فهرست مطالب

Education and Health Promotion - Volume:12 Issue: 4, Apr 2022
  • Volume:12 Issue: 4, Apr 2022
  • تاریخ انتشار: 1401/04/20
  • تعداد عناوین: 35
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  • Govind Nair, Kirthika Venkatesan, Arjun Nair, Irene N Firoz, Nisha Nigil Haroon Page 112
    BACKGROUND

    Vaccine hesitancy presents a major challenge during the COVID‑19 pandemic. It is crucial to address the factors contributing to vaccine hesitancy necessary to control the associated morbidity and mortality. This study aimed to investigate the impact of professional medical guidance on the likelihood of receiving the COVID‑19 vaccine in immigrants of USA and Canada.

    MATERIALS AND METHODS

    A total of 92 immigrants in the USA and Canada who predominantly spoke Malayalam were recruited using social media platforms. An online survey was administered investigating participants’ confidence in receiving the COVID‑19 vaccine. Following, a short webinar was conducted by a medical professional explaining the efficacy and safety of the vaccine. A postwebinar survey was immediately given assessing the confidence and likelihood of receiving the vaccine. SPSS was used to generate descriptive statistics and Pearson Chi‑square analysis where appropriate.

    RESULTS

    Results revealed that participants who attended the webinar reported greater confidence in receiving the COVID‑19 vaccine. There was a statistically significant difference between pre‑ and postwebinar confidence scores for the COVID‑19 vaccine, 2 (12, n = 80) = 43.34, P < 0.01.

    CONCLUSION

    Results from the current study demonstrate the successful delivery of professional medical guidance to the general public through online small‑group sessions to help address the misconceptions surrounding the COVID‑19 vaccine and combat vaccine hesitancy among vulnerable populations. Future studies should focus on interventions addressing vaccine hesitancy in larger and diverse populations and analyze other barriers to vaccination.

    Keywords: Coronavirus, COVID‑19, health care, mRNA vaccines, vaccine hesitancy
  • Habibeh Ahmadipour Page 113
    BACKGROUND

    Online learning self‑efficacy is considered a major contributor to academic success. The present study was conducted to assess the psychometric properties of the Persian version of the Online Learning Self‑Efficacy Scale.

    MATERIALS AND METHODS

    A cross‑sectional study was conducted on 211 medical students at Kerman University of Medical Sciences in 2021 who were selected through the convenience method. Data were collected using a two‑part self‑administered online questionnaire containing demographic information and the Persian version of the Online Learning Self‑Efficacy Scale (OLSES). Forward and back‑translation methods were used to provide the Persian version of OLSES. Internal consistency of the Persian version was determined by the Cronbach alpha coefficient in a pilot study. Exploratory and confirmatory factor analyses were conducted using SPSS version 20.0 and LISREL version 8.80.

    RESULTS

    The mean of the participants’ age was 21.40 ± 2.52 years, and most of them (56.4%) were female. The Cronbach alpha coefficient was determined as 0.74, 0.90, 0.75, and 0.89 for learning, time management, technology use subscales, and the whole scale, respectively. Exploratory factors analysis revealed the justifiability of factor analysis. In confirmatory factor analysis, most of the goodness of fit indices had an acceptable level.

    CONCLUSIONS

    Our study found that the Persian version of OLSES had good psychometric properties and can be used as a simple, valid, and reliable tool to assess students’ self‑efficacy related to the e‑learning environment.

    Keywords: Distance learning, Iran, medical students, online learning, reliability, self‑efficacy, validity
  • Mitra Faghihi, Aliasghar Farshad, Maryam Biglari Abhari, Nammamali Azadi, Morteza Mansourian Page 114
    BACKGROUND

    Health‑care workers are exposed to complex types of health and safety hazards. A high percentage of hospital staff in Iran are women, who in addition to heavy and stressful hospital work, also carry the burden of the family roles. It is in these circumstances that creating a supportive environment for women is of particular importance. Accordingly, this study is designed to determine the characteristics of a mental supporting work environment in the workplace from the perspective of female hospital staff.

    MATERIALS AND METHODS

    This study was performed by a qualitative method and content analysis approach. Sampling was purposive and 26 women working in different wards of this hospital were included in the study. In this study, women with maximum diversity in terms of age, work experience, and employment ward were selected. The main method of data collection in this study was a semi‑structured interview. Interview texts were extracted and divided into meaningful units. To validate and confirm the results plus accuracy of the research, the criterion of data validity or data credibility, admissibility, data accuracy, verifiability, reliability, and transferability were used.

    RESULTS

    Through the data analysis, 58 primary concepts with the same features were classified into 10 subcategories. Then, based on common features at a more abstract level, they were converted into four main categories including job stressors, women’s stress management, providing women’s psychological‑job satisfaction, and women’s work‑life balance.

    CONCLUSION

    Creating supportive work environments for women, especially those operating in workplaces such as hospitals, which brings a lot of work pressure and workload for them, can be an important policy for organizations and hospital work environments.

    Keywords: Health promotion, hospital, women’s health, workplace
  • Gowranga Kumar Paul, Md Shalauddin Swapon, KM Kaderi Kibria Page 115
    BACKGROUND

    The prevalence of self‑medication is high in Bangladesh due to easy access and poor regulatory controls over these drugs. Our study aimed to assess the attitude of university students in Bangladesh toward antibiotic usage, especially their knowledge and awareness about antibiotics and their resistance. We also evaluated the determinants behind their attempts at drug intake without prescription.

    MATERIALS AND METHODS

    A cross‑sectional study was conducted in Mawlana Bhashani Science and Technology University that included information from randomly selected 200 students from 15 departments using a structured questionnaire. The statistical analyses were performed by using SPSS software (version 21) and R programming.

    RESULTS

    The study revealed that 61.0% of the students use self‑medication at different times or always; 32.5% of the respondents keep antibiotics for future use, and 38% of the students think it is right to stop antibiotics when symptoms are improving. Half of the participants (47.5%) use antibiotics based on their previous experience. The criteria of antibiotic selection have a significant relationship with knowledge about antibiotic resistance (P = 0.017) and altered prescribed medicine without doctor’s advice (P < 0.001). The multivariate analysis indicates that respondents who know about antibiotic resistance select antibiotics from the community pharmacists with respect to their own experience 5.102 times higher than those who do not know about antibiotic resistance.

    CONCLUSIONS

    The study mainly explored the knowledge gaps of the students on the options that are responsible for antibiotic resistance in the community and found that students have mid‑level knowledge (66%) about antibiotic resistance.

    Keywords: Antibiotics, Bangladesh, knowledge, prescription, prevalence, resistance, self‑medication, student
  • Muhammad Abdullah Arain, Saleema Begum, Amir H Shariff, Sadaf Khan, KM Inam Pal, Muhammad Rizwan Khan, Muhammad Ali, Jan Ringers Page 116
    BACKGROUND

    The traditional model of teaching surgical skills on “real” patients using graded responsibility is being seriously questioned, and there is a paradigm shift toward exploiting simulators. There is a lack of clarity on the impact of using simulation as a teaching strategy in novice learners. The purpose of our study was to determine if the number and duration of training sessions influence the acquisition and retention of laparoscopic skills in naïve learners. There are some data to suggest that distributed training programs might have better outcomes, but the results are inconclusive. We designed a controlled trial at Aga Khan University, Karachi, with the hypothesis that students trained using the distributed method may have enhanced learning outcomes.

