Journal of Education and Health Promotion
Volume:7 Issue: 1, Apr 2017

Due to the increasing number of elderly and an increase in the number of cases of cancer by age, cancer is a common problem in the elderly. For elderly patients with cancer, the disease and its treatment can have long‑term negative effects on their quality of life (QoL). The purpose of this study was to evaluate the effect of progressive muscle relaxation, body image and deep diaphragmatic breathing on the QoL in the elderly with cancer.

This study was a randomized controlled trial in which 50 elderly patients with breast or prostate cancer were randomized into study and control groups. Progressive muscle relaxation, guided imagery, and deep diaphragmatic breathing were given to the study group, but not to the control group. The effect of the progressive muscle relaxation, guided imagery and deep diaphragmatic breathing was measured at three different time points. European Organization for Research and Treatment of Cancer and QoL Questionnaire‑Core questionnaires was completed before, after and 6 weeks after the intervention for the patients in both groups simultaneously. The data were analyzed by SPSS.

There was statistically significant improvement in QoL (P < 0.001) and physical functioning (P < 0.001) after progressive muscle relaxation, guided imagery and deep diaphragmatic breathing intervention.

The findings indicated that concurrent application of progressive muscle relaxation, guided imagery, and deep diaphragmatic breathing would improve QoL in the elderly with breast or prostate cancer.

In the present era, thesauri as tools in indexing play an effective role in integrating retrieval preventing fragmentation as well as a multiplicity of terminologies and also in providing information content of documents. Goals: This study aimed to investigate the keywords of articles indexed in IranMedex in terms of origin, structure and indexing situation and their Compliance with the Persian Medical Thesaurus and Medical Subject Headings (MeSH).

This study is an applied research, and a survey has been conducted. Statistical population includes 32,850 Persian articles which are indexed in the IranMedex during the years 1385–1391. 379 cases were selected as sample of the study. Data collection was done using a checklist. In analyzing the findings, the SPSS Software were used.

Although there was no significant difference in terms of indexing origin between the proportion of different types of the Persian and English keywords of articles indexed in the IranMedex, the compliance rates of the Persian and English keywords with the Persian medical thesaurus and MeSH were different in different years. In the meantime, the structure of keywords is leaning more towards phrase structure, and a single word structure and the majority of keywords are selected from the titles and abstracts.

The authors’ familiarity with the thesauri and controlled tools causes homogeneity in assigning keywords and also provides more precise, faster, and easier retrieval of the keywords. It’s suggested that a mixture of natural and control languages to be used in this database in order to reach more comprehensive results.

Nonscholastic abilities among medical students are an important area of concern for the health professionals. Very few studies had been conducted in the past with regard to it.

This study was an exploratory study aimed to assess the nonscholastic abilities among medical students in a medical institution in coastal South India.

This study assessed three broad domains of nonscholastic abilities namely personal qualities, interpersonal activities, and communication skills among 106 medical students using a structured questionnaire (27 questions with a total score of 27). The data were analyzed by independent t‑test and linear regression model.

About 41.5% (44) of the subjects were males and 52.8% (56) of them were belonged to 18–19 years age group. Overall mean score of nonscholastic abilities was found to be 19.40 (standard deviation = 3.27). Percentile distribution of subjects is at score 17 (25th percentile), 20 (50th percentile), and 22 (75th percentile). Mean personal quality domain score was found to be proportionately lesser than other domains of nonscholastic abilities. Nonscholastic ability score was significantly associated with marks obtained in the previous examination (P = 0.006). However, linear regression analysis revealed that the presence of family problems (P = 0.005) and alcohol use (P = 0.026) were associated with low nonscholastic ability score among medical students.

Nonscholastic abilities are still a required need in medical student’s career. Further analytical studies will help in identifying the in‑depth evaluation of factors associated with it.

Congenital hypothyroidism and phenylketonuria (PKU) are the most common cause for preventable mental retardation in infants worldwide. Timely diagnosis and treatment of these disorders can have lasting effects on the mental development of newborns. However, there are several problems at different stages of screening programs that along with imposing heavy costs can reduce the precision of the screening, increasing the chance of undiagnosed cases which in turn can have damaging consequences for the society. Therefore, given these problems and the importance of information systems in facilitating the management and improving the quality of health care the aim of this study was to improve the screening process of hypothyroidism and PKU in infants with the help of electronic resources.

The current study is a qualitative, action research designed to improve the quality of screening, services, performance, implementation effectiveness, and management of hypothyroidism and PKU screening program in Isfahan province. To this end, web‑based software was designed. Programming was carried out using Delphi.net software and used SQL Server 2008 for database management.

