فهرست مطالب

Education and Health Promotion - Volume:11 Issue: 11, Dec 2021

Journal of Education and Health Promotion
Volume:11 Issue: 11, Dec 2021

  • تاریخ انتشار: 1400/11/01
  • تعداد عناوین: 40
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  • Linda C Odikpo, Vera I Onyekaonwu, Anulika J Afonne Page 444
    BACKGROUND

    COVID‑19 is a contagious disease without any treatment, vaccine, or immunity, which the only way out is the practice of preventive measures. This article assessed the perception and factors influencing the practice of preventive measures to COVID‑19 among nurses in Anambra State, Nigeria. The study objectives include to determine the perception of nurses toward COVID‑19 and to determine factors that influence the practice of preventive measures to COVID‑19 among nurses in tertiary hospitals in Anambra State.

    MATERIALS AND METHODS

    The design for the study was descriptive cross‑sectional survey conducted among 344 nurses in the two tertiary institutions.

    RESULTS

    Three hundred and three (88.1%) nurses had no formal training on COVID‑19 protocol. They have a good perception of the disease as, among others, they (165 [48.0%]) see it to be highly contagious, 207 (60.2%) can recognize symptoms easily, 168 (48.8%) believed that COVID‑19 could be handled professionally based on their experience, 155 (45.1%) responded that there is no vaccine yet for the disease, and 200 (58.1%) responded that patients should not hide their symptoms and travel history to avoid infecting other people. The result on the false benefits has 323(93.9%) who responded that COVID‑19 preventive measures will predispose one to the disease, 319 (92.7%) who responded that the preventive measures will not slow the spread of the disease, 288 (83.7) who responded that it is independent of normalcy returning to areas affected, and 327 (95.1%) who responded that COVID‑19 preventive measures are among the effective ways to mitigate the disease and enhance life sustainability. Some work‑related/institutional and disease‑specific factors influence their practice of preventive measures to COVID‑19. Such factors include the time to use personal protective equipment (PPE) in an emergency (170 [49.4%]), remembering to use PPE (158 [45.9%]), insufficient nursing staff during a shift (158 [43.0%]), and too many responsibilities during a shift (178 [51.7%]).

    CONCLUSION

    With the increasing death as a result of COVID‑19, of which health workers are not immune to, it is essential to annihilate all negative factors that may impede the accurate practices of the preventive measures and also support the nurses with the necessary tools and knowledge to mitigate their exposure to the disease.

    Keywords: COVID‑19, Nigeria, nurses, perception, practice guideline, prevention
  • Leili Rabiei, Soleiman Kheiri, Reza Masoudi Page 445
    BACKGROUND

    The complex, multifaceted care environment and the threatening situation of caring for hemodialysis patients cause tension in their family caregivers. Due to the severe tension, family caregivers are likely to ignore their basic needs and only pay attention to the patient’s needs and related issues. This study was conducted with the aim of designing and evaluating the Perceived Care tension Questionnaire for Caregivers of Hemodialysis Patients (PCTQHFC).

    MATERIALS AND METHODS

    The present study was a sequential exploratory mixed methods study of scale development variant conducted in two phases: qualitative and quantitative. This study was conducted in 2019 in Shahrekord. The qualitative phase included item development and scale development. In the quantitative phase (Item Analysis), the validation characteristics of the tool were examined using face, content and construct validity, and its reliability by internal consistency and stability. Findings were performed using software SPSS 18.

    RESULTS

    Principal components analysis with orthogonal rotation to generate factors, showed that five factors, namely emotional exhaustion, inadequate social support, care burden, confusion and ambiguity and lack of adaptability skills had an eigenvalue of higher than 1, so that they explained, respectively, 75.98%, 61.36%, 72.49%, 76.33%, and 70.31% of the total variance. The internal consistency was obtained 0.811 and the inter‑class correlation coefficient for the whole instrument 0.832.

    CONCLUSION

    PCTQHFC is a culturally appropriate measure with strong psychometric properties. The instrument designed in this study measures the care tension of hemodialysis patients. Therefore, researchers, health‑care providers, and community health policymakers can plan and implement interventions to reduce the tension of caregivers of hemodialysis patients by analyzing and identifying the tensions of caregivers.

    Keywords: Caregivers, hemodialysis patients, Iran, perceived care tension questionnaire, psychometrics
  • Mehri Alizade, Azizeh Farshbaf Khalili, Jamileh Malakouti, Mojgan Mirghafourvand Page 446
    BACKGROUND

    Worldwide, AIDS is an acute problem. Health Belief Model (HBM) is a model for prevention and control of diseases. This study examined the predictors of preventive behaviors of HIV/AIDS based on HBM constructs in participants.

    MATERIALS AND METHODS

    This cross‑sectional study was performed on 200 women who were referred to vulnerable women’s centers across Tabriz city between November and December 2018. Participants were selected by census sampling. Inclusion criteria were having a health record, multiple sexual partners, reading and writing skills, and willingness to participate in the study. To collect data, questionnaires of sociodemographic characteristics, HIV knowledge, self‑efficacy for negotiating safe sex, perceived sensitivity, perceived severity, perceived benefits, perceived barriers, and behavioral prevention (BP) were used. The collected data were analyzed using SPSS version 19 through Pearson’s correlation coefficient, one‑way ANOVA, and multiple linear regression analyses. The significant level was set at α = 0.05.

    RESULTS

    Pearson’s correlation test showed a statistically significant correlation between BP and perceived sensitivity (r = 0.25), perceived benefits (r = 0.32), self‑efficacy (r = 0.33), and HIV knowledge (r = 0.25) constructs (P < 0.001). According to the multiple linear regression, perceived sensitivity (P = 0.020), perceived benefits (P = 0.036), and some of the sociodemographic characteristics were found to be predictors of preventive behaviors that explained in total 50% of variance of BP (P < 0.05 and R2 = 0.504).

    CONCLUSION

    It seems that the HBM is useful to predict HIV preventive behaviors among this vulnerable group. Training programs should be aimed on improving the health belief of HIV preventive behaviors.

    Keywords: Behavioral prevention, health Belief Model, HIV
  • Hojjat Sheikhbardsiri, MohammadMahdi Doustmohammadi, Parya Jangipour Afshar, Majid Heidarijamebozorgi, Hamidreza Khankeh, Mehdi Beyramijam Page 447
    BACKGROUND

    Following the global emergency of coronavirus disease 2019 (COVID‑19), health‑care workers, especially nurses were encountered with an increasing workload. Therefore, due to the importance of this issue, the present study aimed to examine stress, anxiety, and depression levels among nurses during the COVID‑19 pandemic in Iran.

    MATERIALS AND METHODS

    This cross‑sectional study was conducted in four educational hospitals affiliated to Kerman University of Medical Sciences in 2020. The standard Depression, Anxiety and Stress Scale‑21 questionnaire was applied to assess the levels of stress, anxiety, and depression in nurse personnel with a census method (n = 403). Data were analyzed using descriptive statistics and analytic statistics such as Kolmogorov–Smirnov, Mann–Whitney, Kruskal–Wallis, and multiple linear regression tests through the version 20, SPSS Inc., Chicago, IL, USA, Software at the level of P < 0.05.

    RESULTS

    The results of the study showed that the mean scores of depressions (9.18 ± 4.45), stress (9.62 ± 4.94), and anxiety (10.32 ± 4.85) in nurses were at moderate level. A significant relationship was observed between stressed, anxious, and depressed participants in the gender, marital status, level of education, and working hours per month. No statistically significant relationship was found between other demographic variables including age, work experience, and employment status with anxiety, depression, and stress categories.

    CONCLUSION

    The results of this study can increase the awareness of health system managers, especially hospitals, about the level of stress, anxiety, and depression and can help in order to provide psychological support programs for improving the mental health of nurses during the COVID‑19 pandemic.

    Keywords: Anxiety, coronavirus disease 2019 pandemic, depression, nurse, stress
  • Esmat Nouhi, Tania Dahesh, Fahimeh Shojaefar Page 448
    BACKGROUND

    Patient education is a key factor in promoting the health of people with acute coronary syndrome (ACS), and the effective use of technology can play an important role in this regard. This study aimed to determine the effectiveness of education using media messages on the lifestyle of patients with ACS.

