Journal of School of Public Health and Institute of Public Health Research

Mental Health During the COVID-19 Pandemic: A Systematic Review of Assessment and Coping Strategies

Seyedeh Mahboobeh Hosseini Zare

Background and Aim: The prevalence of COVID-19 and its impact on mental health posed a significant challenge for healthcare systems worldwide. Healthcare systems were required, in addition to their responsibilities such as rapid diagnosis, controlling and slowing the spread of the COVID-19 pandemic, to adopt strategies to mitigate the psychological effects of this disease in the society. The objective of this study was to examine and review mental health during the COVID-19 pandemic and strategies adopted to cope with it in various countries.
Materials and Methods: All published articles on the effect of the COVID-19 pandemic on mental health and coping strategies between February and October 2020 were reviewed in four databases and one search engine. A total of 394 articles that met inclusion and exclusion criteria were selected using a 15-point tool developed by Miton and colleagues. Ultimately 25 articles were selected and analyzed.
Results: The most prevalent mental health issues identified in the reviewed articles were depression, anxiety and stress. In addition, vulnerable and high-risk groups were recognized as being women, individuals with pre-existing health issues, youth aged 18 to 29 years, frontline healthcare workers and individuals without an income.
Conclusion: Despite various strategies chosen and adopted in different countries, the majority of people suffered from mental health challenges arising from COVID-19. During an outbreak collaboration between health system authorities and media in providing accurate and effective information, as well as offering preventive measures, can facilitate the prevention of mental health within a population. Therefore, it is essential for the health systems to pay attention to mental health infrastructure and design comprehensive strategies to address future crises.

Health Literacy and Self-Care for COVID-19 in the City of Shiraz, Iran

Majid Movahed Majd

Background and Aim: Health literacy plays an important role in the health of a society and population during times of illness. During the coronavirus outbreak human resilience and health of the population were at risk. Health literacy and its various dimensions are known as an important factor in strengthening human health. Therefore, research on the relationship between the coronavirus pandemic and health literacy can help formulate policies to promote people's health.
Materials and Methods: This study was a survey in which data were collected using a questionnaire. The statistical population was all citizens of Shiraz city, Iran from whom a sample of 400 people was selected by random sampling. SPSS and LISREL were used to analyze the data.
Results: Analysis of the data collected revealed statistically significant positive correlations between reading, decision-making, health behavior literacy and gender with COVID-19 self-care (p < 0.05). The structural equation model showed that decision-making and behavior had the highest predictive power for COVID-19 self-care, with an impact factor of 3.36. Conclusion: The findings of this study indicate that reading, decision-making, behavior and gender are important factors influencing COVID-19 self-care, while assessment and access have the least impact. These findings can guide healthcare professionals to develop strategies aiming to enhance self-care practices in future pandemics.

The Experience of Medical Residents at Iran University of Medical Sciences Regarding Respect in the Workplace: A Qualitative Study

Maryam Rasoulian

Background and Aim: Medical residents play a pivotal role in the healthcare system of a country. Their mental health directly influences their professional performance and commitment. This study aimed to explore medical residents’ experiences of respect in the workplace and identify instances of disrespect within hospital environments.
Materials and Methods: This was a qualitative study in which data were collected using in-depth individual interviews and focus group discussions. Data were recorded, transcribed and analyzed through content analysis and coding-categorization methods. Qualitative content analysis was performed using the MAXQDA software (Version 20).
Results: The findings revealed that medical residents face numerous challenges, including injustice, verbal abuse, bullying and excessive workload. Educational inequity, overwhelming workloads, and unfair evaluations were identified as manifestations of injustice. Verbal violence, disrespect from the staff, and offensive language exemplified instances of disrespect. Coercion to perform tasks beyond their responsibilities and violations of human rights were categorized as bullying behaviors. These conditions have led to psychological stress, frustration, reduction of incentive and in some cases the use of psychiatric medications, and diminished motivation among residents.
Conclusion: The findings indicate that the working environments for medical residents in many hospitals and educational centers are stressful and unsuitable. Reforms in educational, managerial and support systems are urgently needed to improve these conditions. Respectful behavior not only reduces stress and enhances job satisfaction but it also contributes to the professional development of residents.