Given the weaknesses, problems, and limitations of hypothyroidism and PKU screening program, and the importance of these diseases in a national scale, this study resulted in design of hypothyroidism and PKU screening software for infants in Isfahan province. The inputs and outputs of the software were designed in three levels including Health Care Centers in charge of the screening program, provincial reference lab, and health and treatment network of Isfahan province. Immediate registration of sample data at the time and location of sampling, providing the provincial reference Laboratory and Health Centers of different eparchies with the ability to instantly observe, monitor, and follow‑up on the samples at any moment, online verification of samples by reference lab, creating a daily schedule for reference lab, and receiving of the results from analysis equipment; and entering the results into the database without the need for user input are among the features of this software.

The implementation of hypothyroidism screening software led to an increase in the quality and efficiency of the screening program; minimized the risk of human error in the process and solved many of the previous limitations of the screening program which were the main goals for implementation of this software. The implementation of this software also resulted in improvement in precision and quality of services provided for these two diseases and better accuracy and precision for data inputs by providing the possibility of entering the sample data at the place and time of sampling which then resulted in the possibility of management based on precise data and also helped develop a comprehensive database and improved the satisfaction of service recipients.

To evaluate the impact of mother’s literacy on child dental caries based on a national oral health survey in Iran and to investigate the possibility of ecological fallacy in aggregate data analysis.

Existing data were from second national oral health survey that was carried out in 2004, which including 8725 6 years old participants. The association of mother’s literacy with caries occurrence (DMF (Decayed, Missing, Filling) total score >0) of her child was assessed using individual data by logistic regression model. Then the association of the percentages of mother’s literacy and the percentages of decayed teeth in each 30 provinces of Iran was assessed using aggregated data retrieved from the data of second national oral health survey of Iran and alternatively from census of “Statistical Center of Iran” using linear regression model. The significance level was set at 0.05 for all analysis.

Individual data analysis showed a statistically significant association between mother’s literacy and decayed teeth of children (P = 0.02, odds ratio = 0.83). There were not statistical significant association between mother’s literacy and child dental caries in aggregate data analysis of oral health survey (P = 0.79, B = 0.03) and census of “Statistical Center of Statistics” (P = 0.60, B = 0.14).

Literate mothers have a preventive effect on occurring dental caries of children. According to the high percentage of illiterate parents in Iran, it’s logical to consider suitable methods of oral health education which do not need reading or writing. Aggregate data analysis and individual data analysis had completely different results in this study.

One of the challenges in the fiercely competitive space of health organizations is responding to customers and building trust and satisfaction in them in the shortest time, with best quality and highest productivity. Hence the aim of this study is to survey the impact of customer relationship management (CRM) on organizational productivity, customer loyalty, satisfaction and trust in selected hospitals of Isfahan (in Iran).

This study is a correlation descriptive research. Study population was the nurses in selected hospitals of Isfahan and the sampling has been conducted using stratified random method. Data collection tool is a researcher‑made questionnaire of CRM and its effects (organizational productivity, customer loyalty, satisfaction and trust) which its validity and reliability has been confirmed by researchers. Structural equation method was used to determine the impact of variables. Data analysis method was structural equation modeling and the software used was SPSS version 16 (IBM, SPSS, 2007 Microsoft Corp., Bristol, UK) and AMOS version 18 (IBM, SPSS, 2010 Microsoft Corp, Bristol, UK).

Among the dimensions of CRM, diversification had the highest impact (0.83) and customer acquisition had the lowest (0.57) CRM, had the lowest impact on productivity (0.59) and the highest effect on customer satisfaction (0.83).

For the implementation of CRM, it is necessary that the studied hospitals improve strategies of acquiring information about new customers, attracting new customers and keeping them and communication with patients outside the hospital and improve the system of measuring patient satisfaction and loyalty.

Mindfulness may be conceptualized as a dispositional trait which differs across individuals, so this study was, therefore, designed to determine the survey of mindfulness in multiple sclerosis (MS) patients and its association with attachment style.

This was a cross‑sectional study which was conducted in Kashani Hospital affiliated to Isfahan University of Medical Sciences, Iran, in 2013. Samples were 210 adult patients who suffered from MS completed demographic and disease characteristics questionnaire, Five Factor Mindfulness Questionnaire and adult attachment style. The SPSS version 16 software was used to conduct statistical tests including t‑test, NOVA, and Pearson correlation.

