafter, the opinions of 31 undergraduate students about the teaching session were evaluated by two anonymous questionnaires. Data analysis was performed using descriptive statistics through SPSS (version 19).

    RESULTS

    The VR game developed under expert supervision. The evaluation showed that the median score for students’ perception of learning was 3.11. The median scores of questions related to the “facilitating level of virtual reality” and “student satisfaction” were 8.66 and 9, respectively. The analysis of students’ responses to open‑ended questions highlighted the therapeutic aspect of the game compared to its educational aspect.

    CONCLUSIONS

    Application of VR games in education can enhance the students’ perception of learning. Furthermore, it can provide a better understanding of physiotherapy in patients with neurological diseases as well as the satisfaction of students. However, the survey indicated that the good results of this teaching method are due to the use of VR for guiding the patient’s movements.

    Keywords: Education, neurological rehabilitation, physical therapy, teaching, video games, virtual reality
  • Mohan Kumar P*, Sruthima N. V. S Gottumukkala, K. S. V. Ramesh, T. Sreenivasa Bharath, Gautami S. Penmetsa, C. Naresh Kumar Page 235
    BACKGROUND

    The progress in the usage of technology in hardware, software, and cost‑effective Internet connectivity enable the availability of science‑related information and its usage in all the developing countries. Hence, in this practical world, there should be a need to implement effective and affordable dental education strategies to attain oral health for all in the coming years.

    OBJECTIVE

    The aim of this study is to reduce the need to teach theory‑based, on‑site classes, e‑learning came into existence. E‑learning for dental education may alleviate the burden of severe health worker shortages and deliver affordable access to high‑quality dental education.

    METHODOLOGY

    Evaluation and assessment methods were done to know the effectiveness of e‑learning in dental education by conducting continuing dental education on newer materials and methods, assignments/formative assessments and by open discussions of case descriptions and their treatment modalities through Edmodo app in our dental institute. Effect on knowledge, skills, attitudes, and satisfaction levels of dental students compared to other traditional methods.

    RESULTS

    Dental e‑learning has the capacity to develop into a leading‑edge to strengthen clinical training skills among dental students by conducting continuing dental education, assignments, formative assessments, case descriptions, and their treatment modalities through e‑learning are the best ways to improve quantity and quality in dental education.

    CONCLUSION

    The probable prospective of e‑learning could be innovative or revolutionary because this helps in both theoretical‑related and clinical‑related advancements, and it is possible only with e‑learning in developing countries to meet the quality in education.

    Keywords: Assessment tool, dental education, Edmodo, e‑learning
  • Anahita Zarei Mahmodabadi, Masoumeh Zakerimoghadam, Samerand Ghazi Fatah, Ahmad Sohrabi, Zahra Abbasi Dolatabadi* Page 236
    BACKGROUND

    Percutaneous endoscopic gastrostomy (PEG) is one of the most suitable methods for long‑term nutritional support. In this study, the empowerment of intensive care nurses is examined by a simulation technique to control the short‑term complications of PEG.

    METHODS

    A two‑group clinical trial study will be conducted on eighty intensive care nurses in a teaching hospital in Tehran. The study participants will be randomly assigned to one of the two control and intervention groups based on the inclusion criteria. A pretest will be given to both groups using a researcher‑made tool. Then, the empowerment package developed by the researcher will be provided to the intervention group in two stages. Next, a posttest will be administered. After this stage, patients’ complications with PEG will be observed using a researcher‑made checklist. Nurses’ performances in both control and intervention groups will be evaluated in terms of preventing and controlling short‑term complications up to 1 week after PEG insertion. All of the data collected in this research will be analyzed with statistic tests such as independent t‑test, standard deviation, T pair, ANOVA, and mean based on the SPSS 16 software.

    RESULTS

    At present, the research team is designing an empowerment package for nurses and tools needed to evaluate the nurses’ empowerment.

    CONCLUSION

    This study will attempt to design and evaluate the empowerment package of graduate nurses with a cognitive empowerment approach and using a simulation technique to care for patients with PEG and to control their short‑term complications.

    Keywords: Complications, critical care nurses, empowerment, percutaneous endoscopic gastrostomy, shortterm, simulation training
  • Masoud Ferdosi, Reza Rezayatmand, Yasamin Molavi Taleghani* Page 237
    CONTEXT AND AIMS

    The country development can be promoted through applying policies of the resistance economy in the health system and universities. Therefore, this paper aimed to provide a scientific analysis of resistance economy policies and providing a roadmap for their implementation in the field of health care of Isfahan University of Medical Sciences.

    MATERIALS AND METHODS

    This is a qualitative study. The basis, general purposes, and strategies of the resistance economy were extracted from the review of the policy of the resistance economy with a political research approach. Then, effective programs and indicators to achieve the goals of the resistance economy were proposed by holding 10 sessions of a centralized group discussion. Finally, the implementation of the resistance economy in the deputies of the University of Medical Sciences was approved by these programs and indicators along with other components and Delphi questionnaire to 30 experts. Framework analysis and descriptive statistics were used to analyze the data from the group discussion and the Delphi stage, respectively.

    RESULTS

    Implementation of general policies of resistance economy in the field of health and treatment of Isfahan University of Medical Sciences with eight thematic bases, 39 goals, 54 strategies, and 98 programs and indicators were approved by experts. The eight areas of people‑centered, economic growth, economic justice, support for internal services, economic flexibility, economic stability, economic influence, and economic health were identified as the thematic bases of communicative policies of the resistance economy in the field of health.