    MATERIALS AND METHODS

    The present clinical trial was conducted on 91 cases with ACS admitted to the cardiac ward of Afshar Hospital in Yazd, Iran, during 2018–2019, who were randomly assigned to control and intervention groups. The former only was provided with routine training before discharge, while the latter, in addition to routine training before discharge, received education on social networking and sending text/visual messages. At baseline and 3 months after the intervention, the Walker’s Lifestyle Questionnaire was completed. The independent t‑test, paired t‑test, and Chi‑square test were employed for data analysis.

    RESULTS

    The average lifestyle value of the intervention group was significantly higher compared with the control group after the intervention (P ˂ 0.001). Moreover, the lifestyle score was significantly different pre‑ and post‑intervention in the intervention group (P ˂ 0.001).

    CONCLUSIONS

    Education using media messages is useful to promote the lifestyle in cases with ACS, which seems effective in planning the follow‑up for these patients.

    Keywords: Acute coronary syndrome, lifestyle, media messages
  • Mohsen Poursadeqiyan, Maryam Feiz Arefi, Amin Babaei Pouya, Mojtaba Jafari Page 449
    BACKGROUND

    The quality of life (QOL) is essential in all different stages of life; however, It is more important for older people as it can be effective in promoting their health. Therefore, the present study aimed to review the literature on the QOL in the Iranian elderly population.

    MATERIALS AND METHODS

    The study was carried out as a systematic review. For this purpose, all databases were searched in March 2021. The keywords used for the search were “quality of life, elderly, older adults, aging, seniors, and Iran” along with the Persian equivalents. PRISMA protocol was used to screen articles. After removing duplicate and irrelevant items, two evaluators appraised the articles separately based on a researcher‑made checklist derived from the SBEM and STROBE Statement standard checklists.

    RESULTS

    The initial search yielded 3734 studies on the QOL in the Iranian elderly population. After screening and assessing the studies based on inclusion and exclusion criteria, 22 articles remained in the study. Most of the studies (cross‑sectional) were conducted in Tehran using a 36‑item Short‑Form Health Survey to assess the QOL. The studies investigated sociodemographic determinants, physical and health‑related behaviors, and spirituality and psychological determinants of the QOL. The sociodemographic determinants were the most common factors under study. The results showed that the role of gender and socioeconomic status was the strongest among the sociodemographic characteristics. A significant association was found between the QOL in the Iranian elderly population and factors such as depression and religious confrontation.

    CONCLUSION

    In addition to chronic diseases, diseases of the oral and dental, as well as an unhealthy diet, should be considered in the elderly. Therefore, attention should be paid to all social, physical, and psychological variables that affect the QOL of older people.

    Keywords: Aged, health‑related quality of life, Iran, population, systematic review
  • Shahram Yazdani, Maryam Hajiahmadi Page 450
    BACKGROUND

    Over the last few centuries, the overspecialization of various sciences under the pretext of benefiting from pure disciplinary knowledge led to alienation among and competition between different fields of science. Such competition has deviated knowledge from its main objective which is to understand and explain the phenomena. The remedy to this dilemma is to address a new approach, introduced to higher education in the late 1950s as “interdisciplinarity.” Accordingly, the main purpose of this article is to propose the strategic instances of operationalizing interdisciplinarity as the key requirements to provide a guideline for designing interdisciplinarity activities.

    MATERIALS AND METHODS

    The present survey was carried out through the framework synthesis method. To codify the instances of operationalizing interdisciplinarity, the main elements and structures of the model were set as the basis of the query for each element and structure; an independent query was carried out in the literature of the study. The correspondence of the discovered instances was once more compared with the conceptual boxes of the primary theoretical model. Ultimately, the taxonomy was concluded through the operational instances based on the primary framework.

    RESULTS

    A total of 152 strategies were identified as implications of operationalization of 13 layers and 38 sublayers of the multilayer interdisciplinary model.

    CONCLUSION

    The development of interdisciplinarity in the national higher education system requires several measures to be taken at different levels of a discipline or scientific field of study. Relying on this, which is the main basis of entering into interdisciplinarity activities, the present study suggests and presents strategic instances of interdisciplinarity operationalization

    Keywords: Framework, implication, interdisciplinarity, operation, unification of science
  • Sara Carletto, Marco Miniotti, Alberto Persico, Paolo Leombruni Page 451
    BACKGROUND

    Previous studies have reported that medical students show high rates of depression, anxiety, and stress levels, but mixed findings were found regarding possible differences between gender and different years of medical training. This study evaluated depression, anxiety, and stress levels and psychiatric drug use in students in an Italian medical school and investigated the differences between gender and year of study.

    MATERIALS AND METHODS

    This cross‑sectional study included 694 medical students in their 1st (n = 286), 4th (n = 209), and 6th (n = 199) year of study. The questionnaire included demographic information, self‑report questionnaires regarding depression, anxiety, and stress, and questions about psychiatric drug use. Data analysis was performed using SPSS/Ver 22 through descriptive and analytic statistics, including Mann–Whitney U‑test, Fisher’s exact test, and GLM two‑way ANOVA.

    RESULTS

    Depression, anxiety, and stress symptoms were reported by 365 (52.6%), 428 (61.7%), and 545 (78.5%) medical students, respectively. Female students in their 4th year of study reported higher depression levels than males of the same year (P = 0.004), whereas levels of anxiety were higher in 6th‑year female students compared with those in their 1st and 4th years (P = 0.001; P = 0.025). Stress levels were consistently higher in females than in males for all 3 years (1 st year: P = 0.041; 4th year: P < 0.001; 6th year: P = 0.004). No gender differences were found in the use of psychiatric and stimulant drugs.

    CONCLUSION

    This study provides preliminary evidence suggesting the importance of planning interventions aimed at reducing emotional distress among medical students that should be targeted on gender and year of the study.

    Keywords: Anxiety, depression, medical students, mental health, psychological stress, sex
  • Mahesh Mahla, Shweta Talati, Anil Kumar Gupta, Ritesh Agarwal, Shailesh Tripathi, Sudip Bhattacharya Page 452
    BACKGROUND

    The acceptability of hospital staff in the use of hospital information management system (HIMS) is an emerging research area it can explain the fate of any HIMS development and implementation project in hospitals. The aim of this study was to observe the level of acceptance of HMIS among nursing officials working at a teaching hospital.

    MATERIALS AND METHODS

    This cross‑sectional study was conducted for 1 year in a teaching hospital of northern India by using a pretested questionnaire. Our study participants were nursing officers who were not under the probation period and we used a purposive sampling (10% nurses from each ward). Our sample size was 256.

    RESULTS

    We have observed that majority of 174 (67.96%) participants had good acceptability to the HIMS system. Our study revealed that most of the participants were aware of HIMS. Among all participants, nearly half of them had good acceptability to the HIMS system. This is may be due to their job profiles, distribution of their working places, and their past experiences with HMIS. The bottlenecks such as connectivity problem, error prevention, and lack of training can be addressed by the hospital management by proper measures.

    CONCLUSION

    The acceptance level of HIMS among the nursing officials working in a teaching hospital was good.

    Keywords: Administrator, hospital administration, hospital information system, nurse
  • Jafar Bazyar, Siednour Alimoradi, Mohammadreza Seydi, Negar Pourvakhshoori, Jamil Sadeghifar Page 453
    BACKGROUND

    Utilizing the successful experiences of countries and local regions can be useful in the management and control of coronavirus disease‑2019 (COVID‑19), so the research team aims to determine and extract the strengths, weaknesses, opportunities, and threats of the health system in the risk management of COVID‑19 using strengths, weaknesses, opportunities, threats (SWOT) analytical approach.

    MATERIALS AND METHODS

    This study was performed by a qualitative multimethod approach. In addition to reviewing the minutes of meetings and approvals of the Provincial Anti‑Corona Headquarters, focused group meetings and in‑depth semi‑structured individual interviews were conducted. The results were extracted based on the SWOT analytical approach in the form of strengths, weaknesses, opportunities, and threats of the health system and then based on the SWOT matrix, the necessary strategies were identified.

