Journal of School of Public Health and

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Background and Aim: Undercounting is a common problem in surveillance systems and registries. One of the procedures has been used for assessing sensitivity of a surveillance system or completeness of a registry is capture-recapture method.The objective of the present study was to estimate the number of deaths due to road traffic injuries applying capture-recapture method and using three data sources: police, legal medicine organization and hospital.

Material and Methods: All of the deaths due to traffic injuries occurred within Kerman district in the year 2000 were derived from police, Shahid Bahonar hospital and Kerman legal medicine data sources. Matching cases between the lists was based on three characteristics: first name, family name and date of accident. Loglinear model was used for statistical analysis.

Results: The total number of identified cases was 471 the best fitted loglinear model estimated the actual  number of deaths as 596 (CI 95%: 543-686). Based on Iranian Statistical Center estimates, the population of Kerman district in the year 2000 has been 644673 so the cause-specific mortality rate of traffic injuries is estimated as 92 (CI 95%: 84-107) per 100,000 population. Therefore the proportion of deaths registered in police, legal medicine and Shahid Bahonar hospital are 16%, 58% and 48% respectively. The coverage of total deaths (471) is about 79%.

Conclusion: The findings showed that none of the data sources had enough coverage of all deaths due to traffic injuries. Capture-recapture estimates can help for obtaining better estimates.

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Background and Aim: Hospitals are among the most important health and medical institutions responsible for promoting health, and provision of appropriate health services requires a healthy, hygienic and safe environment. This research was done with the aim of assessing the environmental health situation Qom hospitals in 2005.

Materials and Methods: This research is an applied descriptive - analytic study on hospitals in QOM Province. Data were gathered using survey and observation methods and a two-part questionnaire. The first part of the questionnaire consisted of 45 items covering demographic data on hospitals and hospital managers. The second part comprised 363 questions about the environmental health situation as well as diagnostic, treating and support services. The questionnaires were filled after validity and reliability tests in eight hospitals in Qom Province. For statistical analysis, we performed Mann-Whitney and Kruskal-Wallis tests and calculated Spearman's coefficient, using the software package SPSS.

Results: Poor environmental health was observed in 25% of the radiology wards, kitchens and laundries. The situation was assessed as "appropriate" in 12.5% of laboratories and central sterilization (CSR), 25% of emergency services, 50% of ICU wards and 71% of surgery and recovery rooms, and it was intermediate of the other wards. Overall, the level of compliance with the principles of environmental health was average, i.e. about 72.5 percent. Further analysis of data showed that the situation was better in private, non-teaching hospitals compared to government-run and teaching hospitals. However, environmental health was found to improve with an increase in the number of active hospital beds and the managers' experience in their current job. It declined with increasing hospital age and increasing age of the hospital managers.

Conclusion: Overall, the environmental health situation in Qom hospitals was found to be at an intermediate level. Hence, these hospitals have a long way to go before they can achieve the appropriate level of environmental health

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Background and Aim: Job enrichment is a method that has been used to increase employee satisfaction and work motivation. The Hackman and Oldham job characteristics model (1976) has served as the foundation for many job enrichment efforts. In particular, a considerable amount of research has been devoted to the study of the job characteristics-job satisfaction relations. Te purpose of this study was to statistically determine the relation between job characteristics and job satisfaction among employees of hospitals affiliated to Tehran University of Medical Sciences (TUMS) in 2007.
Materials and Methods: This study was a cross-sectional one, including 6 TUMS-affiliated hospitals-Emam, Shariati, Baharlo, Ziaeian, Madaen and Azadi. The sample size was 400, consisting of 200 administrative employees (50%), 151 nurses (38%) and 49 physicians (12%). The random sampling and stratified proportional sampling methods were used to select the hospitals and interviewees, respectively. Two questionnaires were developed and used to identify job characteristics and job satisfaction: 1) job diagnostics surveys (JDS) and 2) Hertzberg's job satisfaction questionnaire. The reliability of the questionnaires was ascertained by test-retest using the Pearson correlation coefficient (r = 0.88). Linear-by-linear association and ordinal logistics regression analysis were used for analyzing the data gathered.
Results:The relations between the Motivational Potential Score (MPS) and job characteristics (except for feedback) with job satisfaction were statistically significant (p<0.05). Task identity was the most effective determinant of job satisfaction.
Conclusion: It appears that all the job characteristics (except feedback) are important determinants of job satisfaction of the hospital employees. Although the work environment is in need of restructuring, it is important to note, from a positive perspective, that the job characteristics discussed in this study are readily amenable to change job satisfaction at the organizational level.