    CONCLUSION

    The implementation of resistance economy policies entails planning in the long run, culture‑building, appreciating the resistance economy in health issues, cooperation, and synergy among different institutions, restructuring the education system at different levels of the health system, and entrepreneurship training.

    Keywords: Health system, policy, resistance economy, road map, University of Medical Sciences
  • Mohsen Poursadeqiyan, Maryam Feiz Arefi, Saeed Khaleghi, Ali Sadeghi Moghaddam, Ehsan Mazloumi, Mehdi Raei, Mahsa Hami, Alireza Khammar* Page 238
    INTRODUCTION

    Some working and organizational conditions, such as psychological stress and shift work, are factors that threaten the health of staff working in health centers. These factors can cause fatigue in a long time. Fatigue reduces the ability to process information and decrease to respond to hazardous conditions and will affect the safety of the environment. Therefore, the purpose of this study was to determine the relationship between safety climate and occupational fatigue in nurses working in Zabol city.

    METHODS

    This cross‑sectional study was performed on 143 nurses working in educational hospitals of Zabol in 2019. The proportional sampling method was used, and the Swedish Occupational Fatigue Questionnaire and the Nurses Safety Questionnaire were used for data collection. Data were analyzed using independent t‑test, analysis of variance, Mann–Whitney, Kruskal–Wallis tests, and SPSS‑21 software.

    RESULTS

    In the present study, 57.3% were women and 42.7% were men. The mean score of occupational fatigue was 85.09 ± 41.49, and the mean score of safety climate was 67.15 ± 12.73. There is a significant inverse relationship between occupational fatigue and safety climate. The comparison of safety climate and its subscales between occupational and demographic variables showed that the score of male supervisors’ attitude was 01.36 ± 2.41 while the score of female supervisors’ attitude was 8.88 ± 2.61, and this difference was significant. Furthermore, cumulative burnout, the attitude of supervisors, and the safety climate were significantly different between different educational levels.

    CONCLUSION

    The results of this study showed that there is a relationship between occupational fatigue and safety climate. Issues related to safety and risk factors in hospitals due to the high risk of disease outbreak and mortality, in addition to being economical, are important in terms of the human aspect as well. In addition, the activity of nursing staff is more important compared to other groups because of providing health care and communicating with patients; thus, more education about the safety climate of the workplace environment in hospitals can reduce nurses’ fatigue.

    Keywords: Burnout, fatigue, job satisfaction, nurse, safety
  • Sakshi Chopra, Anita Malhotra, Piyush Ranjan*, Naval K. Vikram, Namrata Singh Page 239

    Obesity is a commonly encountered health‑care problem that is an independent risk factor for chronic metabolic complications. Primary care physicians are the first point of contact in the management of obesity. Weight management is a step‑wise intensification of interventions that initiates with lifestyle modification. Dietary and physical activity advices are integral components of all weight loss consultations and should ideally be imparted by a dietician or a nutritionist. In case of their nonavailability, the onus for lifestyle counseling rests with the physician. The prescription for a low‑calorie diet coupled with increased physical activity might seem simple, but the success lies in compliance and sustainability of this advice. Compliance can be enhanced through patient‑specific diet and activity plans along with corrections in eating and activity behavior. Barriers in patient’s environment must also be addressed to achieve sustainable weight loss. This review covers practical insights in standard lifestyle management techniques, which can help the physicians to set better weight loss goals, adapt to patient specific lifestyle counseling, and apply strategies to enhance compliance for sustained weight loss.

    Keywords: Caloric restriction, exercise, obesity management, primary care physician, weight loss
  • Jamshid Eslami, Neda Hatami, Azadeh Amiri, Marzieh Akbarzadeh* Page 240
    BACKGROUND

    Anxiety before and pain intensity after cesarean section is among the factors that should be taken into consideration among the candidates for cesarean section. The present study aimed to investigate the effect of familiarity with cesarean section and the operating room environment on anxiety and pain intensity among the mothers undergoing cesarean section.

    METHODS

    This clinical trial was conducted on 80 women referred to the hospitals affiliated to Shiraz University of Medical Sciences for cesarean section in 2018. The participants were randomly divided into a control (n = 40) and an intervention group (n = 40). The intervention group took part in four educational sessions, while the control group received the hospital’s routine care. The Beck Anxiety Inventory was completed by the two groups before and after the intervention. The McGill Pain Questionnaire was also filled out by the two groups in the ward after the cesarean section. After all, the data were entered into the SPSS software, version 21, and were analyzed using independent t‑test and ANCOVA.

    RESULTS

    The results showed no significant difference between the two groups regarding the mean score of anxiety prior to the intervention. After the intervention, the mean score of anxiety was 7.98 ± 3.77 in the intervention group and 19.70 ± 6.45 in the control group, and the difference was statistically significant (P < 0.0001). Indeed, the mean intensity of pain was 43.98 ± 7.63 in the intervention group and 57.75 ± 10.69 in the control group after the intervention, and the difference was statistically significant (P < 0.017).

    CONCLUSION

    The patients’ familiarity with cesarean section and the operating room environment caused a decline in the anxiety level prior to cesarean section as well as a decrease in the score of pain after the operation. Hence, midwives and nurses have to play effective roles in decreasing pregnant women’s anxiety and pain through identification of strategies for empowering them and managing their worries.

