---

Background & Objective: High rates of cesarean delivery have worried health policy makers. One of the main reasons for cesarean section in Iran is cesarean election. Health Belief Model (HBM) is one of the most powerful models used in health education programs. The objective of this study was to determine the effect of education designed based on HBM on choosing delivery mode among pregnant women.

Methods & Materials: In this experimental study, 128 nulliparous women were recruited from Shahrood health care centers and private gynecologists' offices. Samples were randomly allocated into two equal groups. Women in the experimental group participated in two 40-minutes educational classes which were designed based on HBM. Data were gathered both before and after the classes, and then were analyzed using SPSS.     

Results: The results indicated that there were no significant differences between two groups in demographic characteristics, infertility history, disease history, perceived susceptibility, and perceived benefits and barriers. After the intervention, significant differences were found between perceived  susceptibility (P<0.001), perceived severity (P<0.001), perceived barriers (P=0.004), with practice (choosing the delivery mode) (P<0.001).

Conclusion: The results showed that using HBM in program designing was effective in the pregnant women's decision-making toward delivery mode.

---

Background & Aim: The Clinical Teaching Partner model (CTP) integrates theoretical knowledge with professional skills and brings the reality to workplaces. Closing educational and practical aspects in nursing discipline has been a challenging goal for nursing which requires cooperation between faculty instructors with nurse practitioners such collaboration will led to development and promotion of nursing discipline. Therefore selecting an effective and efficient approach in order to integrate theoretical knowledge with practical experiences would be crucial for nursing profession. This study was conducted in order to investigate the effect of CTP on nursing students&apos clinical skills outcome.

Methods & Materials: A quasi experimental, only post test design was applied. Study sample consisted of 1) three faculty instructors, 2) seven registered nurse practitioners who were staff nurses in three pediatric wards and voluntarily participated in the study and 3) fifty two nursing students which were in the 5th semester of nursing BSc. program and had eligible criteria to enter the study. Students were allocated randomly to the intervention (n=28) and control (n=24) groups. Participants in the control group, initially started their internship period in 3 pediatric wards and were evaluated by faculty instructors regarding their clinical skills at the end students in the intervention group, then started their clinical training course in the same ward as control group, but their clinical education was conducted by the nurse practitioners who voluntarily participated in the study and trained initially in the nursing faculties&apos skill lab. Students&apos clinical skills were evaluated by nursing mentors via some instruments at the end of the educational period in addition, clinical education outcomes and nursing students&apos satisfaction of achievement to apprenticeship goals were assessed at the end of the training period. Data were analyzed using the statistical tests including Chi square, Fisher exact test, Mann-Whiney U, and t-test in SPSS.

Results: Considering students demographic characteristics, both groups were homogenous. There was a significant difference in the students&apos clinical skills between two groups (P<0.001). A significant difference was shown in the nursing mentors and faculty instructors&apos satisfaction of application of cooperative education method between both groups (P=0.004). No significant differences were found between students&apos satisfaction of reaching to educational outcomes between both groups (P=0.058). There were also no statistical differences between nursing mentors and faculty instructors&apos satisfaction of achieving to clinical education outcomes (P=0.109).

Conclusion: According to this study, CTP is an effective approach in clinical education and development of clinical skills for nursing students therefore,

application of this method is recommended in clinical nursing education.

 

---

Background & Objective: Poor physical and psychological health status in chemical warfare victims could result in decreasing quality of sleep. This study was conducted in order to evaluate the effect of using Continuous Care Model on sleep quality in chemical warfare victims with bronchiolitis obliterans.

Methods & Materials: A total of 62 chemical warfare victims with bronchiolitis obliterans were recruited to the study. The participants were randomly allocated to experimental and control groups. The Continuous Care Model was used to experimental group for a period of two months. The quality of sleep was measured using Pittsburgh Sleep Quality Index (PSQI) before and after the intervention in both study groups. Data were analyzed using independent sample t-test, and paired t-test in the SPSS-version 15.