    MATERIALS AND METHODS

    100 medical students were assigned in a 1:1 ratio to one of two groups. Group A underwent a single orientation and supervised practice session of 3 h duration. Group B underwent distributed teaching with three learning sessions of 1 h each spread over 3 consecutive weeks. Participant scores were analyzed before and after the intervention and at 3‑ and 6‑month intervals using repeat measures of ANOVA.

    RESULTS

    Pretest and immediate posttest scores were comparable between the two groups. The 3‑month interval test showed significantly higher scores in Group B (difference = −2.90, P < 0.001). The 6‑month interval test showed no differences in scores between the two groups (P = 0.178).

    CONCLUSIONS

    Distributed teaching resulted in significantly enhanced scores at 3‑month assessment. However, similar scores at 6 months suggest the need for repeated intervention.

    Keywords: Distributed learning, laparoscopy, massed learning, psychomotor skills
  • P P. C. M. Chandrasena, I M. P. S. Ilankoon Page 117
    BACKGROUND

    Social media has become a most inseparable part of young adults’ lives with the rapid development of information and communication technology. The study aimed to assess the use of social media and its association with academic performance, well‑being, and interpersonal relation of the health sciences undergraduates.

    MATERIALS AND METHODS

    A descriptive cross‑sectional study was conducted among undergraduates in Faculty of Allied Health Sciences (n = 220), University of Sri Jayewardenepura, Sri Lanka. Data were collected using a pretested, self‑administered questionnaire and analyzed using descriptive and inferential statistics.

    RESULTS

    The response rate was 79.5%. All undergraduates (n = 175) had social media accounts, and WhatsApp was the most frequently used social media site (96.0%), followed by Facebook (70.9%), mainly for communicating (85.1%), entertainment (83.4%), and online learning (65.7%). Most undergraduates (72.0%) spent 2–5 h daily on social media sites and followed social media 1–10 times per day (54.9%). The majority of them wished to use social media for academic purposes (94.9%), and the most preferred site for academic work was WhatsApp (65.1%). Most undergraduates’ self‑reported Grade Point Average (GPA) (46.3%) was <2.9. There was a statistically significant association between the mean GPA and frequencies of using social media (P = 0.02) (not daily [3.3 ± 0.3], 1–10 times a day [2.9 ± 0.4], and more than 10 times a day [3 ± 0.4]). Perceived social media addiction and duration of sleep (P = 0.02), activities of daily living (P = 0.004), and study time (P = 0.02) were found to be significantly associated.

    CONCLUSIONS

    Despite the undergraduates’ willingness to use social media for academic purposes, the frequency of using social media had a significant influence on their academic performance. This highlights the importance of guidance on effective use of social media and social media addiction to improve undergraduates’ academic performance, well‑being, and interpersonal relationships.

    Keywords: Academic performance, internet addiction disorder, interpersonal relations, social media, Sri Lanka, young adults
  • Maryam Feiz Arefi, Amin Pouya Babaei, Somaye Barzanouni, Sahar Ebrahimi, Amir Reza Salehi, Farahnaz Khajehnasiri, Mohsen Poursadeghian Page 118
    BACKGROUND

    Many measures have been taken so far to minimize the outbreak of COVID‑19, but it is still unclear to what extent people have understood the risk. Public participation plays a vital role in better and effective control of the coronavirus, and the importance of risk perception is effective in their preventive behavior. The aim of this study was to investigate the pandemic risk perception of coronavirus disease after began of pandemic in Iranian society.

    MATERIALS AND METHODS

    This cross‑sectional study was conducted in Iran in spring 2020. The data collection tool was a researcher‑made questionnaire. The questions were extracted through interviews with experts and summarizing the opinions of public interviews, etc., The questionnaire was made available to the public through social media. The information was collected within 3 months. Quantitative data were reported as mean ± standard deviation and the qualitative data were reported as number and percent. Multiple linear regression and cross were also used to examine the demographic factors associated with risk perception. Data Analysis was performed using the SPSS version 21 statistical software.

    RESULTS

    In this study, 402 individuals from 28 provinces (Azarbaijan Gharbi, Azarbaijan Sharghi, Alborz, Ardabil, Bushehr, Chaharmahal and Bakhtiari, Esfahan, Fars, Ghazvin, Gilan, Golestan, Hamedan, Hormozgan, Ilam, Kerman, Kermanshah, Khorasan Razavi, Khorasan Shomali, Khuzestan, Kohgiluyeh and Boyerahmad, Kurdistan, Lorestan, Mazandaran, Semnan, Sistan and Baluchestan, Tehran, Yazd, and Zanjan) of Iran participated. The risk perception score obtained from the sum of the scores of the questions was classified into quartiles. Accordingly, the risk perception score of (22.9) 92 people was very low, (26.6) 107 people low, (26.9) 108 people moderate, and (23.6) 95 people high. The results of multiple linear regression showed that the variables of gender (P = 0.008) and occupation (P = 0.013) had a significant relationship with risk perception. There was no significant relationship between risk perception and variables of age, marital status, and level of education (P > 0.05).

    CONCLUSION

    The study showed that the risk perception of the people is more in categories of moderate to high. Assessing the risk perception of a pandemic can be helpful for preventive measurements and planning, and also, according to the results of the research, can be done appropriate educational interventions. Given that 47.5% of respondents were employees, of course, it should be noted that in sending a questionnaire virtually, there is usually a lot of loss and this is a limitation of the research. The results of this study can be useful in making prevention decisions and maintaining safety and health in the workplace.

    Keywords: Behavior, COVID‑19, health, knowledge, pandemics, perception, risk
  • Babak Moeini, Amir Erfani, Majid Barati, Amin Doosti-Irani, Hatam Hosseini, Mokhtar Soheylizad Page 119
    BACKGROUND

    Childbearing is the most important determinant of population fluctuations and its studies are more important than other population phenomena. Many factors are associated with childbearing, but individual factors associated with it have been less studied in a specific framework. The present study aimed to explore and identify the factors related to childbearing based on extended theory of planned behavior (ETPB).

    MATERIALS AND METHODS

    This qualitative study was conducted among married women <35 years of age and married men whose spouses were under 35 years of age and lived in the City of Hamadan, Iran, in 2019. The data were collected by semistructured and face‑to‑face in‑depth interviews and continued until the data saturation was reached. Overall, 15 interviews were conducted with 17 people. The data were analyzed, using a directed content analysis approach.

    RESULTS

    The data analysis resulted in the extraction of 28 main codes, 9 subcategories, and 4 themes, which were correspond to constructs of the theory, consisting of attitudes, subjective norms, perceived behavioral control, and social support in the field of childbearing. The main predictors were attitude toward childbearing and perceived control.