    RESULTS

    In the necessary strategies, based on SWOT matrix in SO strategies: SO1, formation of regional health assessment teams; SO2, promotion of preparedness, resilience, and effective response; SO3, activation of research and training centers; SO4, integrated management, supervision, and coordination; in WO strategies: WO1, analysis and COVID‑19 risk monitoring; WO2, communication and risk information management; WO3, people‑based management; and WO4, activation of local economic institutions and manufacturing centers; in ST: ST1, comprehensive care system strategies; and ST2, enhancing social trust with a transparency approach; and finally in WT strategies; WT1, stress management; and WT2, specific financial system design for disaster management were identified.

    CONCLUSION

    Now, for the prevention and control of this disease, the need of empathy and participation of all human societies is felt more than anything else. These experience and analysis are based on the SWOT approach for the health system to be able to provide solutions and practical points that can be used by stakeholders.

    Keywords: Coronavirus SARS‑CoV‑2, COVID‑19 virus disease, health system, pandemic, risk management, strengths, weaknesses, opportunities, threats analysis approach
  • Leili Yekefallah, Peyman Namdar, Mahya shafaei, Rahman Panahi, Leila Dehghankar Page 454
    BACKGROUND

    COVID‑19 pandemic poses unique physical and emotional challenges in providing clinical education. Failure to identify the challenges and problems that students face in the clinical learning environment hinders their effective learning and growth. Consequently, the progress of their skills is affected. The aim of this study was to develop a challenge in the clinical education environment of medical students during the outbreak of COVID‑19 questionnaire and to test its psychometric properties.

    MATERIALS AND METHODS

    This study is part of a larger study that was conducted using a combined consecutive method in Qazvin. In the first stage, a phenomenological study was performed with van Manen’s method by interviewing 12 students at Qazvin University. To extract the items of the tool in the second stage, the concept was defined. Ultimately, the psychometric properties of the questionnaire were evaluated with face validity, content validity (quantitative and qualitative), construct validity (exploratory factor analysis), internal consistency (Cronbach’s alpha), and test–retest reliability (intraclass correlation coefficient).

    RESULTS

    The initial tool had 70 questions. After validation, 53 items remained in the final questionnaire. Four extracted dimensions were as follows: “Inadequate professional competency,” “Inefficient clinical planning” and “outcomes of learning‑teaching activities,” and “the challenges related to the stigma of medical staff.” Cronbach’s alpha for the whole questionnaire was 0.98 (range: 0.87–0.98). The test–retest (intraclass correlation coefficient) reliability was 0.98 (P < 0.001).

    CONCLUSIONS

    According to the obtained results, if the items of “Inadequate professional competency,” “Inefficient clinical planning” and “outcomes of learning‑teaching activities,” and “the challenges related to the stigma of medical staff,” the challenges of students’ clinical education can be reduced during the COVID‑19 outbreak.

    Keywords: COVID‑19, education, psychometrics, surveys, questionnaires
  • Parya Jangipour Afshar, Bahram Jabarzadeh Karbasi, Mahmood Nekoei Moghadam Page 455
    BACKGROUND

    Hospitals are a significant part of the health system, so their performance is always measured based on some factors such as patient satisfaction and their safety level.

    AIM

    The present study was aimed to examine the relationship between patient safety culture with patient satisfaction and hospital performance.

    MATERIALS AND METHODS

    This descriptive–analytical, cross‑sectional study was performed on 240 patients, 240 staff and 20 hospital managers in Shafa hospital of Kerman, Iran, in 2020. To collect data, the patient safety culture, the patient satisfaction, and the hospital performance questionnaires were used. The data were analyzed by SPSS and PLS software; to measure the research model, structural equation models and confirmatory factor analysis were used.

    RESULTS

    The variable “patient satisfaction” and its components had a high mean, with the component “the treating physician” having the highest mean. The variables “patient safety culture and hospital performance” had a medium mean. There was a significant positive relationship between patient safety culture–hospital performance, patient safety culture–patient satisfaction, and patient satisfaction–hospital performance.

    CONCLUSION

    The patient satisfaction level was appropriate in the studied center, and a positive and significant relationship was found between patient safety culture and patient satisfaction and hospital performance.

    Keywords: Hospital performance, patient safety culture, patient satisfaction
  • Fateme Moghbeli, Majid Jangi, Zahra Ebnehoseini Page 456

    Renal disease is the most prevalent disease. Kidney failure can cause physical problems. Hence, patients need to use dialysis therapy or kidney transplantation, and actually, people are in the waiting list for a transplant. This research aimed to extract the prognostic models that evaluate the preparation of kidney donors diagnosed with brain death (DBD).This research was a systematic review of PubMed, Science Direct, and general explorers up until 2020. It followed the Preferred Reporting Items for Systematic Reviews and Meta‑Analyses‑P protocol. The assessment of the articles was done by the authors. This evaluation was supposed to be in the form of scoring, prioritizing, and ranking the donors in terms of their preparation. Eleven sources of information included 9 academic articles along with 2 Grey Sources from 7 different countries. 9 algorithms and models were extracted which included, overall 10 factors. All the models were comprised of 4 factors and about 90% of these models considered 4 or 5 factors to evaluate the preparation of kidney donors DBD. Over 60% of the models had taken into account age, blood pressure history, and creatinine factors. Disease prognosis facilitates a doctor’s decision‑making on the emergence of the disease. Prognostic models of renal diseases can be a great help to patients. A review of the related literature revealed that all the models received a high score in terms of the two factors they included, age and history of blood pressure.

    Keywords: Deceased, donation, donors, kidney, prediction, review, scoring, system, transplant
  • Sanjana Kumari, Hitender Gautam, Neha Nityadarshini, Bimal Kumar Das, Rama Chaudhry Page 457
    BACKGROUND

    Nowadays, the use of Internet with e‑learning resources anytime and anywhere leads to interaction possibilities among teachers and students from different parts of the world. It is becoming increasingly pertinent that we exploit the Internet technologies to achieve the most benefits in the education.

    MATERIALS AND METHODS

    This study compares the difference between traditional classroom and e‑learning in the educational environment. Medical undergraduate students of our institution were enrolled to compare between the online versus traditional method of teaching through questionnaire.

    RESULTS

    Forty percent of students found the online lecture material difficult to understand. 42.6% of respondents found it difficult to clear the doubts in online teaching; 64.4% of the participants believed that they have learned more in a face‑to‑face learning.

    CONCLUSION

    In this study, we concluded that online mode offers flexibility on timing and delivery. Students can even download the content, notes, and assignment. Despite all the advantages offered, there is a general consensus that no technology can replace face‑to‑face teaching in real because in this, there will be visual as well as verbal discussion. Looking at the uncertainty of the current scenario, it is difficult to predict how long online classes will have to continue. Hence, it is of paramount importance that we assess the effectiveness of online classes and consequently take measures to ensure proper delivery of content to students, especially in a skilled field like medicine, so we concluded that face‑to‑face learning is of utmost importance in medical institutions.

    Keywords: COVID‑19, higher education, learning effectiveness, medical students, online interaction, onlineteaching
  • Elham Ahmadizadeh Fini, Ali Asadian, Ahmad Sotoudeh, Mohammad Hadadian, Abdoljabar Zakeri, Masoud Dadras Page 458
    BACKGROUND

    One way to reduce the burden of early detection of COVID‑19 disease is in vulnerable and high‑risk groups. The aim of this study was to diagnose and evaluate the disease in the homeless in Southern Iran Bandar Abbas.

    MATERIALS AND METHODS

    The target group of this study was 234 homeless people. Census sampling included all homeless residents of Isin camp Bandar Abbas. People were individually examined, and their information was recorded. COVID‑19 sampling was done for all as outpatients this year.