Results: There were significant differences between experimental and control groups in the means of Subjective Sleep Quality, Sleep Disturbances, Use of Medications, and global scores after the intervention (P<0.05).

Conclusion: Using Continuous Care Model had positive effect on sleep quality in chemical warfare victims suffering from bronchiolitis obliterans.

---

Background & Aim: Micronutrients deficiency is one of the most common health problems among adolescents. Theory based educational interventions which address learners&apos preferences are among the solutions for the matter in hand. The aim of this study was to determine the effectiveness of the Transtheoretical model (TTM) based educational package on vitamin intake in female adolescents in Tehran.

Methods & Materials: A randomized community trial was applied. Study samples were consisted of 80 female students from two middle schools of Tehran, district 17^th. They were selected using a cluster-random sampling method and were randomly assigned to the intervention (n=40) and control groups (n=40). The intervention group received a TTM-based educational package. Changes in vitamin intake were assessed using standard food frequency & 24-recall questionnaires.

Results: Based on pre-test results, intake of vitamin B2, B6, B9, B12, and C were lower than Dietary Reference Intake (DRI) in both groups. Based on the post-test data, a significant increase occurred in the mean score of vitamin intake in the intervention group comparing with the control group and also with the intervention group at pretest (P<0.05).

Conclusion: TTM-based educational package could be effective in improving vitamin intake in urban female adolescents.

---

Background & Aim: Early diagnosis of breast lumps through breast self-examination (BSE) is important for early detection of breast cancer. The aim of this study was to evaluate factors predict the BSE behavior using Health Belief Model constructs in women referred to health centers in Bandar abbas, Iran.

Methods & Materials: In this cross-sectional study, 240 eligible women were randomly selected from eight health centers. Data were collected using a self-administered questionnaire including demographic characteristics and Champion&aposs Health Belief Model Scale (CHBMS). The CHBMS measures the HBM concepts of susceptibility (3 items), seriousness (6 items), benefits (4 items), barriers (8 items) and self-efficacy (10 items). All items were ranged in a Likert scale ranging from ‘‘strongly disagree (score: one)&apos&apos to ‘‘strongly agree (score: five)&apos&apos.

Results: A total of 240 women took part in the study. The mean age of participants was 37.2 (SD=6.1). Of all, 32.5% had high school education and 95.8% were married. The results showed that 31.7% of the women had performed the BSE however, only 7.1% had performed it regularly. Perceived BSE benefits, perceived BSE barriers and perceived BSE self-efficacy of the participants who performed the BSE were significantly higher than those who did not (P<0.03). The results from regression analysis indicated that the perceived BSE self-efficacy and perceived BSE barriers predicted breast self-examination behavior (P<0.001).

Conclusion: The findings of this study indicated that perceived BSE barriers and perceived BSE self-efficacy were influencing factors in predicting the BSE behavior. Therefore, in order to improve self-efficacy and decrease the barriers, BSE training programs are strongly recommended.

---

Background & Aim: This study aimed to assess relationship between perceived benefits/barriers and decisional balance with stages of change for physical activity among high school students in Bandar Abbas, Iran.

Methods & Materials: This cross-sectional study was conducted in high schools of Bandar Abbas, in the south of Iran. A total of 422 high school students were selected. Twenty two participants did not fill out questionnaires completely. A total of 400 questionnaires were analyzed (response rate=94.8%). The perceived benefits/ barriers to exercise and decisional balance were assessed using the Exercise Benefits/Barriers Scale and stages of change were assessed using the Physical Activity staging. Data were analyzed in the SPSS v.16.

Results: The mean age of the participants was 15.9 (SD=1.1) ranging from 14 to 18 years. More than half of the participants (51.8%) were male and 48.2% were female. About half of the participants (49.2%) were engaged in regular physical activities. Fifteen per cent of the participants in the precontemplation stage, 15.8% in the contemplation stage, 20% in preparation stage, 15.8% in action stage, and 33.4% in maintenance stage for physical activity. From precontemplation stage to maintenance stage, the perceived benefits and decisional balance were increased and the perceived barriers was decreased.