    Keywords: Anxiety, cesarean section, familiarity operation room surgery, pain, training
  • Rahman Panahi, Peyman Namdar, Fatemeh Samiei Siboni, Somayeh Fallah, Mohammad Anbari, Leila Dehghankar*, Leili Yekefallah, Mahya Shafaei Page 241
    BACKGROUND

    Health literacy plays an important role in adopting preventive behaviors. Considering the relatively high prevalence of breast cancer in women, this study aimed to assess the association between health literacy and adopting the preventive behavior of breast cancer in Iran.

    METHODS

    This was a descriptive, cross‑sectional study, in which 375 female students at Imam Khomeini International University in Qazvin in the academic year of 2018–2019 were selected through a stratified random sampling method. Demographic and background questionnaire, the standard questionnaire of Health Literacy for Iranian Adults in addition to another questionnaire for measuring breast cancer preventive behaviors, were used for collecting data. Data were analyzed using SPSS 22 using descriptive statistics and logistic regression.

    RESULTS

    The mean of the breast cancer preventive behaviors and health literacy were 8.92 ± 1.82 out of 16 and 70.80 ± 12.49 out of 100. Regression results showed that there was a statistically significant association between the adoption of breast cancer preventive behaviors and physical activity (P < 0.001) and health literacy (P < 0.018). Accordingly, the chance for adopting the preventive behaviors in good level among students with rare and without physical activity was 0.105 and 0.100 times, respectively, more than students who had been doing physical activity on a daily basis. Moreover, the same chance among students with adequate and very adequate health literacy was 1.802 and 2.169 times more than students with inadequate health literacy.

    CONCLUSION

    The results indicated that students with lower levels of health literacy and less physical activity had shown less tendency to adopt preventive behaviors of breast cancer. Therefore, special attention should be paid to health literacy (HL), particularly physical activity, application of health information, and assessment in students when designing educational programs to prevent breast cancer.

    Keywords: Breast cancer, health literacy, preventive behavior
  • Javad Yoosefi Lebni, Mahnaz Solhi*, Farbod Ebadi Fard Azar, Farideh Khalajabadi Farahani Page 242
    INTRODUCTION

    One of the most thought‑provoking problems in the world is child marriage that is affected by various factors. Therefore, the purpose of this study is to identify the social determinants of child marriage in Kurdish regions of Iran.

    MATERIALS AND METHODS

    This qualitative study was conducted using conventional content analysis approach. The participants of the study were 30 Iranian‑Kurdish women married under the age of 18 who were selected through purposeful and snowballing sampling. Data collection was conducted through semi‑structured interviews and face‑to‑face interviews and continued until the saturation of concepts was achieved. Graneheim and Lundman method was used to analyze the data, and Guba and Lincoln criteria were used to strengthen the research.

    RESULTS

    In general, findings include 5 categories and 17 subcategories: 1 – economic factors (financial problems and economic benefits); 2 – sociocultural factors (social customs, cultural beliefs, community encouragement, social learning, gaining prestige, and social support); 3 – individual factors (physical characteristics, personality traits, lack of awareness of the damaging consequences of early marriage, and fear of the future); 4 – family factors (dysfunctional family, weak awareness of parents, and harm prevention); and 5 – structural factors (high demand, limited access to educational services, and the lack of supportive social and legal structures).

    CONCLUSION

    By raising the level of awareness and attitude of girls and their families about the consequences of early marriage, creating the culture of correcting cultural beliefs and social misconceptions, passing appropriate laws, and the use of local and national media to prevent child marriage, this social harm can be reduced.

    Keywords: Child marriage, health promotion, Kurdish girls, qualitative study, social determinants
  • Deepshikha David, Simarjeet Kaur*, Adiba Siddiqui, Jyoti Sarin Page 243
    INTRODUCTION

    Educational interventions have been associated with improved performance and significant changes, especially in perinatal outcomes. Teaching is one of the main components in educational planning which is a key factor in conducting educational plans through various teaching strategies such as simulation, demonstration and video teaching.

    AIM

    The study aimed to assess lecture cum demonstration (LCD) versus video‑based teaching (VBT) regarding active management of the third stage of labor (AMTSL) in terms of knowledge and skills of General Nursing Midwifery (GNM) students.

    METHODS

    This was a quasi‑experimental study conducted on 100 GNM third‑year students selected by purposive sampling and randomly assigned to LCD (n = 50) and VBT (n = 50) groups. Sample characteristics performa, Structured Knowledge Questionnaire, and observational checklist were used to collect data from GNM students through self‑report and observational technique.

    RESULTS

    The study results showed that the mean posttest knowledge scores of LCD (17.32 ± 2.14) and VBT group (16.90 ± 2.41) were nearly equal and mean rank posttest skills score of LCD group (54.40) was slightly higher than VBT group (49.51), but computed “ t ” value of mean posttest knowledge and computed “ Z ” value of skill score of both LCD and VBT group (0.47, 0.54) were found to be statistically non‑significant at 0.05 level of significance.

    CONCLUSION

    It can be concluded that both LCD and VBT were found to be effective in improving knowledge and skills of GNM students regarding AMTSL.