    RESULTS

    Eight percent of people were able to answer the questions of awareness about symptoms, ways of transmission, and ways of prevention of COVID‑19 disease. Nine percent of the homeless people in the target group stated that they used to wash their hands before settling in the camp. Six percent of homeless people stated that they used face masks before settling in the camp. Fifteen participants showed similar symptoms to COVID‑19, yet their test result was negative. However, six people who were asymptomatic ended up afflicted. The mean duration of time (since the emergence of symptoms to the sampling date) was 3 days. The minimum duration of time from the emergence of symptoms to the sampling date was 3 h, and the maximum time was 7 days.

    CONCLUSION

    Considering the spread of the disease, certain social measures need to be taken in society to help take care of these people and transfer them from streets to safe places and provide for their essentials. Diagnostic tests should be done periodically among these people at regular interva

    Keywords: COVID‑19, homeless, screening
  • Masoud Motalebi Gh, Zahra Rahimi Khalifeh Kandi, Sajjad Rostamzadeh, Aliasghar Farshad Page 459
    BACKGROUND

    Many accidents in industries occur due to unsafe practices and unsafe conditions. Occupational accidents endanger the health of workers and impose excessive costs on the employers. This study was designed and conducted to evaluate and implement a behavior‑based safety approach in an industrial workplace based on the theory of planned behavior.

    MATERIALS AND METHODS

    The present study was a quasi‑experimental study performed on 90 supervisors of an industrial workplace. Behavior‑based safety interventions were performed based on the components of the theory of planned behavior using nine strategies of health education and health promotion, including skills training, participation, and social support. The data collection tool consisted of a researcher‑made questionnaire that was answered by the supervisors before and 6 months after the intervention. The collected data were evaluated using SPSS 22 software. The significance level was considered 0.05.

    RESULTS

    The results showed that the constructs of subjective norms, attitude, and perceived control of behavior predict the safe behavior of supervisors. After behavior‑based safety interventions, significant changes were observed in subjective norms, intention, attitude, and perceived control of behavior (P < 0.001) compared to before the intervention.

    CONCLUSION

    The results of this study showed the improvement of safe behavior of supervisors in the workplace due to behavioral‑based safety interventions using the theory of planned behavior. Accordingly, this theory can be used as a suitable theoretical framework for designing and implementing interventions to promote safe behaviors of employees in the workplace.

    Keywords: Behavior‑based safety, healthy workplace, planned behavior model
  • Firooz Toofan, Seyed Mojtaba Hosseini, Khalil Alimohammadzadeh, Mehrnoosh Jafari, Mohammadkarim Bahadori Page 460
    BACKGROUND

    COVID‑19 pandemic has spread all over the world. However, information regarding clinical characteristics and prognostic factors is scarce. The aim of this study was to explore the impact of preexistent chronic comorbid conditions and multimorbidity on risk of mortality in patients with COVID‑19.

    MATERIALS AND METHODS

    We designed a retrospective, cross‑sectional, observational, single‑center study. Data were analyzed from all consecutive patients diagnosed with COVID‑19 who admitted in a pandemic hospital affiliated with Tabriz University of Medical Sciences, Tabriz, Iran, from February 20, 2020, to September 25, 2020. The independent effects of preexistent conditions were evaluated using multivariate logistic regression model.

    RESULTS

    A total of 2597 hospitalized patients with COVID‑19 were included. At least one preexistent condition was observed in 36.5% of study population. Multivariate logistic regression analysis showed that older age, male sex, diabetes, cardiovascular disease, hypertension, cancer, chronic kidney diseases, liver diseases, and chronic obstructive pulmonary disease were associated with increased risk of mortality. In addition, the number of comorbidities was significantly associated with increased odds of mortality compared to no‑comorbidity.

    CONCLUSION

    The results of this study suggest that patients with comorbidities have an increased risk of in‑hospital mortality following COVID‑19 infection.

    Keywords: Comorbidity, Iran, mortality, multimorbidity, SARS‑CoV‑2
  • Anusha Divvi, Shivashankar Kengadaran, Lakshmi Subhashini Katuri, Ravindranath Jampani, Jayashri Prabakar, Kavitha Muthukrishnan, Sivabalakumaran Kengadaran Page 461
    BACKGROUND

    Health‑care workers (HCWs) are highly vulnerable to depression during an epidemic outbreak. Protecting the mental well‑being of HCWs is a priority while battling with COVID‑19. However, documentation on COVID‑19‑related depression among HCWs is scarce due to the limited availability of measuring scales. Hence, this study was purposed to develop a scale to measure depression relating to COVID‑19 and evaluate its psychometric properties among HCWs.

    MATERIALS AND METHODS

    A validation study was carried out among 320 HCWs including physicians of various medical specialties, dental specialists, and nurses in the year 2020. Exploratory factor analysis using Promax rotation with Kaiser normalization for the determination of factor structure was employed in data analysis using SPSS version 16 software.

    RESULTS

    COVID‑19 Depression Scale for HCWs (CDS‑HW) demonstrated a two‑component structure identified as “work‑related anxiety” and “psychological distress.” The mean CDS‑HW score of the study participants was observed to be 23.67 ± 2.82, and the scale demonstrated good internal consistency reliability (Cronbach’s alpha: 0.741).

    CONCLUSION

    CDS‑HW is a rapidly administrable, valid, and reliable tool that can be used to measure COVID‑19‑related depression among HCWs.

    Keywords: Anxiety, factor analysis, health personnel, health‑care provider, stress, validation
  • Mahin Nematollahi, AhmadAli Eslami Page 462
    BACKGROUND

    Osteoporosis is a common disease in women over age 45 years. Calcium intake is among the factors that help prevent osteoporosis. Identifying the social‑cognitive determinants of calcium intake can have a major role in the development of osteoporosis prevention programs.

    MATERIALS AND METHODS

    This cross‑sectional study was conducted on 400 women aged <50 years from 10 health centers by cluster sampling in Isfahan in 2016. A hypothetical social‑cognitive model was assessed using path analysis, and the fit indices and explanatory power of the model were assessed. The constructs, including self‑efficacy, outcome expectations, social support, and self‑regulation, were taken as the explanatory variables and calcium intake as the criterion variable.

    RESULTS

    The mean age of the participating women was 34.07 years (standard deviation = 7.99) (range = 19–50), and their mean calcium intake was reported as 909.94 (12. 6) mg/day. The conceptual model was able to explain 73% of the variance in calcium intake and had good fit indices. Self‑regulation was identified as the strongest predictor of calcium intake, and outcome expectation was eliminated from the model since it was the weakest explanatory factor of calcium intake.

    CONCLUSIONS

    The theoretical model of this study is recommended as a suitable framework for the development of targeted osteoporosis prevention interventions.

    Keywords: Calcium, osteoporosis, self‑efficacy, self‑regulation, women
  • Saiedeh Bahrampouri, HamidReza Khankeh, Seyed Ali Hosseini, Mohammadreza Mehmandar, Abbas Ebadi Page 463

    Today, as age increases, the demand for independent living has increased. Since driving is one of the safest and preferred ways for the elderly to travel, paying close attention to the accurate assessment of the elderly’s driving ability can prevent traffic accidents in this age group. The purpose of this study was to identify and introduce practical tools for drive assessment fitness of the elderly. This systematic review was conducted according to Cochrane methodology and reported findings according to PRISMA. The following databases were searched from PubMed, ISI web of knowledge, Scopus, ProQuest, Medlib, SID, Magiran, Iran doc, and Iran Medex based on the population intervention comparison outcome method. The total records involving 12 main tools were assessed from 26 selected records in the final evaluation. The research findings indicated the selection of seven tools in the psycho‑cognitive function domain such as TMT‑B, Clock Drawing Test, MAZE, Montreal Cognitive Assessment, GDS‑15, MMSE, and ACE‑R, three tools in the sensory function domain such as Snellen, Confrontation Visual field, and Whispered Voice Test, and also two tools in motor function domain such as Rapid pace walk, and Manual test of the range of motion. The findings led to selecting practical, accurate, and fast tools for widespread use for the assessment of driving competencies of the elderly. Therefore, it is recommended that the selected tools be used in practical batteries to assess the driving skills of the elderly.