Conclusion: The results of this study are in line with the Transtheoretical model. This model can be used as a framework to design interventions for improving physical activity in population.

---

  Background & Aim: Oral health is one of the most important components of personal health. Understanding current status of oral health is necessary to provide future oral health interventions. The aim of this study was to determine factors influencing tooth brushing behavior based on the health belief model (HBM) among 5- and 6-grader students.

  Methods & Materials : : In this cross-sectional study, 370 primary school students were selected using the stratified cluster sampling method. Data were collected using a questionnaires based on the HBM. The obtained data were analyzed in the SPSS-20.

  Results: The results showed that 95.7% of the students brushed their teeth once or more daily. Mean and standard deviation of the brushing frequency in one week was 8.66±3.54. There was a significant correlation between the perceived barriers (P=0.00, r=-0.14) and self-efficacy (P=0.04, r=0.10) with the brushing behavior.

  Conclusion : According to the results, educating students and decreasing different barriers seems to be necessary to improve brushing behavior.

---

  Background & Aim: Although breast self-examination (BSE) is no longer recommended for screening of breast cancer, its training and practicing is a gateway to health promotion and provides women with knowledge and attitudes that set the stage for clinical breast examination and mammography screening later in life. The aim of this study was to recognize predicting factors of the BSE based on the Health Belief Model (HBM) and the locus of control model among women aged 20-50 years old.

  Methods & Materials : Inthis cross-sectional study,400 women were selected through theconvenience sampling method from health centers. Data were collected using four questionnaires including the Champion’s Scale, health locus of control, and demographic and functional questionnaires. Data were analyzed in the SPSS using independent T-test, Chi-squared test, logistic and linear regression models.

  Results: The results showed that 10.9% of the participants reported performing BSE regularly. Perceived self-efficacy was the strongest positive predictor in the BSE performance (Exp (B) =1.863). Awareness had direct and indirect effects on the BSE. The locus of control did not predict the BSE (p=0.05).

  Conclusion : Improving self-efficacy, especially in young women, and increasing awareness about cancer among women is necessary to increase the rate of the BSE.

---

  Background & Aim: Several studies have shown that the self-care activity of patients with implantable cardioverter defibrillator is inadequate. This study was conducted to assess the effect of an educational program based on the Orem’s self-care model in self-care ability of the patients .

  Methods & Materials: This clinical trial was conducted among 66 patients with implantable cardioverter defibrillator. Four educational sessions were held based on the patient's needs and Orem’s self-care model. Data was collected using a self-report questionnaire at baseline and one month after the intervention. Data were analyzed using statistical tests (x², t-test, paired t-test) in the SPSS-18 . 

  Results: There were no significant differences in the self-care awareness, tendency to self-care, self-care skills, and self-care ability between the control and intervention groups. After the intervention, the self-care awareness score remained 22.06 ± 3.26 in the control group and increased (28.69 ± 1.51) in the intervention group (P<0.000). There was also significant difference in the tendency to self-care between the control (25 ± 3.31) and intervention (28.9 ± 1.33) groups (P<0.000). The self-care skills differed significantly between the control (14.9±3.06) and intervention (29.03±1.15) groups after the intervention (P<0.000). After the intervention, the self-care ability was also significantly different among the control (61.96±8.06) and intervention (86.63±2.93) groups (P<0.000) .

  Conclusion: The results of this study showed that implementing educational programs based on the Orem’s self-care model can improve self-care ability in patients with implantable cardioverter defibrillator. Applying this method is recommended in nursing interventions to promote health status of the patients .

  

---

  Background & Aim: The Roy’s adaptation model is a helpful instrument to be used in treatment processes of patient s with chronic diseases. According to chronic nature of amputee veterans' diseases, it is expected that the implementation of care plan s based on this model can increase adaptation in the patients . The present study was performed to design and determine validity and reliability of a researcher-designed adaptation questionnaire based on the Roy’s adaptation model on war veterans with lower limb amputation .