    CONCLUSION

    The findings of this study showed that ETPB has a potential to explain the intention and behavior of childbearing. The ETPB makes it possible to understand many of the factors associated with childbearing. The results of this study could be the basis for designing appropriate data collection instrument in quantitative studies and vast surveys.

    Keywords: Health, population, qualitative research, reproductive behavior
  • Morteza Oshagh, Hooman Zarif Najafi, Hamid Jafarzadeh, Faegheh Gholinia, Kazem Dalaie, Habib Jahanbazi Page 120
    BACKGROUND

    The coronavirus disease (COVID) is predicted to cause serious mental health problems among healthcare providers (HCPs) especially dentists. Also understanding the influencing factors of the acceptance of COVID‑19 vaccination among HCPs are important aspects in the design of effective strategies to improve the vaccine coverage rate. Therefore, this study aimed to assess the knowledge, vaccination acceptance, fear, and obsession, as well as the preventive practice behaviors of Iranian dentists and dental students in late 2020 toward COVID‑19.

    MATERIALS AND METHODS

    A descriptive, web‑based cross‑sectional survey was conducted among Iranian dental students and dentists (general practitioners and specialists). All Iranian dentists and dental students living in the Islamic Republic of Iran regardless of their city and workplace were invited to participate in the study. The total number of dentists in Iran was estimated to be 54,927. The sample size was calculated 380. The questionnaires used in this study were adapted from previously published studies based on the authors’ permission. The questionnaire consisted of four sections that sought to collect information on the respondents’ vaccination acceptance, knowledge, preventive practice, fear, and obsession toward COVID‑19. The relationship between the study variables was assessed using Pearson’s correlation coefficient and also multiple linear regression tests.

    RESULTS

    Overall, 394 dentists were filled the questionnaire (65 dental students, 151 general dentists and 178 specialists). There were no differences in terms of vaccination acceptance, knowledge and also fear score in different designation groups. Dentists had significantly higher obsession and also preventive practice scores than other designation groups (P < 0.05). The majority of respondents had good knowledge (more than 9), acceptable preventive practice (more than 19), low fear‑obsession (<2.7), and high acceptance of COVID‑19 vaccination (more than 8.8).

    CONCLUSIONS

    Although obsession and fear scores were low in all designation groups, dentists had higher obsession and also preventive practice scores than other designation groups. More than half of respondents preferred imported COVID‑19 vaccines. Finally, organizations such as the World Health Organization and the Ministry of Public Health in Iran should increase vaccine convenience and accessibility in terms of vaccine importing, distribution, supply, and immunization service.

    Keywords: Coronavirus disease‑19, dentist, fear, health, knowledge, prevention, vaccination
  • Shahla Mohamadirizi, Soheila Mohamadirizi Page 121
    BACKGROUND

    One of the most important clinical teaching keys is the use of new evaluation that plays an essential role in strengthening the quality level of clinical skills students. Hence, the aim of this study was to determine the effect of smartphone clinical skills recording in the labor ward on satisfaction of midwifery students.

    MATERIALS AND METHODS

    This is a quasi‑experimental study that was conducted on 60 midwifery students in the 8th semester was selected through the convenience sampling method. Clinical skills of labor ward recorded by two methods groups (smartphone and traditional). The satisfaction questionnaire was completed before and after by the two groups. Data were analyzed using the descriptive and inferential statistics through the SPSS version 22 software.

    RESULTS

    Independent t‑test showed that the satisfaction scores before intervention in both smartphone and traditional groups were not statistically significant (P = 0.126), whereas there was a significant difference between two groups after intervention (P = 0.002).

    CONCLUSION

    The use of smartphone techniques in the labor ward can be effect in clinical skills recording among midwifery students.

    Keywords: Clinical recorded, education promotion, midwifery, smartphone, students
  • Prasuna Jelly, Rajni Verma, Reena Kumawat, Suman Choudhary, Lisa Chadha, Rakesh Sharma Page 122
    BACKGROUND

    Urinary tract infections (UTIs) are more common in females than males and predominantly based on their unhealthy practices in their day to day lives. This study is trying to assess the occurrence of UTI and strategies used by female student to prevent UTI.

    MATERIALS AND METHODS

    A cross‑sectional descriptive study carried out in a tertiary care teaching institute. A total of 338 conveniently selected B. Sc. Nursing and MBBS Medical students were surveyed. The data were collected by using a pretested, a self‑structured questionnaire related to occurrence and practices to prevent UTI along with necessary demographic details. Descriptive (frequency, percentage, mean and standard deviation) and inferential (Chi‑square test) statistics was used to compute the data.

    RESULTS

    The result of this study shows that 10.05% female students reported of having UTI. The proportion was higher in nursing students (67.6%) than medical (32.4%) but did not show a significance difference (P = 0.61). Age, duration of hostel life, and marital status were significantly associated with the status of UTI (P = 0.001). To prevent UTI, students were using commercial product with Tea Tree Oil, soap, drinking 3–4 l water/day, increased frequency of peri‑wash during menstruation period, and use of Citrus Fruits. The use of western toilet was also significantly associated with status of UTI (P = 0.04).

    CONCLUSION

    The occurrence of UTI was more among nursing students. Most of the perineal hygienic practices by the female students were associated with occurrence of UTI; hence, it is necessary to emphasize on preventive practices to minimize re‑occurrence.

    Keywords: Female, hygiene, medical, menstruation, nursing, students, urinary tract infections
  • Pradeep Banandur, Kalpana Gopalan, Shikha G Pai, Mutharaju Arelingaiah, R Sathya Velu, Lavanya Garady, Jyoti M Koujageri, Vani Naik, Sateesh L Sajjanar, MS Ramesh, K Srinivas, Gururaj Gopalkrishna Page 123
    BACKGROUND

    India today is home for the largest youth population in the world. Youth is a formative phase transitioning from childhood to adulthood. Relationship is fundamental for a healthy and satisfactory life. Relationships assume importance and maturity during adolescence and youth. Relationships and mental health have a bidirectional effect. The effect of relationships on mental health is stronger than vice versa.

    MATERIALS AND METHODS

    Two‑year case record analysis of 8595 beneficiaries aged 15–35 years attending youth guidance centers (Yuva Spandana Kendras) in Karnataka, India, was undertaken to understand factors affecting relationship issues among them. Multivariate logistic regression was performed with any beneficiary having a relationship issue as outcome.

    RESULTS

    Being a student (adjusted odds ratio [AOR] = 1.49; 95% confidence interval [CI] = 1.18–1.89), occupation (AORbusiness/ salaried = 3.04; 95% CI = 2.10–4.40 and AORothers = 1.72; 95% CI = 1.22–2.44), marital status (AORmarried = 1.42; 95% CI = 1.06–1.90 and AORothers = 3.44; 95% CI = 1.45–8.15), having health and lifestyle issues (AOR = 3.61; 95% CI = 3.05–4.27), personality issues (AOR = 2.88; 95% CI = 2.43–3.41), safety issues (AOR = 6.28; 95% CI = 5.01–7.87), gender, sex, and sexuality issues (AOR = 3.10; 95% CI = 1.93–4.98), suicidality (AOR = 1.82; 95% CI = 1.17–2.85), alcohol use (AOR = 5.43; 95% CI = 3.92–7.41), and different emotions experienced (AOR ranging from 0.37 to 3.50), had significant association with relationship issues.