    Keywords: Aged, competency, driver, driving, fit to drive, elder
  • Faranak Jafari, Hamed Azadi, Alireza Abdi, Nader Salari, Azam Faraji Page 464
    BACKGROUND

    Evidence‑based performance competence has a significant impact on the performance of care measures. The higher the qualifications of nurses, the more effective and desirable their performance. Evidence‑based practice demonstrates the competencies and abilities of nurses. There is a need for valid and reliable tools for evaluating and promoting evidence‑based competence in nursing students, and there are few tools in reviewing studies, but they have not considered the cultural dimension. The purpose of this study is to validate cultural competence in evidence‑based practice for nursing students.

    MATERIALS AND METHODS

    A methodological and validation study was conducted in the School of Nursing and Midwifery of Kermanshah and Ilam University of Medical Sciences in 2018. The Evidence‑Based Performance Competency Questionnaire ( EBP‑COQ) is one of the most valid tools used in various studies by Ruzafa‑Martinez et al. Initially, the original version of the competence in evidence‑based practice questionnaire was translated into Persian after securing a permission from the designer of the tool. Totally 300 nursing students were selected through simple sampling method and entered into the study. The validity of the tool was evaluated using face validity and performing factor analysis. The reliability of the questionnaire was evaluated using Cronbach’s alpha and internal consistency. Statistical works were carried out in SPSS and AMOS.

    RESULTS

    To determine the content validity of the tool, comparative fit index of the statements was obtained equal to 0.88. Factor analysis of the items yielded acceptable and statistically significant results (P < 0.001). The reliability of the tool was determined using internal consistency method (Cronbach’s alpha) for the whole tool, which was equal to 0.7. The reliability of the questionnaire was investigated at two stages, and pretest/posttest correlation coefficients were obtained (P < 0.05).

    CONCLUSION

    The questionnaire had an acceptable validity and reliability. It can be used to evaluate evidence‑based practice. Among advantages of the tool is that it is easy to administer in health‑care fields.

    Keywords: Competence, evidence‑based practice, questionnaire, undergraduate nursing, validation
  • Haifa Abdulrahman Bin Shalhoub, MohammadAhmed Hammad Page 465
    BACKGROUND

    Women play a pivotal role in managing crises and diminishing their serious consequences both in the family and society. In the first place, the spread of coronavirus disease 2019 (COVID‑19) is one of the most severe crises in the world. Accordingly, many precautionary measures have been taken in many countries, including Saudi Arabia, such as border closures, lack of movement, and quarantine procedures, leading to an unprecedented impact on the daily lifestyle, and contributing significantly to increasing pressures on women because of her multiroles in family and work. This study aims at identifying the role of women in managing family crises during COVID‑19.

    MATERIALS AND METHODS

    This was a descriptive, cross‑sectional study. An online survey was conducted using self‑designed electronic questionnaire consisting knowledge about the role of Saudi women in managing family during COVID‑19 crises. The questionnaire was applied to 324 Saudi working women in Riyadh and Najran, with an average age of 33 years.

    RESULTS

    The results indicate that the role of Saudi women during the COVID‑19 crisis was approximately 82%. Moreover, results showed that the prevalence of the social, psychological, and professional role of Saudi women during crisis was 82.24%, 83.40%, and 78.80%, respectively, which indicates the importance of the role of Saudi women in managing family crises during COVID‑19.

    CONCLUSION

    Based on these results, the study emphasizes the importance of urging responsible persons to provide a package of rescue and stimulus, including social protection measures. Furthermore, it empowers Saudi women in all sectors of society and provides them with all means of support to help them achieve their mandated role in society generally and in their families particularly.

    Keywords: COVID‑19 pandemic, crisis management, family, role of women, Saudi Arabia, Saudi women
  • Parya Vakilian, Mokhtar Mahmoudi, Fatemeh Oskouie, AliAsghar Firouzian, Alice Khachian Page 466
    BACKGROUND

    This study aimed to investigate the effect of educational intervention based on the Pender’s health promotion model (HPM) on lifestyle and self‑e fficacy of the patients with diabetic foot ulcer.

    MATERIALS AND METHODS

    In this clinical trial conducted in 2019, 74 patients based on inclusion criteria were selected through convenience sampling and allocated to two groups of intervention (n = 37) and control ( n = 37) using the randomized permuted block method. In this study, Demographic characteristics and localized Diabetes Foot Care Self ‑Efficacy Scale and Health‑Promoting Lifestyle Profile Questionnaire for diabetic foot care were completed by two groups. The obtained data were analyzed using SPSS 16 and through descriptive and comparative statistics, independent t‑test, paired t‑test, and ANCOVA.

    RESULTS

    After the intervention, the mean score of the intervention group significantly increased in all lifestyle dimensions (P < 0.001). Furthermore, the mean score of self‑effcacy increased in the intervention group after the intervention (P < 0.001). Comparing the change in the mean scores of lifestyle and self‑efficacy in both the groups 50 days after the intervention, an increase was observed in the mean scores of self‑efficacy (P < 0.001) as well as those of lifestyle and its dimensions in the intervention group compared to those in the control group (P < 0.001).

    CONCLUSION

    Educational intervention based on the Pender’s HPM can promote the self‑efficacy, lifestyle, and its dimensions in the patients with diabetic foot ulcers. The results of this study can be used in educational interventions aiming at patients with diabetic foot ulcers to change their lifestyle and improve their self‑efficacy.

    Keywords: Diabetic foot, health promotion, lifestyle, self‑efficacy
  • Leila Sadati, Mehran Nafar, Sahar Karami, MohamadReza Yazdani, Zahra Nouri Khaneghah Page 467
    BACKGROUND

    M‑learning is “learning across multiple contexts, through social and content interactions, using simple hand‑held technologies, wireless and mobile network. This personal electronic device is a way to facilitate the transfer of learning and improve teaching. Hence, the researchers decided to design a mobile‑based learning application to teach surgical instruments comprehensively and compare students’ learning and satisfaction in both mobile‑based learning and flashcards methods.

    MATERIALS AND METHODS

    An interventional study was conducted on surgical technologist students in Alborz University of medical science (2019). Students were divided into two groups: flashcards (n = 21) and mobile application learning group (n = 21). The difference of pre‑ and post‑test scores was considered for the evaluation of learning level in two groups. Data were entered into SPSS 20.0 software and analyzed by statistics tests.Data were analyzed by a paired t‑test, independent t‑test, and Pearson’s correlation coefficient.

    RESULTS

    There was no significant difference in students’ knowledge level between two groups before intervention ( P = 0.87) but there was significant difference between groups after the intervention (P = 0.003). In the evaluation of student’s satisfaction, the mobile application was preferred by 84.28% of students.

    CONCLUSION

    Given the effectiveness of using both methods (flashcards and mobile application), it is recommended that these methods especially mobile application be used for surgical instruments education.

    Keywords: Apps, flashcard, mobile‑based learning, surgical instruments, surgical technologist
  • Syed Irfan Ali, Jarina Begum, D. Lakshmi Lalitha, M. Ganesh Kamath, Rajesh Kumar Sethi, Aruna Rani Behera Page 468
    BACKGROUND

    An Indian medical graduate needs to be competent in the diagnosis and management of human immunodeficiency virus (HIV) patients. This is crucial in terms of occupational safety. A participatory learning approach could be a possible way to change behavior and improve HIV risk assessment skills among medical students for better occupational safety and health care. The present study was planned to identify the need, provide different learning experiences for acquiring competency, and compare the effectiveness of participatory learning over traditional in developing HIV risk assessment skills.

    MATERIALS AND METHODS

    An educational interventional (randomized controlled trial) was carried out at GEMS and Hospital. Needs assessment survey was conducted, which identified HIV risk assessment as a key competency. For which the outcome‑specific learning objectives were defined, two different learning experiences were employed. A pretest was conducted to assess the baseline knowledge and attitude (n = 92); they were then divided into two equal groups (A and B). “A” group was taught by participatory approach, whereas “B” by traditional techniques followed by posttest and objective structured clinical examination (OSCE) to assess their HIV risk assessment skills. Statistical analysis: Paired t‑test for assessing knowledge and attitude within the same group and unpaired t‑test for assessing skills between the two groups were used in this study.