    Keywords: Efficacy, lecture cum demonstration, video‑based teaching, knowledge, skills, Active managementof third stage of labour
  • Akram Parandeh*, Fatemeh Rahmati-Najarkolaei, Mohsen Saberi Isfeedvajani Page 244
    BACKGROUND

    Nurses’ knowledge and Experience with Health Literacy can affect the treatment process, improving the quality of health care and effectively communicating with all clients. Evaluation of nurses’ knowledge and experience requires a reliable instrument. This study aimed to translate cross‑cultural adaptation and testing of Health Literacy Knowledge and Experience Survey (HL‑KES).

    MATERIALS AND METHODS

    This cross‑sectional methodological study was done during 2018–2019. The study was carried out in two stages: the first phase was designed to obtain a translation and cross‑cultural equivalent of the (HL‑KES), based on the World Health Organization (2018) and the Sousa and Rojjanasrirat (2011) Guidelines in six steps: preparation, forward translation, reconciliation, back translation, back translation review and pretesting and cognitive debriefing of the translated questionnaires. The second phase was conducted to evaluate the psychometric properties of the questionnaire.

    RESULTS

    The content validity index and content validity ratio values of all items were >0.62 and 0.79, respectively. Based on the Kuder–Richardson formula, the reliability of the knowledge dimension was reported as 0.7. Furthermore, split‑half coefficient for inter‑rather reliability and test–retest were 0.76 and 0.96, respectively. The reliability of their experiences with the HL‑KES was measured using Cronbach’s alpha, in which it was 0.82.

    CONCLUSIONS

    The Persian version of the instrument for assessing nurses’ knowledge and experience with health literacy had good validity and reliability. It is recommended that it should be used in educational, clinical environments, and also in future research studies.

    Keywords: Assessment instrument, cross‑cultural, knowledge, nursing, psychometric properties, reliability, validity
  • Masoomeh Latifi, Sohrab Salimi, Nader Alishan Karami, Nasrin Davari Dolatabadi, Leili Allahbakhshian Farsani* Page 245
    BACKGROUND

    Designing information systems will increase the efficiency and effectiveness of the system according to the information needs of the stakeholders. The present study examined the effective features of designing the information system of medicinal plants from the perspective of its users as a prerequisite for the design of this system.

    MATERIALS AND METHODS

    This applied research was carried out using survey method and a researcher‑made questionnaire. The study population consisted of two groups of information users (faculty members, students, and researchers of medicinal plants) and information disseminators (librarians), and 308 individuals were selected by cluster sampling from five universities. Data analysis was performed using descriptive and inferential statistics using SPSS software version 22.

    RESULTS

    The results showed that in view of the two groups of users, there was a significant difference in the search options in the database of medicinal plants and the displaying characteristics of the search results. On an average, the rank of the two groups in these two domains was largely different. In other cases, the users considered shared features for capabilities and facilities in an information system of medicinal plants.

    CONCLUSION

    According to the results, for obtaining the information system of medicinal herbs with better capabilities and facilities, it is essential for designers to pay attention to all elements and objections in the interaction of the human and the system, especially in the field of search.

    Keywords: Characteristics, information system, medicinal plants, users
  • Nooredin Mohammadi, Naiemeh Seyedfatemi, Alireza Nikbakht Nasrabadi, Mokhtar Mahmoudi* Page 246
    BACKGROUND

    The current nursing shortage is complicated because of turnover intention among nurses. Most of the inactive nurses returned to professional nursing practice. Returned to professional nursing practice program was low attrition rates and a more cost‑effective strategy that prepared inactive nurses returning to practice. This study aimed to explain the process of returned to professional nursing practice.

    MATERIALS AND METHODS

    This study was a grounded theory study, which lasted from about 2018 to 2020. Data were collected through semi‑structured interviews and observations with participants after signing an informed consent form. The average interview duration was 45 min. The study participants were selected through purposeful sampling from both public and private hospitals affiliated to Iran University of Medical Sciences. Interviews were verbatim transcribed and analyzed using a constant comparative analysis method.

    RESULTS

    In this study, 16 participants were selected, including ten nurses, two educational supervisors, two head nurses, and two matrons. The “transformed competence” as the core concept and the four main concepts of “feeling alienated with the new environment,” “getting prepared for restart,” “gradual maturity in clinical practice,” and “components of organizational culture” were extracted from the data analysis process.

    CONCLUSION

    The process of returned to professional nursing practice in the context of the organizational culture of incentive learning leading to a high level of competence, and in the context of the organizational culture of inhibiting learning, is leading to deficiency incompetence.

    Keywords: Nurse, nursing programs, personnel turnovers, return to work
  • Zohreh Sedghy, Naser Yoosefi, Ali Navidian* Page 247
    BACKGROUND AND OBJECTIVE

    Unless mental health care is provided to suicide attempters after discharge from the emergency department, suicide prevention opportunities may be lost. The purpose of this study was to determine the effect of motivational interviewing (MI)‑based training on using mental health services and reducing the severity of suicidal thoughts.

    METHODS

    This quasi‑experimental study was performed on seventy suicide attempters who had been admitted to the emergency department of three university hospitals in Southeast Iran in 2019. Eligible patients were chosen through convenience sampling, and they were randomly divided into the experimental (n = 35) and control (n = 35) groups. The intervention group received three MI sessions on the day of discharge and the 1st week after discharge. Twelve weeks after the intervention, the Beck Scale for Suicidal Ideation and the using mental health services were completed in both the groups. Data were analyzed using Chi‑squared test, independent t‑test, and paired t‑test.