The means of age and duration of illness were (33/96 ± 9/5) years and (24/3 ± 6/3) month, respectively. Most patients were married (66/1%), without university education (62/8%) and with incomes suffice (63%). The majority of the patients had received beta‑interferon (55/4%) as their main treatment. The mean ± standard deviation attachment style and mindfulness were 25/6 ± 11/6 and 79/8 ± 25/6, respectively. Furthermore, there was a significant negative correlation between the attachment style score and mindfulness score (P = 0.001, r = −0.32).

The result shows that stronger association between mindfulness and attachment can reflect the beneficial effects of mindfulness interventions on both mindfulness and attachment and it can provide some evidence that mindfulness interventions may enhance secure attachment.

Self‑efficacy is the most influential among factors affecting nurses’ performance. Yet, understanding of the constituent elements of the caring self‑efficacy concept was not considered. This study was to introduce altruism as one of the main aspects of caring self‑efficacy in pediatric nurses.

This is part of a larger study on the concept of caring self‑efficacy conducted with qualitative content analysis approach in Iran. Participants included 27 clinical pediatric nurses and instructors, selected purposively. Data were collected using semi‑structured interviews and analyzed using conventional content analysis method.

Theme “altruism” as one of the main themes extracted from the analysis of the interviews in this study. This theme includes two main categories of “humanistic care” and “caring attitude.”

This paper introduces altruism as one of the values aspects of caring self‑efficacy in pediatric nurses. Efficient nurse with features Humanistic care, through the provision of maternal care and family‑centered care and caring attitudes resulting from religious beliefs and loving children to care for the children.

Understanding the association between psychological affective disturbances and anthropometric parameters, including body mass index (BMI), is important. These issues may have potential preventive effects on weight reduction in relation to different aspects of women’s lifestyles and psychopathological states. The present study aimed to predict BMI based on psychological factors including; depression, anxiety, dietary restraint, and nutritional habits, in a sample of women with sedentary jobs in several Iranian governmental organizations.

Two hundred consecutive women aged over 25 years, working on sedentary or low standing works such as banker, teachers, and employee in the social security organizations in Isfahan, Iran, were entered the study. To assess the severity of depression and anxiety symptoms, the Beck Depression Inventory II and the State‑Trait Anxiety Inventory were used, respectively. To assess nutritional habits, a self‑administered questionnaire was designed, and to evaluate dietary restraint status, the Ruderman questionnaire was used. To find the co‑relationship between BMI and each of the psychological components, Pearson’s correlation coefficient test was applied.

To assess the relationship between BMI and each of the psychological components, a multivariate regression model was used. Only two components of nutritional habits (b = −0.19, P < 0.001) and dietary restraint (b = 0.51, P < 0.001) could effectively predict BMI in Iranian women; while depression and anxiety components had low predictive values for predicting BMI. In total, these four variables could predict 34% of the variance of the dependent indicator (BMI).

Nutritional habits and dietary restraint have high value for predicting BMI status in women aged more than 25 years working in sedentary jobs, while BMI status could not be predicted by assessing depression or anxiety severity.

Multiple sclerosis (MS) could be considered as one of the most common chronic disorders of the central nervous system. However, patient education tasks in this group are a challenge for health care provider team but due to increase in the incidence of MS, a new category of contact, care, and education seems to be useful. Hence, the aim of this study was to compare the effect of electronic education and illustrated booklet on knowledge of patients with MS.

This was a quasi‑experimental research was carried out on 120 patients with MS from January 2013 to July 2013. All patients attended MS clinic located at the Ayatollah Kashani Hospital conducted to Isfahan Neurosciences Research Center (INRC). Patients were divided randomly into two equal groups: (1) Electronic education (n = 60) and (2) illustrated booklet (n = 60). Participants’ knowledge score was collected according to the researcher‑made questionnaire with 40 questions. Data were analyzed using Student’s t‑test and paired t‑test through SPSS (version 11.5) with a significance level of P < 0.05.

Although there was not any significant difference between the knowledge score of electronic education and illustrated booklet group before intervention (18 ± 2.2 vs. 17.01 ± 3.4(, (P = 0.434, t = −5.64), but there was a significant difference after 2 weeks intervention (35.74 ± 1.4 vs. 33.74 ± 3.4), (P = 0.021, t = −6.64). Paired t‑test showed a statistically significant difference in the knowledge level in both groups after intervention as follow: (1) Electronic education (18 ± 2.2 vs. 35.74 ± 1.4), (P = 0.024, t = −7.55) and illustrated booklet (17.01 ± 3.4 vs. 33.74 ± 3.4), (P = 0.003, t = −8.55).