    CONCLUSION

    Investing in health promotion interventions focusing on these precursors of relationship issues among youth seems strategic. Our findings have implications for other states in India and other low‑middle‑income countries like India.

    Keywords: Mental health, relationship, youth
  • Akanksha Yadav, Madhumita Dobe, Bobby Paul, Chandrashekhar Taklikar Page 124
    BACKGROUND

    Despite the implementation of various cervical cancer preventive strategies by the Government of India, there is a scarcity of knowledge and consequent low utilization of cervical cancer screening services among women in India. This contributes to the burden of cervical cancer among Indian women. This study was conducted to assess perceived threat‑regarding cervical cancer among women and to identify its explanatory factors in a slum area of Kolkata.

    MATERIALS AND METHODS

    A cross‑sectional study was conducted among 192 adult women from May to September 2019 in Kolkata. The multistage sampling technique was used using a structured schedule. Perceived threat to cervical cancer was measured using a composite score including perceived susceptibility and perceived severity constructs of the health belief model. Data were analyzed by descriptive statistics and multivariable logistic regression model using SPSS software version 16.

    RESULTS

    Overall, 22.9% of the participants had satisfactory levels of perceived threat to cervical cancer. Statistically significant association was found between unsatisfactory levels of perceived threat with reproductive age group (adjusted odds ratio [AOR] = 3.01; P = 0.036), education level up to primary (AOR = 2.89; P = 0.026), and unsatisfactory knowledge (AOR = 2.94; P < 0.001) among respondents. The multivariable regression model was of good fit.

    CONCLUSION

    The study population had very unsatisfactory levels of perceived threat to cervical cancer. Thus, to increase cervical cancer screening uptake among women, it is necessary to tailor robust behavior change communication campaigns to increase the perception of susceptibility and severity, thereby increasing the perception of threat of cervical cancer among women.

    Keywords: Cervical cancer, health belief model, India, perceived threat, women
  • Athirarani Muraleedharan Rohini, Sujitha Elavally, Geetha Saradakutty Page 125

    Breastfeeding is the single intervention with the largest impact on the health of a new‑born baby. Evidence has to be generated to convince the mother as well as policy‑makers for the promotion of exclusive breastfeeding (EBF) for 6 months. This study aimed to assess the evidence for the effectiveness of breastfeeding education compared with standard hospital information among mothers on the rate of EBF. The study design is systematic review. Trials which are randomized or cluster randomized which studied the effect of educational interventions for mothers on EBF were searched for. Two databases were searched, namely PubMed and Cochrane. Manual search of reference lists of all included studies in Google scholar and Clinical Trial Registry was done. Two reviewers independently assessed the quality of the included studies. Data were extracted using a table format set by the reviewers referring the previously reported high‑quality systematic reviews. Out of the 12 comparisons of nine studies included for review, eight studies report that breastfeeding education has added advantage on increasing the rate of EBF. We conclude that there is evidence to support breastfeeding education versus standard hospital information across diverse settings.

    Keywords: Breastfeed, education, systematic review
  • Fariba Taleghani, Saba Farzi, Ahmadreza Yazdannik, Mehran Sharifi Esfahani Page 126
    BACKGROUND

    Patient‑centered care (PCC) is a key component of high‑quality care. Given the different effects of cancer on patients, patient‑centeredness is very important in oncology nursing care. The aim of this study was to explore nurses’ perceptions of the patient‑centered in oncology nursing care.

    MATERIALS AND METHODS

    This descriptive qualitative study was conducted in 2018–2020, Iran. Data collection methods included observation and semi‑structured interviews. Patient, family, and nurse behaviors were observed (total: 318 h). In addition, interviews were conducted with nurses and nursing managers (12 interviews). Data analysis was performed using Graneheim and Lundman’s approach.

    RESULTS

    Data analysis resulted in the emergence of four themes: “Organizational structure as a barrier to the PCC,” “Lack of institutionalization of PCC in nurses,” “Understanding and paying attention to the patient as PCC,” and “Situational PCC.” The final theme of this study is “PCC in the shadow of paternalism.”

    CONCLUSIONS

    The paternalism approach in the context of oncology nursing care has made the realization of PCC difficult. The first step to promote PCC is increasing nurses’ awareness of the impact of paternalism on patient‑centeredness. Providing patient‑centered oncology nursing care requires changing attitudes, values, and behaviors at individual, professional, and organizational levels.

    Keywords: Cancer, nursing, patient‑centered care, qualitative research
  • Mansour Arad, Leyla Alilu, Hosein Habibzadeh, Hamidreza Khalkhali, Rasoul Goli Page 127
    BACKGROUND

    Since poor communication with the patient has a negative impact on the quality of nursing care, taking the necessary measures to strengthen the relationship with the patient seems necessary. This study was conducted to determine the effect of spiritual intelligence training on nurses’ skills for communicating with patients.

    MATERIALS AND METHODS

    This experimental study with the control group and the pretest‑posttest design was conducted on 70 nurses working in Imam Khomeini Hospital, Mahabad, in 2019. Randomized stratified sampling was used to recruit participants. Then, participants were randomly assigned to the two groups of control and intervention. The demographic information form and the patient‑nurse communication skill questionnaire were used to collect the data. For the intervention group, 7 spiritual intelligence training sessions were held as a workshop in 2 months. Two weeks and a month after the intervention, both groups completed the questionnaires. Data were analyzed with the SPSS software version 17.0.

    RESULTS

    The findings showed that the mean communication skill scores in the intervention group before training were 44.71 ± 7.62, which significantly increased to 66.22 ± 8.43 2 weeks after training. Bonferroni multiple comparisons showed the mean communication skill scores significantly increased before, 2 weeks later and in the follow‑up phase in the intervention group (P < 0.001).

    CONCLUSION

    Spiritual intelligence training is effective in improving the communication skills of nurses. It is recommended that the prepared content can be provided to in‑service training units; consequently, nurses can improve their communication skills by individual and group learning.

    Keywords: Communication, intelligence, nurse, patient, spirituality
  • Sajedeh Amjadi, Sepideh Mohammadi, Ali Khojastehrad Page 128
    BACKGROUND

    The coronavirus disease‑2019 (COVID‑19) crisis has changed many aspects of frontline nurses’ lives. Nurses caring for patients with COVID‑19 reported experiencing significant psychological distress and work‑related anxiety. This study aimed to assess the perceived stress and quality of life among frontline nurses fighting against COVID‑19.

    MATERIALS AND METHODS

    This web‑based cross‑sectional study was conducted on 322 frontline nurses fighting against COVID‑19 in hospitals affiliated to Mazandaran University of Medical Sciences. Data were collected using the two following online questionnaires: the Perceived Stress Scale and World Health Organization Quality of Life-Brief. Data were compiled from October 23, 2020, to November 25, 2020. Data were analyzed using the independent sample t‑test, Pearson’s correlation test, and regression analysis test in the SPSS‑21.