    RESULTS

    While there was no significant difference between the two groups in terms of the mean score of suicidal ideation on the pretest, the experimental group experienced a significant decrease in this respect at the end of the study; thus, this group scored 8.86 ± 5.30, which is considerably lower than that obtained in the control group (15.85 ± 6.65) (P = 0.0001). Furthermore, at the end of the study, the rate of using mental health services increased much more in the experimental group than in the control group (P = 0.01).

    CONCLUSION

    MI training had a significant positive impact on mitigating suicidal ideation and promoting mental health services use. To improve mental health and to better serve suicidal individuals, it is recommended that short‑term interventions be developed in the form of post‑discharge education for suicidal patients admitted to the emergency department.

    Keywords: Emergency department, mental health, motivational interviewing, suicidal ideation, suicide attempt
  • Sudip Bhattacharya*, Amarjeet Singh Page 248

    Due to the short span available for consultation with clinicians, patients try to become well versed with their clinical conditions before the medical consultation. They search Google for their medical information; here comes the problem of authenticity of the sources. It is very difficult to obtain authentic medical information for the patients from the Internet. As a result, sometimes, patients ask questions to the overburdened doctors and irritate them. To solve this problem and wider dissemination of authentic medical knowledge, the existing website of Post Graduate Institute of Medical Education and Research (PGIMER) has been utilized. In PGIMER, Chandigarh, health education materials in text and video formats have been uploaded on the PGIMER website for empowering patients. All these have been successfully tested in the outpatient departments of PGIMER, Chandigarh. To our knowledge, this unique approach is the first of its kind in India. We hope this approach of sharing medical information through the PGIMER website may help patient empowerment to a large extent. Later, this concept can be replicated in all medical colleges in India.

    Keywords: Artificial intelligence, health education, medical institutions, website
  • Soni Rajput*, Amit Kumar, Manjunath P. Puranik, Namita Shanbhag Page 249
    CONTEXT

    Empathy is considered to be backbone of the patient–physician relationship. The consultation and relational empathy (CARE) measure is widely used internationally to measure empathy. However, no validated tool is available to gather patient feedback on dentists’ empathy in India.

    OBJECTIVE

    The objective of this study was to explore the reliability and validity of a CARE measure and to assess the factors influencing CARE score and to determine if there was an association between their CARE score and satisfaction of the patient. SETTING AND DESIGN: A cross‑sectional study was done in dental colleges. SUBJECTS AND

    METHODS

    A questionnaire study was carried out among 100 patients from 6 dental colleges in Bangalore using validated CARE measure. STATISTICAL ANALYSIS: Internal consistency of items was evaluated by the Cronbach’s alpha, and construct validity was assessed by confirmatory factor analysis. Satisfaction was assessed by a question response on 5‑point Likert scale. Descriptive and inferential statistics were performed with significance set at 5%.

    RESULTS

    The mean CARE score was 43.80 ± 5.36. Internal reliability was high (Cronbach’s alpha: 0.859) and was reduced by the removal of any of 10 items. High corrected item‑total correlations ranged from 0.752 to 0.847. Factor analysis showed a single solution with high item loadings (>0.80). Self‑perception of overall health (odds ratio [OR] = 3.78), relationship with family (OR = 4.61) and friends (OR = 3.78), and previous dental experience (OR = 16.00) were more likely, whereas dentist‑provided treatment (OR = 0.20), number (OR = 0.07) and dental treatment taken (OR = 0.13), presence of anxiety (OR = 0.03), and fear (OR = 0.05) were less likely to have CARE score. The satisfaction of the patient regressed significantly with the relationship with family members (ß = 0.77) and CARE score (ß = 0.21).

    CONCLUSION

    This study confirms the educational opportunity and implementation of CARE in dental students. CARE scores among patients varied depending on personal factors and dental treatment‑related factors. The satisfaction of the patient was influenced by the relationship with family members and CARE scores.

    Keywords: CARE measure, dentist, empathy, factor analysis, India, students
  • Mohsen Poursadeqiyan, Edris Bazrafshan, Maryam Feiz Aref* Page 250
    INTRODUCTION

    Spread of novel coronavirus (severe acute respiratory syndrome coronavirus 2 [SARS‑CoV‑2]) has become a global and pandemic crisis. Some measures such as excessive use of disinfectants, increased production of nonbiodegradable waste, and water pollution will be the consequences of fighting against coronavirus disease 2019 (COVID‑19), which harms the environment. Due to the fact that these effects will be identified in the long term, they may be neglected in the current situation. Therefore, the aim of this study was to investigate the environmental challenges caused by the SARS‑CoV‑2 pandemic crisis.

    MATERIALS AND METHODS

    This was a review study conducted by search in databases, including Scopus, PubMed, and science direct until early May 2020. Keywords included “SARS‑CoV‑2,” “COVID‑19,” and “Environment.” Studies published in English and conducted in different countries were also selected for the analysis. The guidelines published by reputable organizations such as the World Health Organization, the Centers for Disease Control prevention (CDC), and the Ministry of Health have also been used in this study.

