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Children are the biggest national investment that a society can make. With increased child population so too have their problems increased, amongst which are the increased incidence of street children, which as a result has endangered their health. This research is a descriptive and cross sectional study towards determining the effective factors on the self-concept of street children aged 6-12 years who were referred to the Khajouye Kermani culture house of Tehran in 1380. In this regard, 140 street children between the ages of 6-12 were chosen. The method was a 4-part questionnaire which included personal, family and societal information and questions related to the self- concept of the children. The data was collected by interviews with the children. In accordance with the average and the deviation criteria achieved, the level of self-concept was divided into four groups, extremely negative, negative, positive and extremely positive. The results showed that half of the subjects (50%) had very negative concepts of themselves and only 2.2% of them had a very positive self- concept levels. Therefore the street children had a very low self- concept level. Also as concerns the factors affecting self- concept was also a meaningful relationship between self- concept and some factors such as gender, education, level of income, duration of work, level of happiness within the family, counseling, reaction to the child's mistakes, having necessities for the home, adequate nutrition and clothing, having street friends before work (P<0.05). Therefore street children are at risk as regards their mental and physical development because they suffer from low self- concept levels and require special attention. Because of the vast responsibilities nurses can play an important role to improve of the health of these children.

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Background & Aim: Evidence-based practice (EBP) education is essential in nursing education. Therefore, identifying factors influencing nurses' adoption of EBP is very important to perform optimum quality nursing interventions. The aim of present study was to determine the factors affecting the adoption of EBP based on Rogers' diffusion of innovations models in nurses.

Methods & Materials: This was a descriptive–analytical study. The research subjects were 130 nurses who worked in the hospitals affiliated to Tehran University of Medical Sciences in 2014. The research instruments were four questionnaires including demographic data; knowledge, attitude and the adoption of EBP; individual innovation and perceived attributes of EBP. Data were analyzed by descriptive and inferential statistics (Pearson correlation coefficient and path analysis) on SPSS v.19 and EQS.

Results: The study findings showed that age and the working experiences of nurses had significant inverse relationships with knowledge of EBP (r=-0.809, r=-0.805). There was a direct relationship between individual innovation and knowledge (r=0.776). In addition, knowledge not only had a significant direct relationship with the adoption of EBP but also had the greatest impact on the adoption of EBP compared to other variables of model (r=0.937). Perceived attributes of EBP had significant direct relationships with attitude and the adoption of EBP (r=0.898, r=0.888 respectively). Attitude toward EBP also had a direct and significant relationship with the adoption of EBP (r=0.869). The results of the path analysis indicated the model variables to have an optimal fit (P<0.001).

Conclusion: The results of this study identify the factors affecting the adoption of EBP. Determining these factors can be an effective step to more adopt it in clinical environments.

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Health (hygienic) literacy is a cognitive skill and an important and effective issue in the healthcare system that was first proposed in 1974 in an educational panel about health education. Since then, this concept has been discussed by the researchers in various fields of literacy and health, and many definitions have been presented for it. Usually, health literacy is defined as a wide range of knowledge and skills in accessing, appraising, understanding and applying health information (1).
The importance of health literacy impact on the health outcomes of the patients has been well recognized and it has an important role in individual’s decision-making regarding their health needs (2). Health literacy as a social and cognitive skill has various aspects including accessing, appraising, understanding and applying. The ability to understand the educational content, as one of its aspects, has a significant importance in the patients (3-6). In recent years, health literacy has been recognized as an important skill that patients require for making an appropriate health decisions in difficult situations they encounter. Improving patients’ health literacy would cause outcomes such as increasing the patients’ potential to make informed decisions, decreasing health-threatening risks, increasing prevention of the diseases, improving patient safety, and improving quality of life and patient care (7-9).
To educate people, usually their general literacy would be considered, not their health literacy; while there is a significant difference between general literacy and health literacy. General literacy means having the ability to read and write and having basic skills. In contrast, health literacy is defined as a cognitive and social skill determining the individuals’ ability to access, understand, and apply information in order to promote health (10). Studies have shown that limited health literacy is associated with various complications in different aspects of health including lack of access to appropriate health services, less willingness to follow up treatments, less compliance with medication, increased number of visits to the emergency ward, increased duration of hospitalization, and increased mortality rate, and it has a significant effect on using healthcare services (3-6).
Furthermore, the negative economic effect of low health literacy on the patients and healthcare system could not be ignored. These issues would indicate the need for paying more attention to individuals’ health literacy.
According to a study conducted by Montazeri et al in Iran, it has been revealed that half of the Iranian population has a limited health literacy and this limitation is more common in the vulnerable groups such as the elderly, housewives, unemployed people and those with lower education levels; this would put them at more health risks (2). Also, results of various studies have shown that some health information is not appropriate for the audience and would not address their needs; whereas the effect of limited health literacy could be improved using appropriate health information. So, the challenging issue regarding these individuals is how to train them (regarding understanding health information); there are various strategies for resolving this issue such as limiting the information provided at each patient’s visit, avoiding technical terms, speaking slowly, finding educational content tailored to individuals’ ability to read, using pictures for explaining important concepts, encouraging people for asking more questions and assessing individuals’ understanding of the education provided using teach back and show me methods (11).
In this regard, in 2011, Centers for Disease Control and Prevention (CDC) designed the Health Literacy Index as a tool for providing appropriate educational content based on people’s health literacy. This comprehensive checklist comprises 63 items organized into 10 criteria; its criteria and items are shown in table 1. According to this checklist and based on its ten criteria, the educational process (content, procedure and evidence) would completely be evaluated to limit the effect of health literacy on the understanding of information provided to individuals (12).
 