    RESULTS

    Statistically significant improvement (P < 0.001) in knowledge and attitude scores was noticed that OSCE scores were significantly higher in the intervention group “A” (P < 0.001) as compared to “B” taught by traditional techniques.

    CONCLUSION

    Participatory learning effectively builds upon existing knowledge and attitude to develop better HIV risk assessment skills.

    Keywords: Competency‑based medical education, human immunodeficiency virus risk assessment skills, medicalstudents, outcome, participatory learning, traditional teaching approach
  • Somayyeh Khazaeian, Fariba Shahraki Sanavi, Hossein Ansari, Fatemeh Mirshekari Page 469
    BACKGROUND

    Osteoporosis is considered a health problem that can be simply prevented by lifestyle modifications in adolescence. Therefore, this study was conducted to investigate the effects of protection motivation theory (PMT)‑based training on osteoporosis‑preventive behaviors in female high school students in Zahedan, Iran.

    MATERIALS AND METHODS

    The present quasi‑experimental study was performed on 240 female high school students who were selected by a multistage sampling technique in Zahedan in 2019–2020. To collect the data, a multipart questionnaire was distributed among the participants in three stages, namely at the baseline, immediately, and 2 months after the intervention. This instrument consisted of demographic information, socioeconomic status, knowledge, PMT constructs, and preventive behaviors. The intervention group was subjected to educational content. The collected data were analyzed in SPSS software (version 22) by descriptive and analytical tests (i.e., Chi‑square, independent t‑test, and ANOVA).

    RESULTS

    Based on the results, the intervention and control groups showed no significant difference in terms of the mean score of knowledge, theoretical constructs, and preventive behaviors at the baseline (P > 0.05). However, the two groups were significantly different in terms of the mentioned variables immediately and 2 months after the intervention (P = 0.001). Mean score of preventive behaviors, the two groups also demonstrated a significant difference (i.e., calcium intake, physical activity, and sunlight exposure) 2 months after the intervention, compared to before the intervention. (P = 0.001).

    CONCLUSION

    The findings of the present study were indicative of the PMT effectiveness, which can, therefore, be used as a framework for designing educational programs regarding osteoporosis prevention.

    Keywords: Adolescents, education, osteoporosis, protection motivation theory
  • Sherafat Akaberian, Marzieh Momennasab, Shahrzad Yektatalab, Mitra Soltanian Page 470
    BACKGROUND

    Diagnosing cancer, as a life‑threatening event, in children and adolescents stops the normal course of life for all family members. Spirituality, which plays an essential role in coping with illness and death, can increase resistance against psychological crises induced by cancer diagnosis and treatment. This study aims to discover the spiritual needs of mothers having children with cancer aged 1–12 years old.

    MATERIALS AND METHODS

    In this qualitative study, the conventional content analysis approach was used. The research environment was three pediatric oncology wards of Amir Hospital in Shiraz, Iran. Data were collected from September 2019 to March 2020 through face‑to‑face semi‑structured in‑depth interviews. Fifteen participants including 12 mothers and 3 nurses were interviewed through purposive method considering maximal variation. The interviews were recorded, transcribed, and subjected to a qualitative analysis. Credibility, dependability, confirmability, and transferability of data were confirmed.

    RESULTS

    The mean (± standard deviation) age of the mothers was 35.76 (±5.96) years old. The spiritual needs of the mothers were classified into three categories, including religious well‑being, existential well‑being, and growth and excellence as well as seven subcategories. Religious well‑being included subcategories of direct and indirect connection with God, existential well‑being included subcategories of need for hope, multifaceted support, and rethinking, growth, and excellence consisted of subcategories of devoting yourself and surrender.

    CONCLUSION

    Mothers of children with cancer face important spiritual needs. Therefore, it is necessary for the treatment team to identify these needs and use them to provide appropriate spiritual care.

    Keywords: Cancer, children, mother, spiritual needs
  • Fatemeh Farajzadeh, Sogand Tourani, Hossein Shabaninejad Page 471
    BACKGROUND

    Entrepreneurship is the engine of economic growth and a main symbol of innovation in any country. The health system of the country needs entrepreneur managers to eradicate the problems and provide better services. The purpose of this study was to identify factors affecting the nurturing of entrepreneurial managers in the Iran’s health system.

    MATERIALS AND METHODS

    This study was carried out qualitatively with the grounded theory method and through semi‑structured interviews with six questions. The data sources were 22 key informants who were purposefully selected from healthcare organizations and other entrepreneurship‑related institutions. Data were analyzed and interpreted using the framework analysis. Data were managed and analyzed using MAXQDA software.

    RESULTS

    Findings of this study indicated 6 main themes and 46 subthemes. The six factors affecting the development of entrepreneurial managers in the Iran’s health system were determined as individual, family, social, economic, organizational, and educational.

    CONCLUSION

    Iranian health organizations need to nurture entrepreneurial managers to tackle the challenges of the health system, compete internationally, and have successful performance. Hence, delivering the health industry to entrepreneurial managers in the long run will bring back positive results of growth and development to the body of the health system. Therefore, paying attention to the identified themes and subthemes and the solutions presented in this study can help nurture entrepreneurial managers’ and successful performance of the Iran’s health sector.

    Keywords: Entrepreneurial managers, health system, Iran
  • Bhuvan Jyoti, Manisha Kiran, Rahul Srivastava, Vikas Jaiswal, Swati Kumari, Amitabh K Sinha Page 472
    BACKGROUND

    Severe acute respiratory syndrome coronavirus 2, the virus that causes COVID‑19, mainly spreads through respiratory droplets. The dental profession is particularly at risk. Routine dental care was suspended after the announcement of the first lockdown in India. This makes the group vulnerable to psychosocial consequences. The present study aims to evaluate the psychosocial issues among dental professionals during COVID‑19 pandemic.

    MATERIALS AND METHODS

    A cross‑sectional study was conducted among 627 dental professionals of India, using online Google Forms from April 23, 2020, through April 30, 2020. Participants were evaluated using self‑constructed and self‑administered personal and professional hardship and fear checklist specifically developed for this study. The 9‑item Patient Health Questionnaire (PHQ‑9) Depression Scale and 7‑item Generalized Anxiety Disorder Scale and PHQ‑15 were used to assess the depression, anxiety, and somatic symptoms.

    RESULTS

    Fear had a remarkable impact on 80.7% of responders. Among the participants, 40.5%, 24.5%, and 30.6% reported symptoms of depression, anxiety, and somatic symptoms, respectively. Somatic symptoms were significantly associated with gender(P = 0.000). Work setting was significantly associated with depression (P = 0.011) and anxiety symptoms (P = 0.001). Concern, worry, and fear due to COVID‑19 were significantly associated with depression (P = 0.000), anxiety (P = 0.033), and somatic symptoms (P = 0.009). There was a positive correlation between depression and anxiety symptoms (P = 0.01) and between age and somatic symptoms (P = 0.5).

    CONCLUSIONS

    This group reported a high level of depression, anxiety, and somatic symptoms. Female dental professionals and private practitioners had more depression, anxiety, and somatic symptoms. Immediate and special intervention is needed for this group. Further exploration into the nature and its effects of the psychological symptoms may be required.

    Keywords: Anxiety, COVID‑19, pandemic, stress disorders
  • Pooja Sharma Kala, Naveen Thapliyal, Hari Shankar Pandey, AR Piyush, Sonam Maheshwari, Vikram Singh Chaudhary Page 473
    BACKGROUND

    COVID‑19 pandemic has forced medical education to undergo sudden metamorphosis from the traditional face‑to‑face education to distance online learning. This transition was dealt with a lot of infrastructure and technical difficulties from both teacher and learner ends, especially in a developing country like India. This study was conducted with the aim of analyzing students’ perspective and problems faced in the live online teaching.

