Journal of School of Public Health and

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Background Aim: Job burnout among health educators is increasing with serious physical, psychological and social consequences. The purpose of this study was to explore the causes of job burnout from the perspective of health educators and identify their needs for reducing it.
Materials and Methods: This qualitative study was carried out in comprehensive health service centers of Sanandaj, west of Iran, in 2017, including 15 health educators selected by purposive sampling. The data were collected through individual interviews and semi-structured group discussions, observation and field notes and analyzed using the conventional content analysis approach with due consideration of acceptability, verifiability and transferability to ensure the accuracy and strength of the data.
Results: The causes of job burnout were extracted in 5 categories including "issues related to comprehensive health service centers", "individual challenges of staff members", "management weakness", "executive system challenges" and "issues related to clients". The participants emphasized the following actions for reducing job burnout: strengthening individual skills, effective evaluation and management support, providing recreational and welfare facilities, reducing job stress, and strengthening intra- and inter-sectoral communications.
Conclusion: The results of this study show that various factors contribute to job burnout among health educators. Improvements in management, laws and welfare facilities not only would reduce job burnout but also may increase the efficiency of health education programs.

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Background and Aim: A common problem among married women is related to sexual function. A large percentage of complaints by women referring to consultation centers are about sexual problems. Determination of factors influencing sexual function can help us to find suitable strategies to solve the problem. The purpose of this study was to investigate the effect of acceptance and practice variables and rumination on women's sexual function mediated by stress tolerance.
Methods and Materials: The statistical population included all women referring to clinics in Isfahan, Iran in 2018. A sample of 120 were selected using the availability sampling method and completed the  Arizona Sexual Experience (ASex), Simons and Gahr (2005) Distress Tolerance, Bond et al. (2011), Acceptance and Action, and Watson and Harris (2008) Rumination Victim questionnaires. The data were analyzed based on the structural equation method, the software being the smart PLS software.
Results: The stress tolerance variable could play a role as a mediating variable among sexual performance, commitment, acceptance and ruminant variables (P<0.05). Further analysis of the data showed that commitment, acceptance and rumination were associated with sexual function and distress tolerance (p <0.01) and that distress tolerance could affect women's sexual functioning (p <0.01).
Conclusion: Based on the findings, it can be said that women’s sexual function is influenced by a variety of factors, including acceptance and action, rumination and distress tolerance.

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Background and Aim: This study aimed to improve the symptoms of children with obsessive-compulsive disorder (OCD), relationships between parents and children, and marital satisfaction using the family-based cognitive-behavioral therapy (CBT).
 Materials and Methods: This was a quasi-experimental pretest-posttest research. The statistical population was all of the 9- to 12-year-old school students suffering from OCD who had consulted the Psychological and Consultation Services Center during academic year 2015-2016 in the city of Tehran. A sample of 28 students selected randomly were assigned to an experimental and a control group. The following questionnaires were completed initially (pre-test) and finally (post-test): 1. Questionnaires completed by the mothers of the children: the Spence Anxiety Scale-Parent Form, the Parent-Child Relationship Questionnaire and the Afrooz Marital Satisfaction Questionnaire (short form); 2. The questionnaires completed by the children: the Spence Children's Anxiety Scale. The intervention program was designed based on CBT and included 22 sessions, eight group sessions for mothers, eight individual play therapy sessions for children, and two specific sessions for each family.

Results: Data analysis using multivariate analysis of covariance showed that family-based cognitive-behavioral therapy was effective in improving marital satisfaction and parent-child interaction as well as reducing child anxiety (p <0.01).

Conclusion: Based on the findings, it can be concluded that family-based cognitive-behavioral therapy intervention may lead to improved relationship between parents and children with obsessive-compulsive disorder and marital satisfaction, as well as reduced anxiety of these children and their parents. 