    RESULTS

    Average perceived stress scores was 30.27 (standard deviation [SD] = 7.01). Average quality of life subscale scores consist of physical health, psychological health, social relationships, and environment were 57.71 (SD = 12.74), 44.3 (SD = 15.58), 45.61 (SD = 16.99), and 47.6 (SD = 18.11), respectively. There was an inverse significant association between all the subscales of quality of life and perceived stress (P = 0.008). Based on the multiple linear regression analysis, the variables of age, gender, marital status, and perceived stress were the significant predictors of quality of life subscales.

    CONCLUSIONS

    Paying serious attention to addressing the concerns of frontline nurses, especially those who are at high risk, is necessary. It is recommended to take action as soon as possible to reduce the perceived stress and improve quality of life on nurses who care for patients with COVID‑19.

    Keywords: Coronavirus disease‑2019, nurse, perceived stress, psychological distress, quality of life, stress
  • Youssra Amekran, Abdelkader Jalil El Hangouche Page 129
    BACKGROUND

    Coronavirus disease (COVID‑19) and resulting restrictions have impacted populations’ lifestyles and posed a challenge regarding their behaviors, including physical activity (PA). This study aimed to evaluate PA patterns of university students during the COVID‑19 outbreak. We also analyzed the association of participants’ characteristics, including their level of anxiety, under the pandemic conditions, with adherence to the world health organization (WHO) recommendations for PA.

    MATERIALS AND METHODS

    This cross‑sectional study comprised 717 Moroccan university students recruited during the COVID‑19 pandemic. The Global Physical Activity Questionnaire (GPAQ V.2) was used to evaluate PA. Data on sociodemographic characteristics and anxiety levels were also collected. Anxiety was assessed using State‑Trait Anxiety Inventory (STAI). Descriptive and inferential statistical analysis was carried out. The association between participants’ characteristics and PA was studied using regression models.

    RESULTS

    Of all participants, 33.2% did not achieve the recommended levels of PA. The daily median (25th–75th percentile) time spent in PA was 34.3 min (12.7–98.6), whereas the median time of sedentariness was 10 h per day (6–14). Multivariate analysis showed that female sex (OR = 0.63; 95% CI: 0.44–0.90; P < 0.05) and high level of state anxiety (OR = 0.43; 95% CI: 0.20–0.92; P < 0.05) were negatively associated with the achievement of the WHO recommended PA.

    CONCLUSION

    The reported PA patterns of university students during the current outbreak should be taken into account and evoke the necessity of encouraging this population to adhere to the recommended PA levels. Targeting state anxiety related to the conditions we are facing may have a promising effect on the promotion of PA.

    Keywords: Anxiety, COVID‑19, physical activity
  • Lopamudra Debasish, Kavita Vasudevan, Premnath Dhasaram, Prakash Mathiyalagen Page 130
    BACKGROUND

    The role of medical undergraduates is limited while interacting with the community related to issues involving human behavior. Since qualitative research seeks to build a holistic understanding of social phenomena, we designed this project to expose them to the basics of qualitative research in a real‑world setting of experiential learning. The aim of this study is to sensitize the medical undergraduates to the basics of qualitative research and able to apply it in the context of experiential learning in the community.

    MATERIALS AND METHODS

    In this current educational intervention, a structured teaching program was designed and applied for the first time, to our students to effectively sensitize them to qualitative research in a natural community setting, intended to provide them a solid base for experiential learning. A batch of students (n = 50) was selected by convenient sampling method who had their clinical postings with us. At first, a “session planning guide” was drawn on the plan of conduction of this program. We followed the “facilitators reference manual by research consortium on educational outcomes and poverty (RECOUP) for our teaching sessions. The framework of our study was executed in the following sequence: sensitization of the learners, exposure to structured quality experience, systematic debriefing sessions with evaluation of learner experiences, and the process and outcome feedbacks from the learners. The students were monitored by trained facilitators. The various study tools used in the structured teaching program included, the teaching sessions using the RECOUP manual, didactic lectures and short group interactive sessions to teach qualitative research and photographs and video clips to facilitate the sessions, mock demonstrations and role plays on interviewing techniques, use of case vignettes on the theme “perception of psychosis” for interviewing the community, structured debriefing guide, and various self‑reflective exercises. Learners’ perspective of community perception, debriefing sessions, and self‑reflective responses were transcribed, and manual content analysis was done to identify the codes and interpret the results.

    RESULTS

    Majority could appreciate the uniqueness of qualitative research over the quantitative counterpart. They could enumerate the attributes of a good qualitative researcher. The debriefing exercises made them summarize their experiences and the self‑reflective exercises enabled them to identify their abilities and critique their ideas. It was a different experience to our learners as they could identify themselves with the sentiments of the community. To them, the facilitating points were the interviewing skills and confidence gained in facing the community. However, they felt time constraint for exploring the sensitive issues during the fixed posting schedule.

    CONCLUSIONS

    The experience of learning beyond the boundaries of a classroom setting sensitized them to various community perceptions and reactions. The students perceived the qualitative methods well and could apply the lessons learnt in the facility. They also felt that this learning exposure gave them community orientation and confidence in dealing with community issues.

    Keywords: Experiential learning, qualitative research, teaching program
  • Atefeh Zabihi Zazoly, Shoaleh Bigdeli, Zohreh Sohrabi Page 131
    BACKGROUND

    In the recent years, the wealth creation of educational institutions has attracted an enormous attention in different countries. Exploring experiences of these institutes help to improve the wealth creation of universities. In this regard, this study was an attempt to explain the viewpoints of the wealth creators of medical sciences regarding wealth creation strategies and define the general path of wealth creation in medical sciences universities.

    MATERIALS AND METHODS

    This qualitative study was conducted at Iran University of Medical Sciences, Tehran, Iran, in 2021. Participants were the experienced knowledgeable wealth creation experts. Fourteen semi‑structured interviews were conducted to reach data saturation. Interview guided questions were about strategies and paths of wealth creation followed by probing questions. Data were analyzed using conventional qualitative content analysis.

    RESULTS

    Data analysis showed that the most important strategies were related to nine extracted categories of “the productions”, “contracts and relations”, revising, predicting and foresight” ‑, “education”, “research”, “healthcare services”, “ interdisciplinary fields between Information Technology (IT) and health‑care”, “ saving and maintenance”, and “altering the procedure of the wealth accelerator centers.” In general, wealth creation path in medical sciences includes six main categories.

    CONCLUSIONS

    The result of this study provide an opportunity for educational policy‑makers and authorities to improve wealth creation in medical universities. Especially, accentuated by the COVID‑19 pandemic, to consider the interdisciplinary fields between IT and health‑care and integrating technology to the various categories of medical sciences are absolute needs.

    Keywords: Economic status, economics, education, health care, medical, medicine, universities
  • Faride Goldoust, Maryam Abolhasani, Elham Shakibazadeh, Mehdi Yaseri, Gholamreza Garmaroudi Page 132
    BACKGROUND

    Exercise self‑efficacy has been identified as one of the primary determinants of physical activity in people with multiple sclerosis (MS). Therefore, assessment of exercise self‑efficacy is important to be measured with valid and reliable scale to provide tailored interventions.