    MATERIALS AND METHODS

    This was a prospective longitudinal study conducted on medical students enrolled in the 1 st, 2nd, and 3rd years of Bachelor of Medicine and Bachelor of Surgery courses at a government medical college located in hilly state Uttarakhand, India. Clearance from the institutional ethical committee was obtained. The students were invited to voluntarily participate in online survey by filling Google Forms which was E‑mailed as well as shared in social media platform. A total of 237 medical students participated. The first survey was conducted at the time of initiation of online mode of teaching, during May 1–7, 2020, and second, after completion of 6 months of regular online teaching, during November 1–7, 2020. The questionnaire comprised initial section on demographic details and consent followed by 27 and 30 sets of statements pertaining to online medical education experience in the first and second questionnaires, respectively. A 5‑point Likert scale was used. Data were analyzed using IBM SPSS version 24.0. Chi‑square test was applied for association, and P ≤ 0.05 was considered statistically significant.

    RESULTS

    A total of 237 students participated in the study. The response rate was 52.7%. Majority of respondents had suitable devices (89.1%) and Internet facilities (62%) for online classes. The students accepted the new method of teaching very well, but for practical sessions and clinics, traditional classes were necessary. Long screen time, lack of student–teacher interaction, and interaction with peers were major concerns of students. However, over the study period, the availability of resources, friendliness toward technology, and inclination toward virtual classes increased.

    CONCLUSIONS

    The pandemic has introduced to a new normal where online teaching cannot be ignored. Despite challenges faced during online learning, 65.5% of students preferred hybrid teaching in future for delivering medical education. Acceptance for online education by students increased over time in the study.

    Keywords: COVID‑19, education, medical, online, professional, undergraduate
  • Parisa Samadi, Zahra Alipour, Kobra Salehi, Shahnaz Kohan, Maryam Hashemi Page 474
    BACKGROUND AND AIM

    Marital satisfaction is a multidimensional phenomenon, which refers to the quality of marital relationship, or the general view of marriage status and reflection of happiness and marital performance. Repetition of certain positive behaviors can make a huge difference in the success of continued married life, and that awareness of such behaviors seems to be critical to recognizing certain warnings. Therefore, this study with qualitative approach conducted to promoting long‑term marital satisfaction by exploring couple’s experiences.

    MATERIALS AND METHODS

    This study was conducted using descriptive phenomenology method. The participants were 12 person (six couples) with a history of 20–30 years of married life expectancy and a marital satisfaction score of above 65. The data were collected by purposeful sampling and semi‑structured interviews, analyzed using Colaizzi method. By categorizing the codes, subcategories, and main categories were extracted.

    RESULTS

    An analysis of the experiences of the participants resulted in emergence of eight subcategories, and three main categories: “Strong Foundation For Living Together,” “Mutual Commitment To Protecting Marital Cohesion,” and “Striving To Improve Sexual Relations.”

    CONCLUSIONS

    A long‑term marriage associated with a variety of variables, including a strong foundation for living together, a mutual commitment to protect marital cohesion, and an effort to improve sexuality. And the results showed that the type of relationship will change during the years after marriage in a way that takes on certain meanings and concepts and can be interpreted in physiological, cultural and other specific contexts.

    Keywords: Long married life, marital satisfaction, phenomenology
  • Leila Zahed Nakhjiri, Azar Darvishpour, Parand Pourghane, Bahareh Gholami Chaboki Page 475
    BACKGROUND

    Identification of frailty syndrome in patients with heart failure can affect the process of the disease and their ability to self‑care. Considering the lack of a study on the relationship between frailty syndrome and self‑care ability in the elderly with heart failure in the Guilan province, the North of Iran, this study was conducted to determine the relationship between fertility syndrome and self‑care ability in these patients.

    MATERIALS AND METHODS

    The present cross‑sectional correlational study was conducted in 2020. Research settings were the CCU and post CCU wards in the East Guilan public hospitals. The sample size was 125 people who were selected by the convenience sampling method. The research tools include; Self‑Care Heart Failure Index and Tilburg Frailty Index Questionnaires. Data were analyzed using SPSS software version 20 using descriptive and inferential statistics with a significance level of 0.05.

    RESULTS

    The results showed that the mean score of frailty syndrome in the elderly with heart failure was 5.44 ± 2.47. In addition, the mean score of self‑care in the elderly with heart failure was 67.16 ± 10.96. There was a significant and negative correlation between frailty syndrome and the ability to care in the elderly with heart failure (P < 0.001, r = −0.358).

    CONCLUSIONS

    According to the results, the elderly with fragility syndrome cannot take good care of themselves. This indicates that in the management of heart failure, the assessment of frailty syndrome as a care/treatment goal in the care programs of these patients should be considered.

    Keywords: Aged, frailty, heart failure, self‑care
  • Parinaz Tabari, Mitra Amini, Neil Arya, Mohsen Moghadami, Kaveh Khoshnood, Mansoureh Shokripour, Navid Omidifar Page 476

    Front‑line clinicians and health‑care workers need to be educated to provide care in critical situations such as large‑scale catastrophes and pandemics. This narrative review is focused on investigating educational strategies in confrontation with coronavirus disease 2019 (COVID‑19) pandemic. We conducted a literature search in December 2020 through LitCovid, PubMed, ERIC, and Cochrane Library in order to retrieve relevant studies regarding the role of education in prevention, diagnosis, and treatment of COVID‑19. There were 12 reviewed studies related to this specific subject. The articles selected for this study demonstrated that education and training had a positive impact on the knowledge and attitude of the participants and also the educational interventions, whether they were simulation‑based or other formats of training, would be deemed crucial for enhancing participants’ level of perceptions and confidence. Therefore, it is highly recommended that public health policymakers consider this important issue.

    Keywords: Coronavirus disease 2019, COVID‑19, severe acute respiratory syndrome coronavirus‑2, diagnosis, education, health personnel, prevention, control, therapeutics
  • Farzad Vaghef Davari, Farzad Teymouri, Hadi Ahmadi Amoli, Helia Mojtabavi, Amirsina Sharifi, Farshid Alaeddini, Mohammad Ashouri, Hossein Zabihi, Ghazal Shariatpanahi, Mohammadreza Zafarghandi Page 477
    BACKGROUND

    This study was designed to assess the clinical judgment of medical students in surgery clinical decision‑making by a standard examination after lecture‑based learning (LBL) or problem‑based learning (PBL).

    MATERIALS AND METHODS

    A prospective randomized trial study on 175 medical students whom were randomly allocated to three groups was performed during November 2017 and January 2018. LBL group (n = 103), PBL group led by an attending (n = 39), and PBL group (n = 33) led by an intern. Chi‑squared test and independent student t‑test were used to compare between the two groups. All the analyses were performed by the two‑sided method using the Statistical Package for the Social Sciences software (SPSS version 22; SPSS, Inc., Chicago, IL, USA), and a P < 0.05 set as statistically significant.

    RESULTS

    The students in the PBL group scored significantly higher on the posttraining multiple‑choice examination, compared to the LBL group (P = 0.048). However, there was no significant difference between the PBL group led by an attending and the PBL group led by an intern (P = 0.892).

    CONCLUSION

    We concluded that PBL remarkably increased the students’ scores in the problem‑solving examination, as compared to the conventional method. We found no significant differences in PBL facilitated by an attending or an intern.

    Keywords: Learning method, medical education, problem‑based learning, surgical education
  • Nour Mheidly, Laura Cervi, Sally Samy Tayie Page 478
    BACKGROUND

    Media news emerged reporting that double masking can increase protection against COVID‑19. This led to differential published reports, fueling debate among the public and creating controversy and confusion. In this paper, we present a lesson plan for health communication students to enhance their critical thinking ability and equip them with the necessary tools to analyze various media texts and products.

    MATERIALS AND METHODS

    The lesson plan included a set of activities on three different news pieces related to double masking, each published through a different media outlet: A newspaper, a television channel, and an online magazine/podcast. The lesson was designed for 120 min, over 2 days. It required a digital device and Internet access. Students were tasked to compare between the news based on set criteria and asked to provide their opinions accordingly. They were also assigned to fill out an inverted pyramid for further analysis and interpretation.

    RESULTS

    Students were assessed through a rubric that evaluated gained competencies after lesson completion. The rubric is composed of five elements to assess the students’ performances. Elements included filling assigned cells and diagrams, usage of proper English, validation of news sources and reported facts, critical analysis of findings, and finishing the lesson on time.