  Methods & Materials: This study was conducted among war veterans referred to the veteran clinic of Orthotics and Prosthetics center using convenience sampling method during 2012-2014 . M ain concepts of adaptation defined based on the Roy’s adaptation model were used to provide items. The validity and reliability of the questionnaire was assessed using the content validity index (CVI), content validity ratio (CVR), face validity, internal consistency (Cronbach's alpha), and stability (test-retest reliability) tests.

  Results: Thirty five items were developed including 15 items on physiological area, 11 items on self-concept area, four items on dependence/ independence area, and five items on role playing area. The CVI was 0.95 . The Cronbach's alpha was 0.78. The correlation coefficient values ​​were more than 0.7 in each area .

  Conclusion: The psychometric analysis of the questionnaire showed proper validity and reliability for measuring adaptation on war veterans with lower limb amputation. The questionnaire is recommended to be used in nursing practice .

  

---

  Background & Aim: Insertion of chest tubes is a necessary measurement in chest trauma. The trauma patients need specific skills for self-care. This study aimed to determine the effect of using supportive-educative system on self-care skills in trauma patients with chest drainage system .

  Methods & Materials: In this quasi-experimental study, 62 trauma patients with chest-tube were selected from three surgery wards of Besat hospital in Hamadan from December 2012 to May 2013. Two wards were randomly allocated into the experiment group (n=31) and one ward was allocated into the control group (n=31). Participants were selected using convenience sampling. The supportive-educative system was designed based on the patients’ needs and was implemented to the experimental group in three consecutive days. The study instruments included self-care needs assessment form and self-care skills checklist. Measurements were completed once the patients were admitted to the wards and three days later by an external observer. Data were analyzed using t-test, Chi-squared test, Mann-Whitney and Wilcoxon tests with a 95% confidence level in the SPSS-16 . 

  Results: There were no significant differences between the two groups in the study variables at baseline (P>0.05). Although self-care skills in both control (P<0.01) and experiment (P<0.001) groups were improved, using educative-supportive system led to better self-care skills in the intervention group in compare to the control group (P<0.001) .

  Conclusion: In general, self-care skills of patients with chest drainage system could be improved by supportive-educative system. The improvement in the control group can be attributed to self-care trainings conducted routinely by doctors and nurses .

  

---

  Background & Aim: Transition from studentship to working life is a stressful and challenging event. The concept of transition is important in nursing education, management, and practice issues. However, despite its supreme importance, there are certain ambiguities about the concept of transition in nursing. The aim of this study was to analyze the concept of transition in the context of nursing in Iran.

  Methods & Materials: We used the three-phase hybrid concept analysis model including the theoretical phase, the fieldwork phase, and the final analytic phase in this study. In the theoretical phase, we conducted an online literature search to find relevant articles published prior to 2012. In the fieldwork phase, five novice nurses, two experienced nurses, and one head-nurse were interviewed. Interviews were transcribed verbatim and analyzed using thematic analysis approach. During the final analytic phase, we compared the findings of the first two phases to provide a clear and comprehensive definition of the concept of transition . 

  Results: The findings of the theoretical phase revealed that transition was a process phenomenon having defined attributes such as detachment, individual perception, awareness, and human response patterns. According to the findings of the fieldwork phase, transition was an interactive, evolutionary, and time-bound phenomenon that embodies attributes such as socialization, unavoidability, and competence and ability development. In the final analytic phase, a comprehensive definition was provided for the concept of transition in the context of nursing in Iran .

  Conclusion: This study provided a comprehensive understanding of the concept of transition from nursing studentship to working life in Iran. The findings of this study can be used to develop theories, instruments, and criteria for evaluation of novice nurses’ transition to experienced nurses .

  

---

  Background & Aim: Reproductive behavior of a society can be studied in different ways. One of these ways is to check the birth intervals. The aim of the present study was to assess the childbirth along with factors influencing childbirth behavioral patterns in Ahwaz .