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Background and Aim: Systematic review of research suggests that different variables can affect the treatment of anxiety and that, although many therapies can be effective, the role of schema therapy in the perfectionism of anxious people has been neglected. Therefore, the aim of this study was to determine the effect of anxiety treatment through schema therapy on perfectionism of anxious people. The study was an applied quasi-experimental study with a pretest-posttest design and a control group.
Materials and Methods: From among all the women with anxiety aged 20 to 30 years referring to the New Presence Clinic in Tehran, a sample of 30 were selected by purposive sampling and randomly assigned to either an experimental (n =15) or a control (15 people) group. Initially they all completed the Terry-Short et al. (1995) Perfectionism Questionnaire. Then the experimental group received education in schema therapy, followed by a post-test for both groups. The data were analysed using multivariate analysis of covariance the software SPSS_V19.
Results: Statistically significant differences were found between the two groups as regards the two components of positive (p<0.019; F=6.275) and negative (p<0.006; F=9.136) perfectionism. Based on the descriptive findings it can be said that, compared with the control group, the experimental group could, after the schema therapy intervention, obtain lower scores in the perfectionism components post-test.
Conclusion: Based on the findings of this study, it can be said that schema therapy in the treatment of anxiety can reduce the perfectionism of individuals. Therefore, a knowledge of this training can help psychologists, counsellors, students and other professionals to improve the positive and negative perfectionism variables in people suffering from anxiety.

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Background and Aim: One of the complex processes in the Ministry of Health and Medical Education in Iran is the process of registering pharmaceutical supplies. Currently the registration process is a multi-stage process, resulting in parallel services, a waste of time and unnecessary expenses. Therefore, an integrated system will improve the relevant service delivery. The purpose of this study was to identify a set of activities that could be collectively considered as a single service to create an integrated system for registering pharmaceutical supplies in the Ministry of Health and Medical Education, Iran.
Materials and Methods: This was an applied research, beginning with collecting information about the registration processes for 20 different products. In order to identify the services/steps of an integrated system for recording pharmaceutical supplies, first the Gray-Wolf multi-objective optimization (GWO) algorithm was proposed. Then the values of the algorithm parameters were extracted by the goal-based requirements analysis method and the algorithm was implemented. Finally the best services were extracted by the hierarchical analysis process.
Results: Through the proposed algorithm seven services were identified, including product class inquiry, document registration, document review according to license type and product class, licensing, laboratory services, clinical studies and payment service. These services were carefully approved with a precision of 97.3 by the experts of the Ministry of Health. The proposed framework for recording drug requirements was found to be effective and could facilitate the process by up to 90%, reduce the processing time by 80% and reduce the processing costs by 65%.
Conclusion: Creating an integrated system for registering pharmaceutical supplies is one of the important challenges of the Ministry of Health and Medical Education. This can be achieved by identifying services and combining these services to create an integrated system.
 

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Background and Aim: Due to the design features, facilities and the presence of crude oil materials or refined products from crude oil, the refining industry is prone to major accidents such as fire and explosions, which cause a lot of damages and losses. On the other hand, due to the development of intelligent technologies and drones (remote-controlled birds) and the widespread use of these technologies in various industries, the use of these new technologies in the oil and gas industry is inevitable. This case study was conducted with the aim of utilizing drone technology in fire crisis management in oil refineries in the Lavan Oil Refinery, Iran.
Materials and Methods: Data were collected using qualitative methods and literature review by combining keywords such as refinery, fire and explosion and drone, as well as holding semi-structured interviews with 15 informed and experienced persons from among refinery personnel. In order to identify internal strengths (S) and weaknesses (W) and external opportunities (O) and threats (T) the gathered data were analyzed using the basic SWOT model.
Results: Analysis of the data show the following strategies to be the results of the external threats and opportunities and internal strengths and weaknesses: Strength/Opportunity (SO), Strength/Threat (ST), Weakness / Opportunity (WO) and Weakness/Threat (WT).
Conclusion: The use of drones for monitoring (finding the location and source of fire), identifying (determining the exact location and extent of the fire), confronting and controlling (relief and rescuing, saving the lives of firefighters, firefighting) in the Iranian oil industry requires making changes in the capacity and levels of technology and the equipment and manpower.  Making these changes requires the support of managers and personnel of the oil industry in order to use this new technology and make it operational. In this way, fire crisis management in refineries can be implemented by using drone technology.