    CONCLUSION

    This lesson plan enhanced the ability of students to understand and analyze various media texts and validate the content and perspectives published through the different platforms.

    Keywords: COVID‑19, critical thinking, lesson plan, misinformation
  • Abdolhussein Shakurnia, Tayebe Fazelinia, Nasrin Khajeali Page 479
    BACKGROUND

    Critical thinking is one of the important skills required for medical students. It is considered as a main component in medical education and training competent physicians. The current study aimed to investigate the trend of critical thinking disposition of medical students and its association with their academic performance.

    MATERIALS AND METHODS

    This descriptive cross sectional study was conducted in 2019 on 315 medical students of Ahvaz Jundishapur University of Medical sciences. A two‑section questionnaire was used for data collection. The first section dealt with demographic characteristics and the second section included Ricketts critical thinking disposition inventory using t‑test, analysis of variance, and Pearson correlation coefficient.

    RESULTS

    Mean and standard deviation of critical thinking disposition of medical students was 121.85 ± 11.32. No significant difference was observed between the mean score of critical thinking disposition and years of study (P = 0.74, F = 0.590). Pearson correlation test also showed no significant association between critical thinking disposition and the students’ grade point average (P = 0.89, r = 0.007).

    CONCLUSIONS

    The results of the current study showed that medical students’ level of critical thinking disposition is above average, and there is no significant correlation between critical thinking disposition and years of study and academic performance of the students. It seems that the educational process in medical school has not been effective in improving the level of students’ critical thinking disposition.

    Keywords: Academic performance, medical student, thinking
  • Sharon Jalene, Jennifer Pharr, Manoj Sharma, Brach Poston Page 480
    BACKGROUND

    Depression prevalence in college students is three to six times higher than US adults. Counseling utilization increased by 30%–40% despite reports of student unwillingness to pursue therapy. Pursuance of alternative options, like exercise or meditation, is rarely reported. This study examined students’ willingness to seek depression treatment through university mental health services (UMHS) and alternative options (AO).

    MATERIALS AND METHODS

    This was a cross‑sectional study. Students (n = 780) completed a survey including validated depression and estimated cardiorespiratory fitness instruments. Yes/ Maybe/No responses regarding willingness to seek UMHS and AO were analyzed for associations with demographics, depression status, and fitness level. Descriptive and inferential analyses were employed.

    RESULTS

    Students were more likely to select “Yes” for AO than UMHS (Χ2 = 104.145, P < 0.001). Low‑fit students (Χ2 = 8.35, P = 0.02) and those in depression treatment (Χ2 = 15.182, P < 0.001) selected “Yes” to UMHS more often than expected. Younger (Χ2 = 7.893, P = 0.02), nondepressed (Χ2 = 7.355, P = 0.03), and fit students (Χ2 = 10.617, P = 0.005) chose “Yes” while males selected “No” (Χ2 = 8.99, P = 0.01) more often than expected for AO. Approximately 31% of students reported having moderate‑to‑severe depression, 7.8% were in treatment, and 55% were classified as having low fitness levels.

    CONCLUSIONS

    The findings of this study should be considered when developing antidepressant programming on university campuses.

    Keywords: Cardiorespiratory fitness, college, meditation, therapy, treatment preference
  • Mahin Tafazoli, Mahboobe Gholami, Zahra Mohebbi Dehnavi, Fatemeh Shaghaghi, Zahra Kamali Page 481
    BACKGROUND

    Candidiasis vaginitis is an opportunistic and common mucosal infection. Although Candida albicans is the most common isolated species, other species of Candida such as Candida glabrata, Candida krusei, Candida parapsilosis, and Candida tropicalis have also increased significantly in recent years. The aim of this study was to identify Candida species in women with candidal vaginal infection in order to promote health in women.

    MATERIALS AND METHODS

    This cross‑sectional descriptive study was performed on nonpregnant women of childbearing age who referred to health centers in Neyshabur in 2018. At the beginning of the study, 163 people entered the study and the culture results were positive in 68 of them. In vitro, culture was performed in subduxtrose agar medium containing chloramphenicol and gentamicin. Species identification was performed using Candida specific culture medium (Saburo dextrose agar and chloramphenicol). After culture, 15% of the residual wet slide with potash (KOH) was prepared and observed with a lens. Finally, the data were analyzed with SPSS software version 24.

    RESULTS

    The participants in the study were women with a mean age of 35.55 ± 5.47 and the average number of deliveries was 1.38 ± 1.15. In this study, the prevalence of C. albicans was 59.7%, C. tropicalis was 14.8%, C. krusei was 15%, and C. glabrata was 7.61% and also krusei and tropicalis were 3% simultaneously. Therefore, C. albicans was the most common species isolated from clinical specimens.

    CONCLUSION

    In this study, the most common species after albicans were C. tropicalis and cruciferous. Considering the role of C. glabrata in the development of resistance to antifungal drugs, the lower prevalence of this species in the present study can be associated with improved treatment outcomes in patients.

    Keywords: Candidal infection, Candida species, health promotion, vaginal infection, women
  • Gholamreza Kheirabadi, Mehrnoosh Shirani, Mahrokh Keshvari, Gholamreza Sharifirad, Mahboobe Bahrami Page 482
    BACKGROUND

    Increasing in elderly’s population and their individual and social problems especially mental health problem in this group need special attention. The aim of this study was evaluation of health promotion behaviors training program efficacy on general health components in elderlies referring to health centers in Isfahan city.

    MATERIALS AND METHODS

    This study was a tri phasic field trial in 2014 in which 72 elderlies allocated randomly in two case and control groups. Case group participated in 9 training sessions on stress management and interpersonal relationships and the control group participated in 2 sessions with a neutral discussion content. Data collection tools were demographic information questionnaire and general health questionnaire 28. Pretest, posttest, and 2‑month follow‑up were performed in two groups. Data were analyzed by t‑test, analysis of variance with repeated measurement, least significant difference post hoc test, and SPSS 20 software.

    RESULTS

    Findings of this study showed that the average of general health score in case and control groups had not significant difference before the intervention (P > 0.05). However, the mean difference of general health score after intervention and 2‑month follow‑up was statistically significant in two groups (P < 0.001).

    CONCLUSIONS

    This study showed that interpersonal relationship and stress management training program are effective on promotion of mental health in elderlies. Hence, the findings of this study can be used in the field of treatment and care of the elderly by other health‑care categories.

    Keywords: Geriatric, health promotion behavior, interpersonal relationship, mental health, stress management, training program
  • Ali Mehri, Maryam Saber, Mehran Nakhaeizade, Hadise Safinejad Page 483
    BACKGROUND

    Domestic violence against women is a global problem that can lead to many negative consequences on physical, mental, and social health that various sociocultural causes play a role in its occurrence in different societies. Therefore, this study was conducted to determine the causes and type of violence against spouses in married men in Kerman.

    MATERIALS AND METHODS

    This cross‑sectional study was performed in 2018. The study was conducted on 400 married men who experienced violence against their wives. Sampling was a multistage cluster sampling method. The data collection tool was a questionnaire on violence against women. Data were analyzed using descriptive statistics, one‑way analysis of variance (ANOVA), and two‑variate analysis.

    RESULTS

    The results of the data showed that the highest rate of violence in the group of housewives was related to physical violence and in the group of women living in dormitories and pregnant women was related to verbal violence. The results of data analysis with a one‑way ANOVA test showed that between the three groups, all dimensions of violence and the overall score of violence had significant changes (P < 0.05). The results of the two‑variate analysis test showed that there was a significant relationship between the variables of age, duration of marriage, male education, spouse education, type of marriage, male job, and spouse job with the overall score of violence in all three groups (P < 0.05).

    CONCLUSION

    According to the results of the present study, it seems that the empowerment of women in all dimensions to improve and promote health to deal with domestic violence is essential. As a result, the relevant measures should be taken by the support systems taking into account the circumstances of the individuals.

    Keywords: Domestic violence, health promotion, men, women, women’s empowerment