The electronic educational program applied in this study appears increased knowledge of patients with MS. Therefore, the conveyance of this program to earn time for patient and healthcare provider team is suggested as a valuable and appropriate teaching method.

Multiple sclerosis (MS) occurs with a variety of physical and psychological symptoms, yet there is not a conclusive cure for this disease. Complementary medicine is a current treatment which seems is effective in relieving symptoms of patients with MS. Therefore, this study is aimed to determine and compare the effects of reflexology and relaxation on anxiety, stress, and depression in women with MS. Subjects and

This study is a randomized clinical trial that is done on 75 women with MS referred to MS Clinic of Kashani Hospital. After simple non random sampling, participants were randomly assigned by minimization method to three groups: reflexology, relaxation and control (25 patients in each group). In the experimental groups were performed reflexology and relaxation interventions within 4 weeks, twice a week for 40 min and the control group were received only routine treatment as directed by a doctor. Data were collected through depression anxiety and stress scale questionnaire, before, immediately after and 2 months after interventions in all three groups. Chi‑square, Kruskal–Wallis, repeated measures analysis of variance and one‑way analysis of variance and least significant difference post hoc test via SPSS version 18 were used to analyze the data (P < 0.05) was considered as significant level.

The results showed a significant reduction in the severity of anxiety, stress and depression during the different times in the reflexology and relaxation groups as compared with the control group (P < 0.05).

The results showed that reflexology and relaxation in relieving anxiety, stress and depression are effective in women with MS. Hence, these two methods, as effective techniques, can be recommended.

The need for a correct follow‑up for medical advices of health givers is the cornerstone for avoiding drug‑related complications in especial period of elderly people life. There isn’t any data about drug therapy regimens adherence of elderly people of Isfahan. In this study, we aimed to cover this deficit.

In this cross‑sectional study which was carried out in Isfahan (Iran) in 2013 senior citizens (aged 65 or more) who were taking at least one medication and had no record of residency in nursing homes were included. We used Morisky medication adherence scale (after validation and reliability assessment for using this questionnaire in Persian language) to evaluate the level of adherence in the study population.

A total of 200 elderly participants were fully studied (n = 200, 61% females), and 52% of them had poor medication adherence. 77.5% of participants were suffered from at least four medical illnesses, and 18.5% of them were taking more than eight medications per day. We have not found any significant statistical relationship between vision or hearing loss disorders and the medication adherence of the participants). There was a significant positive relationship between the level of education and medication adherence (P = 0.001), (2 = 0.29).

Low Medication adherence is a common and important drug issue in the elderly in Isfahan. This issue can lead to medical complications and huge cost if it is not addressed appropriately.

Concept map is a useful cognitive tool for enhancing a student’s critical thinking (CT) by encouraging students to process information deeply for understanding. However, the evidence regarding its effectiveness on nursing students’ CT is contradictory. This paper compares the effectiveness of concept mapping and traditional linear nursing care planning on students’ CT.

An experimental design was used to examine the CT of 60 baccalaureate students who participated in pediatric clinical nursing course in the Shahrekord University of Medical Sciences, Shahrekord, Iran in 2013.

Participants were randomly divided into six equal groups of each 10 student, of which three groups were the control group, and the others were the experimental group. The control group completed nine traditional linear nursing care plans, whereas experimental group completed nine concept maps during the course. Both groups showed significant improvement in overall and all subscales of the California CT skill test from pretest to posttest (P < 0.001), but t‑test demonstrated that improvement in students’ CT skills in the experimental group was significantly greater than in the control group after the program (P < 0.001).

Our findings support that concept mapping can be used as a clinical teaching‑learning activity to promote CT in nursing students.

Information‑seeking anxiety is a feeling caused by abundance of information or failure to proper interpret the information that can adversely affect the ability of individuals for seeking information and meeting their information needs. Therefore, it is necessary to investigate information‑seeking anxiety, factors causing it, and methods for addressing and reducing this type of anxiety. The purpose of this study was to evaluate information‑seeking anxiety in postgraduate students of Isfahan University of Medical Sciences.

This study has been conducted using survey method. A total of 265 postgraduate students of Isfahan University of Medical Sciences were selected with the help of stratified random sampling. Data collection tool was a questionnaire designed for this purpose. The gathered data was analyzed using descriptive and inferential statistics.