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Background and Aim: Family female heads are one of the most vulnerable groups in the society and empowering them is essential. This research was a systematic study to design and develop a model of educational needs of female heads in the female-headed households.
Materials and Methods: This study was a qualitative applied research of a research synthetic type conducted using content-analysis and meta-analysis. The statistical population included all the relevant works published in Persian or English between 2012 and 2021 available in four reliable databases, namely, ERIC, Science Direct, PubMed and Google Scholar. Using the keywords "education of women-headed households, women's empowerment, women-headed households, and skills of women-headed households" and based on the inclusion criteria, initially 140 scientific articles were identified and finally, based on the exclusion criteria, 47 articles were selected for the final analysis. The Software MAXQDA 18 was used for the qualitative analysis of the articles.
Results: Analysis of the data obtained showed the educational needs of women-headed households as the main theme to consist of four subthemes including "knowledge and skills of desirable sexual orientation", "knowledge and skills of raising children", "knowledge and skills of occupation" and "individual and social development and empowerment”. Based on meta-analysis out of the four main themes 22 themes were extracted and a model was designed for educating female-headed households.  
Conclusion: Considering that the educational needs of female-headed households have been identified, it is recommended that educational courses be designed in accordance with their educational needs.
 

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Background and Aim: Demographic policies are designed and implemented with the aim of creating a better life for individuals in the society as well as protecting national interests. However, whether the implementation of these policies has achieved this goal or has had other, possibly unwanted, consequences that would affect the lives of the citizens, especially vulnerable people, requires careful investigation. These policies have had profound effects on the family and the health of family members, especially women. The purpose of this research was to investigate the understanding and interpretations of women in the southern areas of Tehran who had experienced unwanted pregnancy regarding population increase policies and their effects on women and their family lives.
Materials and Methods: This research was a descriptive qualitative study. Data were collected through semi-structured in-depth interviews with 23 married women with a history of unwanted pregnancy referring to the comprehensive health centers in districts 16, 17 and 19 of South Tehran Health Network. Purposive sampling was continued until a theoretical saturation was reached, and data analysis was performed based on the foundation data theory.
Results: Out of the primary data consisting of a total of 850 open codes, 452 concepts, 15 main categories and 47 sub-categories were extracted. Finally, "dissatisfaction with interventionism" was chosen as the main phenomenon covering the rest of the categories.
Conclusion: The most important factors causing dissatisfaction with government intervention among the participants are imposing costs related to unwanted pregnancies and keeping and raising an unwanted child. The intervening conditions of this phenomenon are "poverty and high cost". The participants' strategies included suppressing their wants, regret and attempts to improve the situation and reducing sexual relations.                

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Background and Aim: Public vaccination programs are a way to control the Covid-19 disease. The success of a vaccination program requires the acceptance of the Corona vaccine by the society. The aim of the present study was to predict the acceptance of the Corona vaccine by medical students based on their anxiety, optimism and rumination.
Methods and Materials: This was a descriptive and correlational research. The study population consisted of all the medical students of Azad University, Tehran, Iran during the academic year 2021-2022, from among whom a sample of 509 was selected by the available sampling method. Data were collected using the Acceptance of the Corona Vaccine (KAPC), Anxiety of the Corona Virus (CDAS), Life Orientation (LOT) and Ruminative Responses Scale (RRS) questionnaires. The data were analyzed using the Pearson correlation, partial correlation and standard regression tests.
Results: Data analysis showed that several variables including corona anxiety (with components of mental and physical anxiety), optimism (with components of expectation of a positive outcome and hope for the future) and confidence in the safety of vaccine could positively predict the acceptance of the Corona vaccine. Rumination (with two components of depression symptoms and brooding) negatively predicted the acceptance of corona vaccine. Finally, the reflecting component, age and gender could not significantly predict the acceptance of the Corona vaccine.
Conclusion: To increase the acceptance rate of corona vaccine, paying attention to the roles of psychological factors such as corona anxiety, optimism, trust, and rumination can be helpful.
 

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Background and Aim: Probiotics, or useful microorganisms tobtained from beneficial microorganisms, have attracted the attention of the world community, especially the health sector, in recent years. The reason is that probiotic products can help in treating diseases and strengthening the human body without any side effects, unlike drugs which may usually have many side effects. Considering the importance of these products, this study was conducted to find and explain the drivers of probiotic industry development in Iran's food industry.
Materials and Methods: Data were collected, using the thematic analysis method, on the views of the experts of the probiotic industry in Iran, including experts in nutritional and medical sciences and probiotic producers, concerning the most important driving forces in the development of probiotic industry businesses in Iran. Based on the data the effects of the variables obtained were investigated using the structural equation modeling method with a partial least squares approach.
Results: Analysis of the data showed that the development of probiotics industry was statistically significantly related directly both to macro-environment (coefficients T=3.13, p=0.033<0.05;  95% confidence level) and micro-environment (coefficients of T=2.13, p=0.001<0.05; 95% confidence level).
Conclusion: It can be concluded that the development of the probiotic industry in Iran is influenced by both the macro-environment and the micro-environment. What can provide the basis for the development of this industry in the macro-environment and the micro-environment sectors is the political forces such as governments and the private sector, respectively.
 