    MATERIALS AND METHODS

    The English version of the exercise self‑efficacy scale was translated into Persian using a forward‑backward translation approach. Factorial validity was conducted using the expletory factor analysis (EFA) and the confirmatory factor analysis (CFA). In addition, construct validity was performed using convergent and known‑group validity. Reliability was evaluated by internal consistency and test‑retest reliability. Participants were recruited from two hospitals (MS clinics).

    RESULTS

    Expletory factor analysis identified a single factor structure which explained 64.7% variance in exercise self‑efficacy scale (EXSE). CFA supported a single factor structure with a good model fit. Average variance extracted = 0.60 and composite reliability = 0.93 values confirmed the convergent validity. The known‑group validity was verified with significant differences between subgroups. The Cronbach’s alpha coefficient = 0.93 and intraclass correlation coefficient = 0.85 supported reliability of EXSE scale.

    CONCLUSIONS

    Our findings provided sufficient evidence of validity and reliability for EXSE scale in people with MS. This measure can utilize by researchers and health‑care providers in studies and clinical practice as a robust measure to assess exercise self‑efficacy and to develop interventions in people with MS.

    Keywords: Exercise self‑efficacy, multiple sclerosis, validity, reliability
  • Zahra Mansouri, Ali Tayebi, Robabe Khalili, Fakhrudin Faizi Page 133
    BACKGROUND

    Coronary artery bypass graft (CABG) plays an important role in reducing coronary heart disease mortality, but patients are still at risk after surgery. Consequences can be avoided if threatening behaviors are soon detected and lifestyles are promoted. Therefore, the present study aimed to evaluate, follow‑up, and promote a healthy lifestyle in the patients.

    MATERIALS AND METHODS

    The present research was a quasi‑experimental pre‑ and postintervention single‑group study on 35 patients under the CABG at two hospitals affiliated to the Baqiyatallah University of Medical Sciences in Tehran from August 2020 to April 2021. The samples were selected using the purposive sampling method and the educational content was determined by creating an expert panel. We utilized the Health‑promoting Lifestyle Profile II to collect data, and SPSS 22 to analyze them.

    RESULTS

    There was a significant difference between mean total scores of health‑promoting lifestyle before and after the intervention and they reached from 138.7 ± 20 to 157.2 ± 18 (P < 0.0001). There was also a statistically significant difference between mean scores of nutrition (P < 0.003), physical activity (P < 0.0001), health responsibility (P < 0.0001), and stress management (P < 0.0001) before and after the intervention, but there was no statistically significant difference between mean scores of interpersonal relationships, and spiritual growth before and after the intervention.

    CONCLUSIONS

    The program had a positive effect on the health‑promoting lifestyle scores of patients after CABG. It is possible to increase scores of healthy lifestyles in the patients by combining face‑to‑face and virtual training methods as well as involving family members and relatives of patients in training and follow‑up programs.

    Keywords: Coronary artery bypass graft, health promotion, healthy lifestyle, nursing education
  • Wahyul Anis, Rize Budi Amalia, Erni Rosita Dewi Page 134
    BACKGROUND

    Maternal knowledge is one of the indirect causes of maternal mortality in Indonesia. Maternal knowledge that mothers must possess includes knowledge about pregnancy, childbirth, and postpartum. Maternal knowledge should be provided during pregnancy. The aim of this study is to identify maternal knowledge in postpartum women who have a history of the frequency of pregnancy visits according to the minimum standard.

    MATERIALS AND METHODS

    A descriptive quantitative design was performed by assessing maternal knowledge to postpartum mothers using an online questionnaire which conducted in 2020 at two public health centers of Surabaya, Indonesia. A sample of this research involved postpartum mothers who completed inclusion criteria, namely physiological postpartum mothers and had regular pregnancy at least 6 antenatal care (ANC) visits. In contrast, the exclusion criteria were postpartum mothers who were not included in the target areas of research. It uses random sampling techniques and performs an analysis using descriptive statistics.

    RESULTS

    Three research questions showed a large percentage of wrong answers, namely preparation to face complications (64%), contraceptive methods in breastfeeding mothers (50%) and the first time using contraception during childbirth (42%). Meanwhile, all the correct results (100%) are exclusive breastfeeding and supplementary feeding for babies.

    CONCLUSION

    Completing minimal standards of ANC visits cannot ensure adequate maternal knowledge, particularly crucial health information that influences maternal and neonatal health status.

    Keywords: Health policy, midwifery, maternal health, postpartum, pregnancy, maternity care
  • Elham Rostami, Sedigheh Khanjari, Hamid Haghani, Houshang Amirian Page 135
    BACKGROUND

    As pediatric surgeries are rising and current methods to reduce perioperative anxiety are lacking in preschool children. The purpose of this study was to determine the effect of video games on preoperative anxiety in 3‑ to‑6‑year old of a sample of Iranian children undergoing elective surgery children.

    MATERIALS AND METHODS

    In the current quasi‑experimental pretest posttest design, after standard translation, the modified Yale preoperative anxiety scale was administered to 102 children undergoing surgery from December 2016 to August 2017 in Kermanshah, Iran. Children are assigned to an intervention or control group. Each child’s anxiety was measured at two points at the time of arrival and after waiting for 20 min in the holding area. Data were analyzed by SPSS, version 22. The Chi‑square, independent t‑test, and paired t‑test at the significance level of P < 0.05 were performed.

    RESULTS

    There was no significant difference between the mean anxieties in control group (42.58 ± 18.54) and intervention group (46.11 ± 14.09) before the game (P = 0.282). However, after playing the video game in control groups (53.26 ± 18.00) and game groups (34.88 ± 10.81), there was a significant difference in favor of the video game (P < 0.001).

    CONCLUSION

    Findings of the present study suggest that approved video game by experts to decrease mean preoperative anxiety in 3‑ to‑6‑year‑old children. Therefore, video games recommended to be implemented at the preventive level in hospital.

    Keywords: Anxiety, children, preoperative care, surgery, video game
  • Maryam Avizhgan, Nikoo Yamani, Athar Omid, Shahrzad Shahidi Page 136
    BACKGROUND

    This study was conducted on accountability, aiming to design components for monitoring the curricula of universities of medical sciences.

    MATERIALS AND METHODS

    This study was a developmental one, conducted in Isfahan University of Medical Sciences with the document and literature review, a focus group, and a survey from 2018 to 2020. The first version of the components was designed by the library research and content analysis method. Following developing the initial tool, its validity was evaluated with a focus group, and the questionnaire was prepared according to face and content validity.

    RESULTS

    In this study, 73 components were designed in eight domains for curriculum supervision, including requirements (12), needs and goals (6), content (10), teaching–learning strategies (10), educational materials and resources (5), educational time (2), educational setting (10), and evaluation (18).

    CONCLUSION

    The components of curriculum supervision were designed due to their importance in the evolution and innovation of medical sciences, particularly accountability in the education system, and lack of relevant research. With these components, the current and optimal status of curricula can be determined in universities.