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Background and Aim: Factors determining the health care-seeking behaviors of an individual are social, cultural, and economic (treatment costs). Utilization of a health care system by a person will, on the whole, depend mainly on the socio-economic and demographic factors, cultural beliefs and practices, gender discrimination and women's status, the economic and political systems, environment, patterns of illness, and the health care system itself. The main objective of the present study was to examine current patterns of health care-seeking behavior in residents of Tehran, Iran in 2007.

Methods and Materials: In a cross-sectional study a two-stage cluster sampling method was used to select neighborhoods at the first stage and households at the second. The sample included a total of 1882 individuals over 18 years old in the households. The data were collected using a questionnaire. For analysis of the data the exact fisher test, X2, and multivariate logistic regression were used the software used was SPAA.3

Results: About 22/9% (431 persons) of the participants reported 1-2 illnesses during the previous month. Multivariate logistic regression indicated that age, sex, perceived severity of the illness, educational level, and marital status were all statistically associated with an attempt to seeking care, whether self-treatment or consulting a health center. The effects of different variables on decisions related to seeking care from a health care center versus self-care were also examined. The data showed that age, sex, perceived severity of the illness, income, educational level, household size, and method of payment were statistically the most significant variables affecting seeking care from a health center.

Conclusion: Based on these findings, it may be concluded that increasing social awareness about side effects of medicines, potential dangers of self-treatment, continuous education and training of physicians and pharmacists, improving health insurance systems and universal insurance coverage will be appropriate strategies for better utilization of health care services by the people.

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Background and Aim: By providing the greatest amount of direct service to patients, nurses play an extremely valuable and unmatched role in the quality and efficiency of care and curative services. Workplace violence is regarded as one of the factors which can reduce job satisfaction and the quality of working life of nurses and their interaction with patients, as well as the work efficiency of nurses and hospitals. In this study, after translating and validating tools of violence measurement in the health sector, the exposure of nurses to psychological violence was measured in a large teaching hospital in Tehran

Methods and Materials: A descriptive-cross sectional design was used in this study in summer of 2009 (1387). The study population included all the nurses (n=413) working in a large teaching hospital in Tehran. The questionnaire used for collecting data was adopted from a standardized questionnaire designed jointly in 2003 by the International Labor Office, the World Health Organization, the International Council of Nurses, and the Public Services International. Analysis of the data was made using the descriptive statistical methods and the Chi square- and t-tests.

Results: Sixty-nine percent of the nurses had experienced workplace violence. The most common forms of violence were verbal abuse (%64) and bullying-mobbing (%29). On the whole, 26% of the nurses had experienced both forms of violence in the previous year, while 335 had not faced any form of violence in their workplace. Nurses working in outpatient clinics and emergency wards experienced the highest number of encounters with verbal abuse. Encounters with bullying and mobbing were more common among female nurses than the male ones. Overall most of the violent behaviors were committed by patients and their relatives.

Conclusion: Exposure of nurses to psychological violence is considerable and comparable to that reported by previous investigators in other countries. Thus it is highly crucial to adopt appropriate management policies aiming, particularly, at educating the medical personnel in ways of preventing and reporting violent behaviors.

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Background and Aim: Domestic violence against women is a serious public health problem and women adopt different solutions to fight against it. This study was carried out to determine the prevalence of intimate partner violence and views of women
on adopting ways to fight against it in Arak city, Iran, year 2008.

Methods and Materials: In a cross-sectional study in Arak city in 2008, a total of 1037 women were interviewed. The data collected were analysed statistically.

Results: Findings showed that the common types of abuse were emotional (64.6%), verbal (57.1%), financial (32.3%), and physical (26.8%). The women mentioned that the most efficient ways they chose to counteract the abuses were as follows: resuming talking after the settlement of quarrels (93%), keeping silent on the part of one of the partners (81%), and seeking advice from the older members of the family (81%). The considered going into a temporary sulk (51%) and reciprocation (46%) ineffective methods. Correlations were found between violence on the one hand and education, job, addiction of the spouse, income of the spouse, mental disorder of the partner, and number of children on the other hand (p<0.05).

Conclusion: Results of this study show that a large number of women are subjected to different types of violence. It seems that increasing awareness of married women and girls concerning effective counteractive methods can be an effective step in solving this social problem.

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Background and Aim: Previous studies show that disability and mortality due to cardiovascular diseases are closely related to socioeconomic status in a community. The objective of this study was to determine the relationships between socioeconomic factors and coronary artery disease (CAD) among people under 45 years old at Shahid Rajaei Hospital, Tehran, Iran.