  Methods & Materials: In this study , factors affecting birth intervals of women aged 15-49 were investigated . To achieve this goal, given the nature of the birth intervals, the accelerated failure time model was applied. To estimate the parameters of this model, the R statistical software was used . 

  Results: Results indicated that women's educational level , husbands' ethnicity , place of residence , use of contraceptives , age at marriage and pregnancy status were factors significantly influencing first birth interval. Furthermore, women's ethnicity, contraceptive use, number of abortions or stillbirths, pregnancy status , duration of breast feeding and type of childbirth were the most important variables affecting the second birth interval. Also, husband's ethnicity, contraceptive use and duration of breast feeding had significant effects on the third birth interval in this study .

  Conclusion: Comparing the results of this study with those of previous studies shows a recent decline in pregnancy acceleration and an increase in average birth interval. In other words, changes in socio-economic and cultural statuses have caused longer birth intervals and fertility decreases .

  

---

Background & Aim: Pap smear test is an effective screening method for early detection of cervical cancer. This study aimed to determine the effect of education based on the health belief model on women’s belief and practice regarding Pap smear test.

Methods & Materials: In this quasi experimental study, 100 married women under coverage of Bushehr health centers participated in the study in 2014-2015. The data collection instrument was a questionnaire consisted of demographic information, the questions concerning knowledge and the HBM constructs regarding Pap smear. The training program was performed in two group sessions. Three months after the intervention, women’s practice about Pap smear test was evaluated in both groups. After data collection, data were analyzed by descriptive statistics, repeated measure analysis of variance, independent t-test and Chi square on SPSS software v.20.

Results: Before the study, both groups had not any significant differences in all variables and constructs. After the intervention, the mean scores of knowledge (P<0.001), perceived seriousness (P=0.015) and perceived barriers (P<0.001) were significantly different between two groups. Three months after the intervention, 42 (85.7%) in the intervention group and 4 (8.2%) in the control group had performed Pap smear test (P<0.001).

Conclusion: Designing and implementing educational program based on health belief model can promote women’s awareness and reduce their perceived barriers and as well as enhance their practice regarding Pap smear test.

---

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.

---

Background & Aim: Reducing water-pipe use is among the most effective ways to reduce chronic disease and some cancers. The aim of this study was to determine effect of education based on Health Belief Model (HBM) by health volunteers on water-pipe use among women.

Methods & Materials: This Quasi-experimental study performed on 127 women who used water-pipe (63 in the intervention group and 64 in the control group) in Bushehr in 2014. The data collection tool included demographic characteristics, the HBM constructs about water-pipe use, knowledge about water-pipe complications, and behavior (frequency of water-pipe use in last week and nicotine dependence scale). Intervention group received two sessions of education based on HBM by health volunteers. Data were analyzed using descriptive statistics, Chi-square test, Mann-whitney test, independent t-test, repeated measures ANOVA, and Friedman test on SPSS software version 18.

Results: Before education, both groups were similar in terms of demographic variables, the mean score of knowledge and all the HBM constructs (P>0.05). After education, the mean scores of HBM constructs and knowledge significantly increased and nicotine dependence decreased in the intervention group compared to the control group (P<0.001). After 3 months, the frequency of water-pipe smoking significantly reduced in the intervention group (P=0.007). But in the same period, there was no significant difference in term of the frequency of water-pipe smoking in the control group.

Conclusion: The results show that education based on the behavior change patterns by health volunteers can be effective in changing beliefs and reducing water-pipe use among women.

---

Background & Aim: Fertility is the most important factors affecting population fluctuations. Reproductive behaviors of a community can be studied through different methods. One of the methods is the evaluation of the interval between marriage and the birth of the first child. The aim of this study was to investigate the factors influencing the interval between marriage and first birth using the Cox regression model.

Methods & Materials: In this study, 1230 first-time mothers referred to urban and rural health centers of the city of Bandar Abbas were selected and studied in 2012-2013. The Cox regression model (proportional hazard) was performed to investigate the interval between marriage and first birth and the factors influencing this interval. Descriptive analysis of data was performed using SPSS software version 22 and data modeling was performed by R software version 3.2.1.