The results indicated that the topic selection factor played a more prominent role in creating information seeking anxiety compared to other factors. Apart from students of school of medicine, information seeking anxiety was below average among the students. In addition, there was a significant difference between information seeking anxiety in students from different departments. Finally, female students had higher information seeking anxiety compared to male students.

Although information seeking anxiety among students was lower than average in most cases, further reduction of anxiety could be achieved by facilitating access to information resources and library information services and increasing the quality of students’ information literacy through training courses tailored to each discipline are necessary.

Job stress can impose significant costs to the workplaces and organizations due to some issues such as absenteeism, less productivity, and medical costs. Job overload and lack of decision latitude can lead to job stress. The current study aimed to investigate the job demands and control as predictor of job stress and its relationship, with some of the demographic characteristics of Iranian prison staff.

This study was performed on 171 male employees working in four prisons located in Ilam, Iran. The sampling method was census and all four prisons’ staff were selected to respond the Job Content Questionnaires. Finally, the data were analyzed using t‑test or independent samples test as well as SPSS 20.

The highest amount of job demand (mean = 21.28) and the lowest amount of job control on average (9.76) were reported by those staff working in Darehshahr prison. There was also a significant relationship between job post and job control among the prison staff (β = −0.375, P = 0.001).

The level of job stress reported by prison staff was high in this study mainly caused by high job demand and low job control, especially in Darehshahr prison staff.

Although respecting human dignity is a cornerstone of all nursing practices, industrialization has gradually decreased the attention paid to this subject in nursing care. Therefore, the present study aimed to investigate nurses’ commitment to respecting patient dignity in hospitals of Isfahan, Iran.

This descriptive‑analytical study was conducted in hospitals of Isfahan. Overall, 401 inpatients were selected by cluster sampling and then selected simple random sampling from different wards. Data were collected through a questionnaire containing the components of patient dignity, that is, patient‑nurse relationships, privacy, and independence. All items were scored based on a five‑point Likert scale. The collected data were analyzed using descriptive statistics and Chi‑square tests. P < 0.05 were considered significant in all analyses.

Most patients (91%) scored their relationships with nurses as good. Moreover, 91.8% of the participants described privacy protection as moderate/good. Only 6.5% of the subjects rated it as excellent. The majority of the patients (84.4%) believed their independence was maintained. These subjects also approved of taking part in decision‑making.

According to our findings, nurses respected patient dignity to an acceptable level. However, the conditions were less favorable in public hospitals and emergency departments. Nursing authorities and policy makers are thus required to introduce appropriate measures to improve the existing conditions.

The ability to access, analyze, evaluate, and convey information in various forms of media including print and nonprint requires media literacy, but the capacity to obtain, process, and understand basic information and services needed for appropriate decisions regarding health, considered an important element in a woman’s ability to participate in health promotion and prevention activities for herself and her children, is needed to a level of health literacy. The purpose of this study was to determine the relationship between media literacy and health literacy among pregnant women in health centers in Isfahan.

This study used a descriptive correlation study. Data collection tools include Shahin media literacy and functional health literacy in adults’ questionnaires. The population include pregnant women in health centers of Isfahan (4080 people). Ten out of the 351 health centers in Isfahan were selected as cluster. Data were analyzed using both descriptive and inferential statistics.

Media literacy of respondents in the five dimensions was significantly lower than average 61.5% of pregnant women have inadequate health literacy, 18.8% had marginal health literacy, and only 19.7% of them have had adequate health literacy. There was a significant positive relationship between media literacy and health literacy among pregnant women.

This study showed that the majority of pregnant women covered by health centers had limited health literacy and media literacy. Since one of the basic requirements for the utilization of health information is needed for adequate media literacy, promotion of media literacy is necessary for the respondents.

The medical and nonmedical care of patients is the necessary skills in nursing profession. That it needs proper knowledge and attitude. Hence, it is important to promote nurses’ knowledge and attitude by education based on need assessment. This study aimed to define the efficacy of a medical and nonmedical intervention educational workshop on nurses’ knowledge and attitude until 3 months after holding the workshop in psychiatric wards of educational hospitals in Isfahan.

This is a quasi‑experimental study. The study population comprised all nurses working in psychiatric wards of Nour and Farabi Hospitals (64) in Isfahan in 2012. An educational workshop was held through educational sessions in the form of lectures and group discussion in two above‑mentioned hospitals. Nurses’ level of knowledge and attitude were investigated by a researcher made questionnaire before, immediately after and 3 months after intervention. Data were analyzed by descriptive statistical tests of repeated measure ANOVA and Bonferroni.