    Keywords: Accountability, curriculum leadership, curriculum management, curriculum supervision
  • Nopparat Senahad, Wongsa Loahasiriwong, Naowarat Maneenin Page 137
    BACKGROUND

    Health literacy (HL) enables a person to make good decisions regarding health care, disease prevention, and health promotion to maintain and improve health. In Thailand, most existing studies focus on adults’ HL rather than children. This research aimed to determine the influence of sociocultural and health knowledge on HL among children ages 9–10 years in Thailand.

    MATERIALS AND METHODS

    A cross‑sectional study was conducted among 1650 children aged 9–10 years. The respondents were recruited using multistage random sampling from 39 primary schools of 13 provinces in all four regions of Thailand. A self‑administered structured questionnaire was used to collect the required data. The multilevel analysis was used to determine the association between sociocultural, health knowledge, and HL while controlling the effects of covariates. The result was presented as adjusted odd ratios and its 95% confidence interval (CI).

    RESULTS

    Of the total 1650 respondents, 86.24% (95% CI: 84.49%–87.82%) had adequate and excellent levels of HL. The multivariable analysis indicated factors that were significantly associated with adequate and excellent levels HL including adequacy of per diem (adjusted odds ratio [adj. OR] = 6.78; 95% CI: 3.54–12.97) and had good relationship with teachers (adj. OR = 2.19; 95% CI: 1.55–3.09). Sources of health education which were received health education from parents (adj. OR = 3.51; 95% CI: 2.39–5.14), from teachers (adj. OR = 2.03; 95% CI: 1.43–2.89), and from the Internet (adj. OR = 1.83; 95% CI: 1.12–2.99) were also significantly associated with HL. Another significant factor was had good level of health knowledge (adj. OR = 1.86; 95% CI: 1.30–2.66) when control clustering effect of region, provinces, school, and classroom size.

    CONCLUSIONS

    More than 85% of children ages 9–10 years in Thailand had adequate and excellence levels of HL. Sociocultural and health knowledge had influence on children HL.

    Keywords: Children ages 9–10 years old, health knowledge, health literacy, sociocultural
  • Bouhaba Abdelmounaim, Zineb Boumaaize, Youssef Elmadhi, Hinde Hami, Abdelmajid Soulaymani, Hajar Darif Page 138
    BACKGROUND

    Stress and burnout syndrome are more common for people who work in professions that include direct contact with humans, such as education and the medical field. To contribute to the prevention of this syndrome, the Maslach Burnout Inventory-Student Survey (MBI-SS) has been validated and used in different countries worldwide except for Morocco. The main purpose of this study is to develop and validate a special version of the MBI‑SS scale to assess academic burnout among Moroccan trainee teachers during their training period.

    MATERIALS AND METHODS

    A self‑administered questionnaire was carried out to assess the sociodemographic factors and certain stressors of the interviewees as well as the MBI‑SS. Two hundred fifty‑five trainee teachers of the CRMEF (Regional Centre for Education and Training) participated to assess the validity of the MBI-SS scale in its French version and its three components during the academic year 2020/2021 of the Rabat-Salé-Kénitra region. The inferential method of data analysis was used by Cronbach’s alpha to determine the overall reliability of the instrument as well as the three components of the assessment. After that, exploratory factor analysis was carried out.

    RESULTS

    Sixty five percent of the participant were male, and most of them were between the ages of 20 and 30 years. The results demonstrated a satisfactory psychometric characteristic for its dimensions and validated the 3-dimensional structure of the MBI-SSM, yet they indicate the necessity to remove two items to guarantee their reliability. The Cronbach’s alpha value of the MBI‑SSM was greater than (0.7). The Cronbach’s alpha also showed a good homogeneity for the three dimensions of the MBI‑SSM, (0.853) for emotional exhaustion, (0.570) for cynicism, and (0.776) for academic efficacy.

    CONCLUSIONS

    It is concluded that the MBI-SSM is determined to be an objective and a valid instrument and can be used to assess academic burnout in the Moroccan context.

    Keywords: Academic burnout, exploratory factor analysis, Maslach Burnout Inventory-Student Survey, Morocco, psychometric characteristics, trainee teachers
  • Sandip Meghnad Hulke, Santosh L Wakode, Avinash E Thakare, Rachna Parashar, Rajay N Bharshnakar, Ankur Joshi, Yuganti P Vaidya Page 139
    BACKGROUND

    With the emergence of COVID, we are forced to use e‑learning in form of arranging online classes for students. Medical educators all over the world are conducting online classes for students. This study aimed to evaluate the perception of online learning among MBBS students and teachers through a questionnaire‑based survey.

    MATERIALS AND METHODS

    A cross‑sectional study was done in the AIIMS, Bhopal. The study was based on questionnaire (online Google form) response received from 43 number of faculty and 156 number of students. STATISTICAL ANALYSIS USED: Chi‑square test and unpaired t‑test were used for statistical analysis using statistical software Systac 13.2.

    RESULTS

    Handling software, technical issues, and lack of face‑to‑face interaction were more significant problems in students compared to faculty. The desire for the social site which causes disturbances in learning was a significant problem in the students compared to faculty. Giving and taking assessment problem was reported by 60% and 63.8% of faculty and students, respectively (P = 0.67). Both groups preferred the Google Classroom platform (P = 0.16). Students (65.3%) preferred audiovisual recording, while faculty (72%) preferred PowerPoint with narration. PowerPoint presentation without narration was the least preferred (10.8%). Both groups stressed the importance of training (P = 0.17) and infrastructure development (P = 0.85). Students, as well as faculty, strongly discouraged e‑learning for practical/clinical teaching.

    CONCLUSIONS

    Students, as well as faculty, have mixed reactions toward e‑learning. Most importantly affected in the present scenario is practical/clinical teaching and assessment. Every attempt needs to be done to strengthen infrastructure and impart training to students and faculty.

    Keywords: COVID, eLearning, Google Classroom, medical education, perception, teacher–student interaction
  • Syed Sameer Aga, Nusrath Yasmeen, Muhammad Anwar Khan, Alqassem Y Hakami, Abdullah Awadh, Israa Abdullah Malli Page 141
    BACKGROUND

    Human papillomavirus (HPV) infection is the major risk factor for cervical cancer (CC) in women of reproductive age. Despite advances in treatment and prevention of CC by HPV vaccination, very few women utilize them because of a lack of awareness about HPV.

    MATERIALS AND METHODS

    We conducted this cross‑sectional study among Health Professions Students (HPS) at King Saud Bin Abdul Aziz University for Health Sciences, Jeddah. Data were collected using a predesigned and validated study questionnaire to assess the knowledge, attitude, and perception of HPS toward HPV.

    RESULTS

    A total of 580 HPS responded to the survey; 128 (22.1%) were male, while 452 (77.9%) were female with the mean age ± standard deviation 20.36 ± 1.74 years. There was no significant difference between males and females related to screening of HPV and CC (82.8%; 82.3%). A minority (30.3%) of participants thought that HPV infection leads to CC, while 38.3% did not know about it. Furthermore, knowledge about HPV screening and vaccination was poor.

    CONCLUSIONS

    Students from the college of medicine had more knowledge and awareness about HPV (34.9%, P < 0.001). Thus, it is important to implement effective education programs, curricular activities, and awareness campaigns for health professions to augment the learning process effectively.