Table 1. The criteria of the health literacy index

Criterion	Items	Evaluated subject
Plain language	8	Writing style (short and easily readable sentences) Terms (avoiding technical terms) numbers and data (ease in understanding the content)
Clear purpose	8	Precision, summaries and reviews Number of key points purpose of material (purposiveness) Using visual elements in the educational content
Supporting Graphic	6	Explanatory labels Graphic and images of the educational content in relation with the text to help the understanding of the abstract concepts
User involvement	7	Interactive strategies (the level of attention received by the audience and the extent of their active participation through the column of counseling, answer and question, games or competitions and storytelling narrations) Audience response
Skill-based learning	3	Focus on behavioral skills (modifying a health behavior and providing examples related to this modification)
Audience appropriateness	6	Match between audience and material (cultural and social appropriateness to the audience in terms of their experiences, values and beliefs) Audience identified
Instructions	6	User instructions Instructions for using the educational content regarding its technicality, applicability and comprehensiveness
Development details	3	Authors’ contact information Recent review of the studies
Evaluation methods	13	Process, formative and outcome evaluations
Strength of evidence	3	Evaluation findings

 
Andrade and colleagues studied the impact of using this index in providing educational materials for falling in the elderly. The results of this study showed that all the educational information is not suitable for audience and does not meet their needs. However, with the help of Health Literacy Index, it is possible to provide educational materials that are fit for the level of health literacy of elderly (7).
Due to the Low health literacy is very common particularly in the elders, it is crucial to provide educational materials that are consistent with the level of health literacy in target groups. Regarding the small number of studies have been conducted on the impacts of using health literacy index, It is imperative that the researchers in the related fields provide empirical evidence for its efficiency and effectiveness.
 
 
 

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Background & Aim: Women's health is important in middle age, and lifestyle, including healthy eating, has an impact on it. This research was aimed to determine the effect of an educational program based on BASNEF model on nutrition in middle-aged women.
Methods & Materials: This clinical trial was conducted on 95 women under coverage of the healthcare centers affiliated to Tehran University of Medical Sciences in 2016. The demographic characterizes and the BASNEF constructs regarding nutritional behavior were measured by questionnaire before and eight weeks after the intervention. The intervention was performed in three one-hour sessions. Data were analyzed by descriptive statistics, Chi-square and Mann-Whitney U tests using the SPSS software version 16.
Results: Before the intervention, both groups had not any significant differences in all variables and constructs. After the intervention, in the experimental group, the median and interquartile range were 10±3 for knowledge, 38±10 for attitude, 3±1 for subjective norms and 1±1 for behavioral intention. But in the control group, the scores were 6±2 for knowledge, 37±5 for attitude, 4±1 for subjective norms and 1±1 for behavioral intention. There was a significant difference between the two groups (P˂0.05). However, the scores of enabling factors were not significantly different between the two groups of intervention (3±1) and control (3±1) (P=0.4).
Conclusion: Designing and implementing the educational program based on BASNEF model not only can improve the knowledge and attitude about healthy nutrition in middle-aged women, but also modify their behavioral intention.
Clinical trial registry: IRCT2016042427566N1
 

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Background & Aim: The main care need of patients with myocardial infarction (MI) is continuous care, presenting an important challenge in the field of nursing care. Therefore, This study aimed to evaluate the effect of nurse-led home-based cardiac rehabilitation on adherence to therapeutic regimens in patients with MI.
Methods & Materials: In this randomized clinical trial study, 80 eligible patients were selected through convenience sampling from selected hospitals affiliated with Tehran University of Medical Sciences in 2020-2021. Subsequently, they were randomly allocated to either the intervention or control groups. The control group received routine education upon hospital discharge, whereas the intervention group participated in a nurse-led cardiac rehabilitation program conducted both in-person at home and online, comprising four 90-minute sessions once a week, and were monitored for two months. Participants completed socio-demographic and treatment compliance questionnaires before and three months after the intervention. The collected data was analyzed using descriptive and inferential statistics with SPSS software version 20.
Results: Both groups were homogeneous in most demographic variables (P>0.05). The mean and standard deviation of treatment adherence scores before the intervention in the intervention and control groups were 70.82±7.91 and 67.94±11.20, respectively (P=0.015). After the intervention, these values changed to 75.10±6.13 and 68.77±10.12, respectively, with a statistically significant difference observed between the two groups (P<0.001).
Conclusion: The results revealed that nurse-led home-based cardiac rehabilitation was effective in enhancing treatment adherence. Therefore, it is suggested that cardiac rehabilitation care be consistently extended to the home setting.
Clinical trial registry: IRCT20201006048953N