    CONCLUSION

    The results of this study have shown that the COVID‑19 virus, in addition to human damage and mortality, also affects the environment, and the damages and losses resulting from this pandemic may be identified later. Water pollution, increasing chemical pollution in the air, and increasing the production of nonbiodegradable waste are of these issues. For this purpose, it is recommended that, in addition to trying to improve the control of this pandemic, other environmental aspects in disinfection methods and disposal of dry and wet contaminated waste should be done more accurately and based on standard protocols. Infectious waste, in addition to the problem of standard sanitation, will become a major challenge that pollutes the environment. Based on this, it can be said that if home quarantine is observed voluntarily, in addition to reducing the risk of the SARS‑CoV‑2 and reducing the volume of visits to medical centers, it can be associated with another positive achievement, which is the reduction in waste production and protection of the environment.

    Keywords: Corona virus, coronavirus disease 2019, environment, pandemic, severe acute respiratory syndromecoronavirus 2
  • Masoumeh Hosseinpanahi, Mojgan Mirghafourvand, Azizeh Farshbaf‑Khalili, Khalil Esmaeilpour, Masoumeh Rezaei, Jamileh Malakouti* Page 251
    INTRODUCTION

    Infertility by creating a disturbing and debilitating condition is considered as an important individual, public, and social health problem. The purpose of this study was to determine the effect of counseling based on acceptance and commitment therapy (ACT) on mental health and quality of life in infertile couples.

    METHODS

    In this randomized controlled trial, 54 infertile couples referring to the Sanandaj‑Iran Infertility Clinic were assigned into two groups of counseling and control by random blocking with a 1:1 ratio. The consulting group received 8 weekly 90‑min sessions of group counseling based on ACT. The General Health Questionnaire‑28 (GHQ‑28) and Fertility Quality of Life were completed before and 1 month after the completion of the intervention. Primary outcome measures were mean score of mental health and quality of fertility life. Independent t‑test, ANCOVA, and Mann–Whitney U‑test were used to analyze data.

    RESULTS

    There was no significant intergroup difference in demographic information (P > 0.05). One month after the end of the intervention, the mean overall mental health score in the couples of the counseling group was significantly less than the control group (adjusted mean difference [aMD]: −8.4; 95% confidence interval [CI]: −10.4–−6.4; P < 0.001). Furthermore, the mean overall score of quality of life in the counseling group couples was significantly more than the control group (aMD: 14.8; 95% CI: 11.8–17.9; P < 0.001).

    CONCLUSION

    Based on the effectiveness of counseling based on ACT on mental health and quality of life in infertile couples, it can be used in the infertility clinics. Health‑care providers and counselors should train in the ACT courses to improve the mental health and quality of life of infertile couples.

    Keywords: Acceptance, commitment therapy, counseling, infertile couples, infertility, mental health, qualityof life
  • Bharathnag Nagappa, Yamini Marimuthu*, Gokul Sarweswaran, Manikandanesan Sakthivel, Yuvaraj Krishnamoorthy, Tanveer Rehman Page 252
    CONTEXT

    Harmful use of alcohol has led to 1.7 million deaths from noncommunicable diseases and 1 million injury deaths including road traffic accidents, self‑harm, and interpersonal violence. The opportunistic screening can be used to screen for substance abuse in outpatient department (OPD) attendees of primary health‑care (PHC) settings in India.

    AIMS

    This study was conducted to determine the prevalence of willingness to quit alcohol use among alcohol users and factors associated with it. SUBJECTS AND

    METHODS

    A facility‑based cross‑sectional study was conducted in urban PHCs and willingness to quit alcohol was assessed among the alcohol users. Alcohol Use Disorder Identification Test (AUDIT) scale was used to assess the alcohol use disorder score. Data were entered using Epidata version 3.1 and analyzed using STATA version 14.

    RESULTS

    It is found that two‑third of the male OPD patients are using alcohol and 59% of the alcohol users were willing to quit alcohol. Education (adjusted prevalence rate ratio [aPR] = 1.9; 95% confidence interval [CI]: 1.2–2.9), occupation (aPR = 1.4; 95% CI: 1.1–1.8), higher AUDIT scores (aPR = 2.7; 95% CI: 2.2–3.5), frequency of alcohol use (aPR = 1.6; 95% CI: 1.2–2.0), and positive family history of alcohol‑related illness times (aPR = 1.6; 95% CI: 1.3–2.0) were significantly associated with willingness to quit alcohol.

    CONCLUSION

    Two‑third of the male OPD patients are using alcohol and 59% of the alcohol users were willing to quit alcohol. Education, occupation, higher AUDIT scores, frequency of alcohol use, and positive family history of alcohol‑related illness were significantly associated with willingness to quit alcohol.

    Keywords: Alcohol abuse, Alcohol Use Disorder Identification Test, intention to quit, operational research, willingness to quit
  • Farzaneh Rahimi*, Shadi Goli, Fariba Eslami Page 253
    BACKGROUND

    In the postpartum period, changes in sexual desire and marital satisfaction can be seen. Learning and giving enough information on changes in pregnancy and postpartum can help to increase marital satisfaction. The purpose of this study was to determine the effect of prenatal training on the level of postpartum marital satisfaction in nulliparous women.

    METHODS

    This study is a semi‑experimental two‑group study in which 150 nulliparous women were divided into two groups: control and intervention groups. The samples into intervention group received routine prenatal care and eight sessions of prenatal education with a training package (educational pamphlet on sexual health and sexual issues and an educational CD on pregnancy and pelvic exercises), and the control group received only routine prenatal care along with a pregnancy education pamphlet. Marital satisfaction was measured before intervention during pregnancy and 3 months after delivery (after intervention) using the ENRICH Marital Satisfaction Scale. Data were analyzed using t‑test, paired t‑test, Mann–Whitney, and Chi‑square test.