Materials and Methods: This case-control study was conducted in Shahid Rajaei Hospital, Tehran, Iran in summer 2008. The participants were 100 CAD cases (<45 years old, mean age = 41.2 years 85% men) and 100 controls from among accompanying persons matched for age and gender. In order to assess the risk of factors related to such variables as educational level, occupation, income, social exclusion, social support, stress, exercise, nutritional status, smoking, etc, odds ratio (95% CI) was used. Multinomial logistic regression was used to assess the synchronic effect of the risk factors, and the t-test was used to find differences between means.

Results: The odds ratio (95% CI) for smoking vs nonsmoking was 3.9 (1.9-7.9) for CAD. Individuals with a low educational level showed an odds ratio of 2.7 (1.9-7-9), compared to those with a high educational level. Eating fruits and vegetables at least seven servings a week has an odds ratio of 2.7 (1.01-7.4) vs eating fewer servings. Occupation, job grade and physical activity had statistically significant relationships with CAD. Mean BMI was different between cases and controls. The disease had no significant association with stress, social support, social exclusion or income.

Conclusion: Smoking, a low educational level and eating small amounts of fruits and vegetables were the most important socioeconomic factors contributing to coronary artery disease. Policymaking and planning aiming at improving the socioeconomic situation of the people, particularly those under 45 years old, seem essential.

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Background and Aim: Length of stay (LOS) in a hospital is one of the best hospital indicators that can be used for various purposes. In this survey, we studied the hospital LOS and its associated factors in Tehran University of Medical Sciences Women's Hospital (a teaching hospital) in Tehran using the Cox proportional hazards semi parametric model and compared the results with the results obtained using the multiple linear regression.

Materials and Methods: This was a descriptive-analytical study in which we reviewed 3421 files of inpatients hospitalized in, and those discharged from, the oncology, surgery and obstetrics units in 2008. The required data were collected using a data collection sheet and inpatient interviews. A P<0.05 was considered statistically significant.

Results: The median of patients' LOS in the hospital was 50.8 hours, that in the obstetrics, surgical and oncology units being 48.5, 54.4 and 94.2 hours, respectively. Of all the patients, 2632 (76.9%) had been discharged with a recovery status and the rest (23.1%) with a no-recovery status. Results of the Cox proportional hazards model showed that the following variables had increased LOS: a distance longer than 200 km between a patent's residence and the hospital, hospitalization in the surgery and oncology units, admission on a Thursday, admission by an internist, hospitalization for neoplastic, endocrine, nutritional, or genitourinary system diseases (P<0.005), as well as a high number of diagnostic laboratory tests, radiographies or sonographies (P<0.001). Patients admitted and hospitalized as an emergency case had a shorter LOS (P<0.001) than others. On the other hand, based on the multiple linear regression model results, some occupations (being a worker, a farmer, a stockbreeder, or a retired spouse) admission on a Thursday, (The first day of the weekend in Iran), suffering from a neoplastic disease, and a high number of diagnostic tests or radiographies or sonographies increased, and admission by a resident decreased, patients' LOS (P<0.05).

Conclusion: Considering having censored data, the Cox proportional hazards model is a more suitable model than the multiple linear regression models for identifying factors influencing patients' LOS in a hospital. From among the LOS Cox model's associated factors as identified in this study, policy-makers and managers can only change admission days and the number of diagnostic tests. That is to say, they should try to prevent admission on a Thursday (unless emergency cases) and also perform the required primary diagnostic tests before admitting a patient into the hospital, which would lead to a more effective utilization of hospital beds and other resources.

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Background and Aim: Pressure ulcer is a common problem and a large drain on hospital resources, especially in wards such as ICU where patients stay for a long time. The aim of this study was to explore the likely factors contributing to pressure ulcers in the ICU units of Tehran University of Medical Sciences teaching hospitals, Tehran, Iran.

Materials and Methods: This project was conducted in all the seven ICUs of four teaching hospitals affiliated to Tehran University of Medical Sciences. In the first phase the researcher performed a direct observation of all the 90 patients who were admitted to the ICU units to check the presence of any pressure ulcer. In the second phase, 310 patients discharged from the same ICU units between March 2007 and February 2008 was randomly selected and their medical records reviewed. A structured questionnaire was used to collect the data.

Results: Pressure ulcer occurred more frequently in the elderly women patients who were less active and had less mobility, hospitalized for a long time, or those with fever, diabetes, high blood pressure, paralysis, or respiratory diseases. In addition, pressure ulcer was seen more frequently in the patients hospitalized in the general ICUs, as well as in those with infections and different types of tumors.