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Background and purpose: The purpose of this research was to  write a critical review of the available service packages in the Mental and Social Health and Addiction Office (MSHAO) of the Ministry of Health and Medical Education in the areas of drugs, alcohol and tobacco, which are currently used in the primary health care system. The content analysis method was used to extract the specialists’ critiques.
Materials and Methods: Initially the MSHAO sent 1362 pages of information in the form of 47 files to researchers to be reviewed. The files were classified, eliminating/removing additional, unrelated and duplicated items; finally 840 pages in 29 files were studied and carefully examined. Then, seven experts in the field of addiction were asked to criticize the packages, using the content analysis method to extract the experts' critiques.
Results: The findings showed that comprehensive information about drugs, alcohol and tobacco addiction is provided to the clients. However, based on a critical review of the existing packages four main critiques were extracted, namely, sources/references, epidemiology, incompatibility of Iranian-Islamic culture, and technical-specialist issues. In addition, criticisms were also extracted in the following areas/services: the number of files and the variety of interventions, editing and writing problems, interventions and discussions with inappropriate in-text sources/citations, some old sources/references (published in 2013 and 2014), old interventions, lack of appropriate compatibility with the culture of the Islamic society of Iran, and direct translation of some parts of the original texts and documents of international meetings/gatherings.
Conclusion: Despite the efforts of the Mental and Social Health and Addiction Office to cover the needs of the majority of people referring to the primary care system, it seems that the high number of interventions and additional information can cause confusion of/for the physician, mental health care provider, family health care provider, general health care provider and other relevant individuals. It is, therefore, suggested that some packages be merged with each other, duplicate items be removed and specific sections be added, some packages be fundamentally revised based on the suggested items, and updated packages be developed with due consideration of  to the culture of the Iranian society.
 

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Background and Aim: Adolescence is a period of rapid biological, cognitive and neurological changes. The aim of this research was to conduct a cultural critique of the educational package of intra-family and extra-family communication for adolescents, which was implemented as part of the mental health services within the health network and based on Iranian-Islamic culture.
Materials and Methods: This qualitative study utilized the theme analysis method developed by Brown and Clark in 2006. The study population comprised all mental health contents within the health network. Targeted sampling was used to investigate the content related to communicating with adolescents. Data analysis involved the use of theme format analysis, theme network, and comparative analysis.
Results:  Data analysis resulted in the extraction of 30 primary, 4 secondary and 2 overarching themes. The secondary themes included respect for parents, social norms, moral norms and a lack of cultural norms, while the overarching themes included values and norms.
Conclusion: The findings of this study highlight the need to revise and rewrite the content of the family foundation-strengthening program for parents and adolescents.
 

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 Background and Aim: Available evidence shows the effectiveness of psychotherapy. However, the number of patients who deteriorate or do not improve is still problematic. On the other hand, while some therapists are generally more successful than others, most therapists have experienced both success and failure of therapy in different cases. The purpose of this study was to determine the factors effective in psychotherapy from the perspective of therapists and clients.
Materials and Methods: Based on the purpose of this research, it can be considered as an applied research and qualitative in nature. Data were collected through interviews and analyzed using the content analysis method based on the analogical approach. The samples of therapists and clients were selected purposefully from the statistical population including 1. Therapists (psychiatrists, psychologists and counselors) licensed by the Psychology and Counseling Organization with 5 years or more of therapy experience, and 2. Clients who had participated in at least one psychotherapy course. The sample size was based on theoretical saturation and, therefore, the interview process continued until ensuring sufficiency of the collected data; thus the interviews ended with the 21st person in the therapists group and the 15th person in the clients group.
Results: The factors in effective treatment were found to be in three areas, namely, the therapist (attitude, competence, personality, maturity, ability and appearance), the client (demographic characteristics, reason and method of referral, insight), and environmental factors (economic, socio-political issues, location of the psychological center, supporting problems, and daily living events of clients and therapists).
Conclusion: The findings of this research show the components and importance of the model of effective factors in effective psychotherapy to policy makers, trustees, professors and therapists in the field of mental health. The achievement of these components can increase the efficiency of the therapists in achieving their goals and also help a clients to choose a therapist.
 

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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.
 

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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.