    RESULTS

    There was no significant difference in demographic and obstetric variables and pregnancy status between the two intervention and control groups (P > 0.05). There was no significant difference in marital satisfaction during pregnancy between the two groups (before intervention) (P > 0.05). However, there was a significant difference in the level of postpartum marital satisfaction in the intervention group (P < 0/05). So that, the average marital satisfaction is increased from 52.2 to 64.6.

    CONCLUSION

    The results of this study show that eight sessions of prenatal education class with a training package (educational pamphlet on sexual health and sexuality and training CD of prenatal and pelvic floor exercise) can improve postpartum marital satisfaction in women.

    Keywords: Childbirth, education, postpartum, pregnancy, sexual satisfaction
  • Masoumeh Alidosti, Elahe Tavassoli* Page 254
    INTRODUCTION

    Oral health is a very important issue for different groups, especially adolescents. Social cognitive theory seeks to describe and promote people’s health behaviors in a variety of ways. The aim of this study was to determine the role of self‑efficacy, outcome expectation, and outcome expectancy in promoting oral health behaviors in adolescent girls in Shahrekord.

    METHODS

    The present study was performed as an intervention in junior high schools in Shahrekord (school year: 2018–2019). Using cluster sampling method, a total of eighty adolescent girls studying in Shahrekord public schools were selected and randomly divided into two groups of intervention and control. A researcher‑made questionnaire was used to collect data on demographic variables, outcome expectation, and outcome expectancy constructs. In addition, a checklist was used to assess the status of oral health among the participants. Education for the experimental group was held in four sessions, each lasting 50–60 min. The data required for the study were collected in three stages: before the intervention, immediately after, and 2 months after the intervention. Using SPSS statistical software version 18, the collected data were analyzed through paired t‑test and analysis of variance via repeating the observations.

    RESULTS

    There was no significant difference between the two groups in terms of demographic variables. Before the intervention, there was no significant difference between the two groups in terms of the mean scores of outcome expectation, outcome expectancy, and self‑efficacy; however, after the intervention, there was an increase in the scores of the experimental group (P < 0.001). Two months after training, there was also a significant increase in the mean score of oral health behavior in the experimental group (P < 0.001).

    CONCLUSION

    Training based on perceived self‑efficacy, outcome expectation, and outcome expectancy played an important role in creating the desired attitude toward oral health‑promoting behavior among students.

    Keywords: Adolescent, oral health, outcome expectancy, outcome expectation, perceived self‑efficacy
  • Hamideh Ehtesham, Reza Safdari*, Arash Mansourian, Shahram Tahmasebian, Niloofar Mohammadzadeh, Sara Pourshahidi Page 255
    BACKGROUND

    Oral soft tissue diseases include a broad spectrum, and the wide array of patient data elements need to be processed in their diagnosis. One of the biggest and most basic challenges is the analysis of this huge amount of complex patient data in an increasing number of complicated clinical decisions. This study seeks to identify the necessary steps for collecting and management of these data elements through establishing a consensus‑based framework.

    METHODS

    This research was conducted as a descriptive, cross‑sectional study from April 2016 to January 2017, which has been performed in several steps: literature review, developing the initial draft (v. 0), submitting the draft to experts, validating by an expert panel, applying expert opinions and creating version v.i, performing Delphi rounds, and creating the final framework.

    RESULTS

    The administrative data category with 17 and the historical data category with 23 data elements were utilized in recording data elements in the diagnosis of all of the different oral diseases. In the paraclinical indicator and clinical indicator categories, the necessary data elements were considered with respect to the 6 main axes of oral soft tissue diseases, according to Burket’s Oral Medicine: ulcerative, vesicular, and bullous lesions; red and white lesions of the oral mucosa; pigmented lesions of the oral mucosa; benign lesions of the oral cavity and the jaws; oral and oropharyngeal cancer; and salivary gland diseases.

    CONCLUSIONS

    The study achieved a consensus‑based framework for the essential data element in the differential diagnosis of oral medicine using a comprehensive search with rich keywords in databases and reference texts, providing an environment for discussion and exchange of ideas among experts and the careful use of the Delphi decision technique.

    Keywords: Clinical data management, dental informatics, differential diagnoses, oral medicine
  • Mohsen Kolahdouzan, Mohsen Mahmoudieh, Mehdi Rasti, Athar Omid*, Arvin Rostami, Nikoo Yamani Page 256
    INTRODUCTION

    Teaching is one of the most important needs of human societies, and selecting the best method of teaching is so important to improve the teaching as well as learning of students. The purpose of this study was to determine the effect of case‑based teaching (CBT) and flipped classroom methods in comparison with lecture method on students’ learning and satisfaction at internship of Department of General Surgery, Isfahan University of Medical Sciences.

    MATERIALS AND METHODS

    This experimental study was performed on fifty medical surgery internship students in Isfahan University of Medical Sciences in 2017. Students were randomly divided into two groups of control group and intervention group. The data were collected by a posttest after holding every class and a researcher‑made form for evaluating students’ satisfaction after the end of the project. The results of this study were analyzed by SPSS 21 software using descriptive statistical methods (mean and standard deviation) and paired t‑test.