A significant increase was observed in mean scores of nurses’ knowledge immediately after and 3 months after education compared to before education (P < 0.001). Also, the mean of attitude score in 3 phases have significant different (P < 0.009). Nurses have the high satisfaction (86.3%) of need assessment based education workshop. Moreover, it is effective in the science information revival of nurses.

Educational sessions notably affected the promotion of nurses’ knowledge and attitude. With regard to nurses’ satisfaction with the workshop which was held, designing and organizing educational workshops based on constant needs assessment is suggested for the promotion of nursing cares.

During the library loan process, the printed resources can be a carrier of pathogenic bacteria. In this study, it was tried to compare the Bacterial Contamination Rates and their antibiotic sensitivity pattern in printed resources of a hospital and a non‑hospital library.

This is a cross‑sectional study. Returning books from the Al‑Zahra hospital library and library of Sciences faculty of Isfahan University provides the research community. The sample size, 96 cases, was calculated using quota sampling. For sampling sterile swab dipped in trypticase soy broth medium and transfer trypticase soy broth medium were used. To identify different type of isolated bacteria from Gram‑staining test and biochemical tests such as; TSI, IMViC and etc., were used.

76 (79.2%) and 20 (20.8%) of cultured samples were negative and positive, the respectively. Of 20 positive samples, 11 samples (55%) belong to the family Enterobacteriaceae that after detecting by Differential teste identified all 11 samples of Enterobacter that all of them were sensitive to Gentamicin and Ofloxacin. Also the most resistance to Nitrofurantoin and Amikacin was observed. 9 cases remained (45%) were coagulase‑negative Staphylococcus that all of them were sensitive to the Trimethoprim‑sulfamethoxazole and Cephalexin antibiotics also the most resistance to Cefixime was observed.

Considering that the Enterobacter sp and coagulase‑negative Staphylococcus were separated from the books, the books as well as other hospital and medical equipment can transmit the infection to librarians, library users, patients and hospital staff, and also it can produce serious infections in patients with immune deficiency.

The rate of caesarean delivery is increasing worldwide. Maternal beliefs may be influential on the mode of delivery. This study aimed to validate pregnant women’s preferences for mode of delivery questionnaire among pregnant women.

This was a cross‑sectional study which was done in Ahvaz Public and Private Health Care Centers. A total of 342 low‑risk pregnant women were included in a study conducted in spring 2011 in Ahvaz, Iran. After careful consideration and performing content and face validity, a 62‑item measure was developed and subjects completed the questionnaire. Reliability was estimated using internal consistency and validity was assessed by performing face, content and structure and discriminate validity. Data were analyzed using explanatory factor analysis, t‑test, and correlations in SPSS 16.

The findings of content and face validity showed almost perfect results for both content validity ratio = 1 and content validity index = 1. The explanatory factor analysis indicated a 7‑subscale measure (Eigenvalue >1, factor loading >0.4), and discriminate validity revealed satisfying results P < 0.05 for 6 out of 7 subscales. Internal consistency as measured by the Cronbach’s alpha coefficient was acceptable for subscales.

In general, the findings suggest that this newly generated scale is a reliable and valid specific questionnaire for assessing pregnant women’s preferences for mode of delivery. However, further studies are needed to establish stronger psychometric properties for the questionnaire.

The expansion of outpatient services and the desire to provide more outpatient care than inpatient care create some problems such as the overcrowding in the outpatient clinics. Given the importance of overcrowding in the outpatient clinics, this qualitative study aimed to determine the factors influencing the overcrowding in the specialty and subspecialty clinic of a teaching hospital.

This was a qualitative study conducted in the specialty and subspecialty clinic of a hospital using content analysis method in the period of January to March 2014. The study population was all managers and heads of the outpatient wards. The studied sample consisted of 22 managers of the clinic wards who were selected using the purposive sampling method. The required data was collected using semi‑structured interviews. The collected data was analyzed using conventional content analysis and the MAXQDA 10.0 software.

Three themes were identified as the main factors affecting the overcrowding including the internal positive factors, internal negative factors, and external factors.

Despite the efforts made to eliminate overcrowding, and reduce waiting times and increase access to the services for patients, the problem of overcrowding still has remained unresolved. In addition, the use of some strategies such as clarifying the working processes of the clinic for staff and patients and the relationships between the clinic and other wards especially emergency department, as well as using a simple triage system on the patients’ arrival at the clinic are recommended.