    Keywords: Cancers, cervical, college of medicine, health professions, human papillomavirus, students
  • Elaheh Mazaheri, Rahele Samouei, Mousa Alavi, Roya Kelishadi, Hasan Ashrafi-rizi Page 142

    Today, the ability of the organizations to successfully knowledge management and sharing can help them in better performance. Effective knowledge sharing (KS) in the clinical context provides better clinical decisions and improves the quality of care services. This systematic review will be conducted to identify the factors related to the clinical KS (CKS). This systematic literature review will be conducted to search the published documents about the affecting factors on the (clinical) KS. To this end, PubMed, Scopus, Web of Science, ProQuest, Cochrane, Embase, SID, Magiran, IranDoc, and ISC will be thoroughly assessed with considered keywords and search strategy. No time limit will be considered and all relevant documents published will be evaluated until the start date of the search. To the best of our knowledge, no systematic review study has been conducted on the factors related to CKS and our research will try to comprehensively extract the effective factors in this topic. Identifying the factors affecting CKS will lead to transparency in the exchange and interpretation of clinical knowledge in clinical care delivery and making the best clinical decisions as well as improving the quality of clinical care. It will also provide a condition to facilitate the delivery of more effective clinical education for policymakers in the field of clinical education.

    Keywords: Clinical education, clinical knowledge, clinical knowledge sharing, health personnel, physicians, systematic review
  • Roghieh Sodeify, Zeinab Habibpour, Masoumeh Akbarbegloo Page 143
    INTRODUCTION

    With the unintended closure of classrooms following the outbreak of COVID‑19, the virtual education method is used as an alternative to face‑to‑face education. Virtual education is one of the important factors in promoting the learning of medical students and has many benefits such as increasing the ability of critical thinking, problem‑solving skills, and self‑directed learning. However, critically examining students’ perceptions of e‑learning can help improve quality and better planning.

    MATERIALS AND METHODS

    This research was a qualitative study. Twelve students were enrolled in the study based on purposive sampling. Data were collected using in‑depth semi‑structured interviews in 2020. All interviews were recorded and then transcribed and analyzed using a continuous comparison and conventional content analysis approach.

    RESULTS

    Data analysis revealed four main themes and ten subthemes. The main themes included “student concern,” “teacher barriers,” “technology weakness,” and “asynchronous virtual learning flexibility.”

    CONCLUSION

    Asynchronous e‑learning in the COVID‑19 outbreak had its advantages and disadvantages. By analyzing students’ perceptions in this field, some better designs and planning can be done to increase the quality of education.

    Keywords: Education virtual education, medical, perception, students
  • Mohd Altaf Mir, Debarati Chattopadhyay, Madhubari Vathulya, Vishal Mago, Rajesh Kumar Maurya, Akshay Kapoor, Neeraj Rao Page 144
    BACKGROUND

    In this study, we attempted to assess the change of perception of postgraduate students on objective structured clinical examination (OSCE) in burns and plastic surgery after first five OSCE.

    METHODS

    A prevalidated feedback questionnaire was used to assess and score the perception of postgraduate students on OSCE in burns and plastic surgery. The opinion of postgraduate students on the feedback questionnaire after first and fifth assessment tests based on OSCE was analyzed. The results were compiled on a data sheet and analyzed using Microsoft Excel and plotted as graphical interpretation. The statistical analysis was done using MedCalc software.

    RESULTS

    The results of the study showed that there is a positive change in perception of students in favor of monthly assessment based on OSCE in burns and plastic surgery after fifth assessment. The mean students’ favorable perception score after the first assessment with was 30.2 ± 2.828 (mean ± standard deviation [SD]) and after fifth assessment, 43 ± 2.828 (mean SD) with Student’s test t = 10.119 and P < 0.0001 which is highly significant statistically in favor of OSCE after fifth assessment.

    CONCLUSIONS

    We observed in our study that the monthly assessment based on OSCE is well accepted by the students of our subspecialty after few assessments; however, further studies are required to augment the evidence.

    Keywords: Clinical examination, examination assessment tool, objective structured
  • Ghazaal Etemadi, Reza Rezayatmand, Nasrin Shaarbafchizadeh Page 145
    BACKGROUND

    Nowadays, various strategies are applied by governments to control costs and finance hospitals and the health sector. Public‑private partnership (PPP) option is one of these strategies. Considering the growing importance of hospitals in different communities and their problems, this study aimed to identify PPP challenges, opportunities and solutions in hospitals. This study aimed to identify the challenges and opportunities of PPP in the country’s hospitals and then offered an appropriate solution to overcome these challenges.

    MATERIALS AND METHODS

    This is a qualitative study and content analysis approach is undertaken. The participants were selected through purposive sampling and data were collected using a semi‑structured interview with experts in the public and private health sector until the saturation point achieved. Data analysis was performed through the thematic analysis of expert’s statements using MAXQDA. 10 software in this sector.

    RESULTS

    According to the study results, 3 main themes (challenges, opportunities, and solutions), 10 sub‑themes, and 32 codes were identified in relation to the public and private partnership. 4 sub‑themes on challenges of PPP, 3 sub‑themes on partnership opportunities and 3 sub‑themes on challenges solutions were identified.

    CONCLUSION

    The results of this study revealed that given the discussed challenges the most important challenge seems to be not evaluated outsourcings, incorrect usage of participatory models, and inadequate and inappropriate postoutsourcing supervision, however, it appears evaluated outsourcing backed with adequate supervision could solve many current hospitals’ problems.

    Keywords: Challenges, hospital, opportunities, public‑private partnership, solutions
  • Nafiseh Karimi Badrabadi, Sogand Tourani, Asef Karimi Page 146
    BACKGROUND

    Nowadays, medical tourism reports impressive growth in terms of number of persons, income, and number of countries involved in cross‑border flows. It refers to people traveling abroad (from home to a target country) to obtain medical treatment. The present study aimed to identify the themes and codes of the medical tourism business in Iran.

    MATERIALS AND METHODS

    We searched international databases (such as PubMed, Scopus, Embase, and Web of Science) and Iranian bibliography thesaurus and repositories (namely, Scientific Information Database and Magiran) using keywords such as medical tourism, international medical travel, and medical tourism business in the English and Persian literature, published between January 2000 and December 2019, identified with no restriction on the type of the studies. The data were analyzed based on the content analysis method.

    RESULTS

    Out of 1054 articles, 14 were finally selected. In the end, eight themes of the medical tourism business including competitive pricing, safety and security, information and communication technology, labor market and human resources, structure management, leading the way in medical tourism, infrastructure, and exchange with the international world were identified which on the whole contain 45 codes. Most of the articles were quantitative. Four of the themes (competitive price, labor market and human resources, structure management, and infrastructure) were most frequent and of the highest importance.

    CONCLUSION

    The themes and codes identified in this study helps companies and individuals who want to work in the field of medical tourism. According to this study, all 8 themes and 45 codes are of high value, but still, some themes are of higher value than others and special attention should be paid to them.

    Keywords: Business, Iran, medical tourism, systematic review