The Effect of Educational Intervention Based on the Self-Efficacy Theory on the Healthy Lifestyle of Health Brokers of People's Home for Participation in Health, Tehran University of Medical Sciences, 2024

Davoud Shojaeizadeh

Background and Aim: Health brokers are responsible for conveying messages related to a healthy lifestyle to the target community, who are selected by them in the public participation houses, otherwise called People's Home for Participation in Health (PHPH). Implementing focused educational interventions can strengthen the self-efficacy of health brokers in performing health-promoting behaviors. The aim of the study was to determine the effect of educational intervention based on self-efficacy theory on the healthy lifestyle of health brokers.

Materials and Methods: This was a quasi-experimental and interventional study with a pretest-posttest design and a control group in 2024. The statistical population included health brokers in PHPHs affiliated with Tehran University of Medical Sciences. Using the simple random sampling method 4 participating households were selected as the experimental group, the rest acting as the control group; the total number of participants was 74. Four 2-hour training sessions were held for the experimental group, and reviewing of the topics and assignments and answering questions were done through a virtual training group. Data were collected using standard "self-efficacy" and "health-promoting lifestyle" questionnaires and analyzed using SPSS 28, the statistical tests being Chi-square, T-test, Pearson, and Kolmogorov–Smirnov tests.

Results: After the intervention, the health-promoting lifestyle score increased from 30.40±21.00 to 168.31±24.71 and the health self-efficacy from 68.57±10.21 to 84.57±11.84 in the experimental group (P<0.001). The highest significant correlation was observed between lifestyle dimensions and self-efficacy (r=0.741)

Conclusion: The findings of this study show that training based on self-efficacy theory can improve healthy lifestyle behaviors in brokers and can be used as an effective strategy in health education.

Modeling of the Mediating Role of Health Literacy in the Relationship Between Early Maladaptive Schemas and Coping Strategies in Cancer Patients

Javad Siahmoshtei

Background and Aim: Cancer patients face numerous psychological and physical challenges in which various psychological, social, economic and medical variables are involved. This study aimed to model the structural equations of coping strategies in cancer patients based on early maladaptive schemas with the mediating role of health literacy.
Materials and Methods: This was a correlation analysis study based on structural equation modeling. The statistical population consisted of cancer patients aged 20 to 60 years visiting private medical centers in Tehran between April 20th and September 21st, 2024, from among whom 665 participants were selected through convenience sampling. Data were collected using the Early Maladaptive Schemas Questionnaire (1998), the Adult Health Literacy Questionnaire (2023), and the Coping with Stressful Situations Inventory Questionnaire (1990) and analyzed using the structural equation modeling methods using SPSS 25 and Amos 24 software at a significance level of 0.05.
Results: Data analysis showed that the early maladaptive schemas had a statistically negative relationship with health literacy (β = ─ 0.84, p < 0.001) and a positive relationship with coping strategies (β = 0.25, p < 0.001). In addition, health literacy had a negative association with coping strategies (β = 0.83, p < 0.001). In addition, health literacy had a negative association with coping strategies (β=─0.83, p<0.001).and an intermediary role in the association between primary maladaptive schemas and coping strategies (β=0.25, p<0.001). Goodness-of-fit indices indicated an adequate fit of the model (GFI = 0/916, IFI = 0/910, CFI = 0/909, and RMSEA = 0.078).
Conclusion: The findings show that early maladaptive schemas are associated with low
health literacy and coping behaviors in cancer patients. Improving health literacy can, as a mediating variable, moderate these negative effects, and can also contribute to better constructive coping behaviors. Educational interventions to increase health literacy can be useful in mental therapy and rehabilitation.