Results: In this study, the mean interval between marriage and first birth was 27.63 (±24.35) months. Based on the Cox model, mother’s age at marriage with HR(Hazard-Ratio)=1.13 (1.01–1.25) and place of residence with HR=1.28 (1.12–1.46) had significant effects on the interval between marriage and first birth.

Conclusion: The results of the current study compared to previous studies show that the interval between marriage and first birth has decreased, and some changes are observed in the factors influencing this interval.

---

Background & Aim: Although compassionate care is recognized as a core component of nursing care, there is not still a precise definition about this complex and challenging concept. This study aimed to analyze the concept of compassionate care in nursing using a hybrid model.

Methods & Materials: A three-phase hybrid model (theoretical, field work, and final analysis) was used in this study. In the theoretical phase, the concept of compassionate care was searched in main databases from 2000 to 2016. In the field work phase, in-depth, face to face interviews were done with 11 nurses. The content analysis method was used to analyze the data. Final analysis was done in the last phase.

Results: The results of the final analysis showed that compassionate care is a process in which nurses interactively communicate with patients, try to explore patients’ concerns by putting themselves in their positions and understanding their situations, and do their utmost to eliminate these concerns.

Conclusion: According to this concept analysis, the constructive interaction between nurse and patient is one of the most important features of compassionate care that has not been mentioned in previous definitions. Also in this study, the nurses emphasized that they did their best to resolve the patients’ concerns. Therefore, the current study could be the basis for future studies in the area of compassionate care.

---

Background & Aim: Prostate carcinoma is the most common cancer among men and the second lethal cancer. The present study aimed to investigate the prostate cancer screening behaviors and its related cognitive psychological factors among men over 50 years of age using the health belief model.
Methods & Materials: This cross-sectional study was performed on 300 men over 50 years of age in Hamadan, selected by cluster sampling method. Data collecting tool was a questionnaire consisted of three sections: demographic information, prostate cancer screening behaviors and health belief model constructs. Data were analyzed using Chi-square test, Fisher's exact test and logistic regression through the SPSS software version 18.
Results: Findings revealed that 12% and 9% of the participants reported having a digital rectal examination (DRE) and prostate specific antigen (PSA) testing respectively. Perceived benefits and perceived barriers were the predictors of prostate cancer screening behaviors (P<0.05). Also, there was a significant relationship between prostate cancer screening behaviors and age and a history of prostate problems (P<0.05).
Conclusion: Given that the health belief model is effective in predicting prostate cancer screening behaviors, using these findings in designing educational interventions for people over 50 is recommended.
 

---

Background & Aim: Empowerment is a dynamic, positive, interactive and social process, leading to the improvement of quality of life (QOL) in patients with chronic disease. The purpose of this systematic review and meta-analysis was to determine the effect of family-centered empowerment model (FCEM) on QOL in adults with chronic diseases.
Methods & Materials: By searching FCEM in Persian databases including SID, MagIran, IranMedex, IranDoc, and googlescholar, Scopus, Pubmed, Web-of-science, Proquest, and Sciencedirect, all relevant studies were extracted. The methodological quality of the papers was examined using Cochrane-risk-of-bias. Data analysis was carried out through the random effects model and heterogeneity by I² index. The data were analyzed using the STATA software version 11.0.
Results: Of the 647 initial studies, only 8 studies examined the effect of FCEM on the QOL in adult patients using SF-36. The pooled standardized mean difference of the 8-dimensions of QOL included: social-functioning (1.781), Physical role limitation (1.416), bodily pain (0.987), general health (1.352), social functioning (1.010), general health (1.122), emotional role limitation (0.656), and vitality (1.361).
Conclusion: The implementation of FCEM had a significant effect on the 8-dimensions of QOL based on the SF-36 questionnaire. The implementation of FCEM is recommended in order to improve the QOL of adult patients with chronic disease.