Conclusion: Using a standard risk assessment tool and paying attention to the main risk factors of pressure ulcer can be a useful method for identifying the high-risk patients before admission in order to prevent them from developing such ulcers.

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Background and objectives: Relapse after treatment is a common problem among drug addicts in addiction control and prevention programs. About 80% of the addicts relapse into drug abuse within 6 months after treatment. The purpose of this study was to determine factors associated with drug abuse relapse in patients consulting two selected addiction treatment centers in Tehran. 

Material and Methods: In this case-control study, 160 relapsed patients were compared with 160 abstentious patients. A researcher-developed questionnaire was used to collect data. Chi-square test, odds ratio (OR) and logistic regression were performed for data analysis.

Results: The findings showed that factors increasing rate of relapse were smoking after relapse (OR=7.14, CI=3.855-13.244), substance-related cues (OR=6.76, CI= 3.915-11.678), interaction with addict peers (OR=6.38, CI=3.921-10398), malaise (OR=3.93, CI=2.446-6.305), and family conflict (OR=2.04, CI=1.227-3.385). Opium- and dross-addicts were found to be less likely to have a relapse than crack- or pot- users (OR= 0.208, CI-0.128- 0.336). 

Conclusion: The findings of this study reveal that relapse into drug abuse is significantly associated with personal, social, psychological and medical variables. It is recommended to 

integrate family counseling and therapeutic approaches, constant monitoring, and health care in treatment plans in order to reduce the adverse effects of factors such as family conflicts, peer pressure and drug-related cues in patients' likelihood of relapse.   

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Background and Aim: The quality of working life is a very important variable in connection with human resources. Therefore, it should be taken into consideration by managers if they aim to improve the capabilities and efficiency of their staff, which will, in turn, lead to improved productivity and economic growth. Productivity is an important factor in the success of hospital nurses too. The objective of this study was to determine the association between the quality of working life and productivity of nurses. Knowledge of this relationship can help plan to improve the nurses' quality of working life and, subsequently, improve their productivity and, ultimately, productivity of a hospital.

Materials and Methods: This was a cross-sectional correlation study conducted in 2011. The study population was nurses of the Shahid-Beheshti University of Medical Sciences hospitals in Tehran, Iran. Using the randomized stratified multistage sampling method, 380 nurses were selected as the study sample. Data on the nurses' quality of working life and productivity were collected using two questionnaires and analyzed using SPSS-17, the statistical tests being Chi-2, ANOVA, T-test, and the Pearson correlation test.

Results: The findings showed that nurses' quality of work life and productivity were at the middle level, with a mean of 2.47 and 3.07, respectively.  A very small number (1.55%) of the nurses reported that their quality of work life was at a high level, while the majority (82.4%) believed their quality of work life to be at a moderate level. The Pearson correlation test showed a significant positive relationship between the quality of work life and productivity of the nurses (r = 0.66, p-value = 0.001).

Conclusion: Only a low proportion of the nurses report their quality of working life and productivity to be at a high level. Therefore, bearing in mind that a statistically significant relationship exists between the quality of working life and productivity, authorities should atempt to promote the nurses' quality of work life in order to increase their productivity.

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Background and Aim: Bullying a form of persecution, physical, sexual and psychological one or more students against another student repeatedly over a period of time. The aim of this study was to evaluate the psychometric characteristics of the bullied scale in elementary school.

Materials and Methods: The study population all elementary students in Semnan in the 2013-14 school year. To this end, 607 students of Semnan were selected by using a stratified sampling method. All of them Harter's bullying Scale, Illinois bullying and Harter’s motivation questionnaire to complete. Data in the context two classical theories and the test-questions theory analyzed. Exploratory factor analysis, item-total correlation and reliability analyses were undertaken to assess the psychometric properties of the Harter's bullying Scale. The Sami Jima answers Scaled model Fitness data were used for analysis.

Results: Results showed Harter’s bullying scale of factor is saturated. Rating scale using Cronbach's alpha coefficient bullying Harter’s 0.74 respectively. Harter's bulling scale significant positive correlation with absence from school and with academic motivation, academic achievement and discipline scores showed a significant negative relationship. Data answer questions Harter’s scale with Samejima model had a good fitness and more information about the test showed that the slopes of -0.8 to +2.2 continuums feature.

Conclusions: Persian version of Harter's bullying scale had acceptable psychometric properties and could be used as reliable and valid instrument in psychological research.

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Background and Aim: Nowadays, in health promotion and disease prevention great emphasis is put on participatory community-based approaches. These approaches are considered as the main strategy of health promotion by using multiple interventions. Community assessment is a participatory research approach in which problems prioritization and resource distribution are done using information collected in a region aiming at promoting health of the community.