Designing a Model for the Effectiveness of Media in the Development of Home-Based Sports during Pandemics

Seyyed Jafar Moosavi

Background and Aim: This study aimed to design a qualitative model of the role of media in the development of home-based sports during the COVID-19 pandemic.
Materials and Methods: This was an interpretivism research with a qualitative approach (Grounded theory). Data were collected through semi-structured interviews with 15 experts in sports sciences and media selected purposefully using the snowball technique. The interviews were analyzed both textually and aurally using the MAXQDA 2024 software. To ensure research validity, expert knowledge of the participants and external review of the coding by two specialists in physical education were used. The inter-coder reliability was assessed using recoding reliability, resulting in a coefficient of 0.82.
Results: Analysis of the interviews yielded 405 meaningful units, ultimately categorized into 32 final codes which were identified into five main dimensions based on the systematic paradigm of Strauss and Corbin and in line with the design of the model, including causal conditions (infrastructural limitations, sociocultural impacts), contextual factors (media coordination with sports institutions), intervening factors (technical challenges in content production), strategies (digital interaction, platform development), and consequences (engagement in online exercise, media economic sustainability). The findings of the qualitative model showed that the expansion of digital media and shifts in the audience behavior played a central role in the development of home-based sports.
Conclusion: Developing home-based sports requires purposeful investments in digital platforms, contents tailored to the audience needs, and leveraging digital data and analytics. In addition, the media must also strengthen their collaborations with sports institutions and revise their strategic approaches, considering the current technical challenges and economic constraints.

Quality of Intrapartum Care Based on a Comprehensive Quality Assessment Model at the Ommol Banin Hospital, Mashhad, Iran

Liela Najafi

Background and Aim: Providing high-quality prenatal and postnatal care plays a crucial role (during pregnancy and at labor) in reducing maternal and neonatal mortality and complications, improving outcomes, and increasing patient satisfaction and enhancing healthcare system efficiency. This study aimed to assess the quality of intrapartum care using the Comprehensive Quality Measurement in Health Care (CQMH) model.
Materials and Methods: This was a descriptive study conducted in 2020 at Ommol banin hospital in Mashhad, Iran, including 324 mothers admitted for childbirth. Participants were selected through simple random sampling and data were collected using the CQMH questionnaire, which assesses three dimensions of care quality, namely, technical quality, service quality, and customer (client) quality. Data analysis was performed using the SPSS version 27.
Results: The overall quality index score was 80.9. Technical quality was rated as favorable (mean score: 90.3), while service quality (mean score: 79.5) and customer quality (mean score:73) were rated as moderate. As regards service quality communication, continuity of care and preventive measures had the lowest scores.
Conclusion: While the technical quality of intrapartum care was found to be satisfactory, there is a pressing need to strengthen provider–patient communication and empower mothers to actively participate in theirown care during childbirth.

Investigation of the Prevalence of Coxiella Burnetii in Traditional Cheese and Raw Milk Supplied in Qom City, Iran Using the Nested PCR Method

Ebrahim Rahimi

Background and Aim: Q fever, caused by Coxiella burnetii, is a zoonotic disease widely distributed in humans and livestock. It affects domestic animals, wildlife and humans. This disease is asymptomatic in livestock and its clinical consequences include abortion, stillbirth, infertility, mastitis and endometritis. Unpasteurized milk and dairy products are the most important source of transmission of C. burnetii to humans. The aim of the present study was to investigate the prevalence of C. burnetii in traditional cheese and raw cow's, sheep's, goat's and buffalo’s milks
supplied in Qom city, Iran using the Nested PCR method.
Materials and Methods: Initially 150 samples including 30 samples of traditional cheese and 120 samples of raw cow's, sheep's, goat's and buffalo’s milks were selected from the supply centers in Qom city in the summer of 2024 and transferred to the laboratory under sterile conditions to prevent secondary contamination. The samples were tested using the Nested PCR method to detect contamination.
Results: The results showed that out of a total of 120 samples of raw ruminant milk and 30 samples of traditional cheese, 8 samples (5.33%) were contaminated with Coxiella burnetii. The proportions of contaminated samples in cow's, sheep's and goat's milks and traditional cheese were 3 (2%), 1 (0.67%), 1 (0.67%) and 3 (2%), respectively; buffalo raw milk was not contaminated.
Conclusion: Based to the results of the present study, it is recommended to prohibit the consumption of raw dairy products to reduce the risk of pathogenicity and infection by Coxiella burnetii.