    RESULTS

    The comparison of the mean posttest scores in the three classes showed that the mean scores of the students in the intervention group in the first and second sessions unlike the third session were higher than that in the control group; this difference was statistically significant in the first session (P = 005) and the third session (P = 0.002). Students’ satisfaction with case‑based learning method (4.03 ± 0.87) was higher than that of lecture method (2.88 ± 0.78).

    CONCLUSION

    In CBT and flipped classroom, students’ learning and the quality of teaching were improved. In addition, students were more satisfied with this method in comparison with the lecture method. However, it should be noted that the success of using this teaching method depends on choosing the appropriate subject.

    Keywords: Case‑based teaching, flipped classroom, lecture
  • A. V. Ancy, Prabha Thangaraj*, Kumaraswamy Hemalatha, M. Bethubarani Page 257
    BACKGROUND

    Medical students should have adequate knowledge on tuberculosis (TB) and national guidelines pertaining to its control, which is a major public health problem in developing countries. The present study aims to evaluate the knowledge on TB and Revised National TB Control Programme (RNTCP) among medical interns and the change in the level of knowledge following the dissemination of self‑directed learning (SDL) modules using an e‑learning tool (WhatsApp).

    MATERIALS AND METHODS

    A prospective, nonrandomized, pre‑ and posttest study was done among 124 medical interns in a private medical college during July–August 2019. A semi‑structured, self‑administered questionnaire was prepared and filled by the interns in the pretest. Following the educational intervention, the same questionnaire was administered and posttest data were collected. The pre‑ and posttest results were expressed in frequency and percentage. Wilcoxon signed rank test was used to compare the change in the total mean score of knowledge using the e‑learning tool following the dissemination of SDL modules.

    RESULTS

    The mean age of the interns was 22.82 ± 0.82 years. Of the total 124 interns, 60 (48.3%) had heard about the recent changes in RNTCP. The Internet (25.8%) and textbooks (23.4%) were the most common source of recent information regarding TB and RNTCP. The mean pretest score was 12.9 ± 3.08, which increased to 15.3 ± 2.62 during the posttest (z = −9.75, P < 0.05) following the intervention.

    CONCLUSIONS

    The knowledge regarding TB and RNTCP among the interns was inadequate. The usage of an e‑learning tool “WhatsApp” was found to be effective in improving the knowledge in posttest as compared to pretest.

    Keywords: E‑learning, interns, Revised National Tuberculosis Control Programme, tuberculosis
  • Nasrin Galehdar, Maryam Ehsani, Alireza Irajpour, Soheila Jafari-Mianaei* Page 258
    BACKGROUND

    Assessing how programs are implemented from the perspective of the learners themselves is one of the most effective ways to improve the quality of continuing education. The aim was to evaluate the implementation of in‑person continuing education programs from the perspective of nurses.

    METHODOLOGY

    Setting of the study was the selected hospital of Isfahan University of Medical Sciences (Al‑zahra hospital). This study is a descriptive cross‑sectional one. Using a researcher‑made questionnaire, the implementation of continuing education programs in four areas of the aim, educational techniques, educational content, and educational field was evaluated. The sample consisted of 236 nurses working in these hospitals who participated in the study through convenience sampling. Data were analyzed by SPSS software version 19 using descriptive statistics.

    RESULTS

    Based on the results, “the need for new content learning” was mentioned as the first priority in continuing education programs. The majority of participants scored each of the following domains (aim, educational techniques, educational content, and education field) as well as all items related to the continuing education program evaluation as “moderate.”

    CONCLUSION

    Most nurses assessed the implementation of in‑person continuing education programs implemented in Isfahan University of Medical Sciences in general and in each of the domains as “moderate.” Therefore, in order to improve the quality of programs, it is necessary to take steps to match the goals with the needs of learners, improve teaching techniques, improve the quality of program contents, and optimize the scope of the programs.

    Keywords: Continuing education, evaluation, Iran, nurses
  • Nastaran Abbasi, Mohammad Hossein Fallahzadeh*, Mitra Amini, Simin Rezaee, Alireza Goudarzi, Ali Baseri Page 259
    INTRODUCTION

    In order to improve outpatient education, it is necessary to carry out formative standard evaluation to reveal the strengths and weaknesses to improve planning the quality of clinical education. Due to numerous challenges in clinical education, the present study was conducted to determine the extent to which outpatient education standards were achieved in the major departments of Shiraz Medical School.

    METHODS

    In this quantitative combined, cross‑sectional and practical investigation in the academic year 2018–2019, 178 interns who had passed the outpatient education in the four major wards (internal medicine, pediatrics, gynecology, and surgery) in Shiraz Medical School were randomly selected. A 26‑item researcher‑made questionnaire, based on the Handbook of the Ministry of Clinical Education (Outpatient Education) for Health and Medical Education’s Criteria and indicators, was used in three areas of preparation, timing and implementation; and the psychometric properties of the questionnaire were determined. For quantitative data analysis, SPSS version 22 was used. Furthermore, we performed a qualitative study through semi‑structured interviews with 16 interns and analyzed the data using MAXQDA 10 software.

    RESULTS

    The results of the quantitative study showed that 8.4% of interns evaluated the program as poor, 66.3% moderate, and 25.3% good. The qualitative study showed that number and diversity of patients, instructor’s educational model, and number of interns had a significant role.

    CONCLUSION

    Although the outpatient teaching in the four major departments of Shiraz Medical School was evaluated relatively acceptable, it is far from the ideal point and need to be improved.

    Keywords: Assessment, medical student, outpatient clinics, standard