Materials and Methods: In this applied research community assessment was made in the Chahestaniha region in the City of BandarAbbas with the objective of identifying and prioritizing the main problems. The assessment consisted of eight phases, namely, the formation of a community assessment team, Primary and secondary data collection, data analysis and interpretation, combining district-level health statistics with community assessment data, reporting to the community, prioritizing health problems, and prepared a community assessment document.  In the eighth phase, after considering all risk factors that cause high prevalence of Children head lice, the action plan was designed and implemented to solve the problems.

Results: The Chahestaniha community assessment led to identifying 52 problems. The priority problems were classified. High prevalence of lice on children’s head was chosen as the top major problem to be solved, an action plan for solving it was developed and implemented.

Conclusion: The full cycle of community assessment methodology can be applied, with only some small changes, in most communities with different sizes, cultures, traditions and social habits. The method can obtain participation of the people in conducting the study and implementing interventions.

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Background and Aim: The present research aimed to study the psychometric characteristics of a subjective well-being questionnaire among high school students.

Materials and Methods: This was a descriptive correlational study. A total of 400 high school students (200 boys and 200 girls) in the City of Ghom, Iran were selected by multistage cluster sampling.  Data were collected using the Oxford subjective well-being and happiness inventory questionnaire. Factor analysis and Cronbach's alpha coefficient and the Pearson correlation test were used to analyze the data. 

Results: Factor analysis showed that the scale was saturated with four factors. In addition, Pearson correlation test indicated that subjective well-being was positively associated (p < 0.01) with happiness (r=0.27), discipline (r=0.11) and academic achievement (r=0.28). Also the reliability of the subjective well-being questionnaire using Cronbach's alpha was found to be  0.87 for the total scale and 0.69, 0.85, 0.73 and 0.78 for the subscales school connectedness, joy of learning, educational purpose and academic efficacy, respectively; these findings indicate that the tool used was quite good and reliable.

Conclusions: Based on the findings is concluded that the Persian version of the subjective well-being questionnaire is an acceptable tool to determine the psychometric characteristics of high school students and can be used as a valid instrument in psychological research.

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Background and Aim: The objective of this study was to assess the psychometric properties of the Adolescent Depression Scale (ADS) based on the item-response theory and compare the results with those based on the classic test theory.

Materials and Methods: A total of 750 students (364 males and 386 females) were selected through multistage random clustering (levels proportional to size) and completed a questionnaire comprising 46 questions developed by the investigators.

Results: Results of factor analysis and questions structure showed that the important item-response theory presumptions, namely, unidimensionality and local independence, are contained in ADS. As regards the psychometric characteristics of the questions, results from the two theories were similar, except that the item-response theory provided more valid indices for assessing the questions. Further analysis of the data indicated that the two theories showed close values for internal consistency with regard to psychometric characteristics, such that values of 0.933 and 0.947 were obtained for Alpha Cronbach and marginal validity, respectively. Finally, the normality scores were calculated based on the Item Response Theory with those based on the Classic Test Theory. Ranking the individuals by the two theories showed considerable differences as regards the depression construct continuum, such as a difference of 86, 92, or 93 individuals.

Conclusions: Based on the findings, it can be concluded that the item-response theory models provides a higher number of more exact indices for judgment and making decisions about questions, tests and individual ranking. Therefore, application of the item-response theory for assessment of other educational and psychological constructs is recommended.

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Background and Aim: In recent years bullying behaviors among school adolescent have risen and have raised concerns for psychologists, teachers and their families around the world. The use of bullying control methods in schools is important. Therefore, the purpose of this study was to evaluate the effectiveness of bullying control training program on health promotion behaviors in bullying adolescents in Tehran.
Materials and Methods: The statistical population consisted of students aged 12 to 17 years old in public schools in Tehran. A total of 40 subjects (20 controls and 20 experimental groups) were randomly assigned into two groups of experimental and control groups. Using a pilot, pre-test, post-test and one month follow up with the control group, Hartler's bullying questionnaire and health promotion behaviors were implemented on both groups. Then, experimental testing of bullying control training was performed in 8 sessions on the experimental group and after the completion of the sessions the post-test was presented to both groups. After that, a month's follow-up was carried out. For data analysis, multivariate analysis of repeated measurements was performed using SPSSV22 software.
Results: The results showed that the cognitive-behavioral bullying control training program on health promotion behaviors between the two groups was significantly different in three stages (p<0.05).
Conclusion: According to the results of this study, bullying control education can be effective on health promotion behaviors of adolescents aged 12 to 17 years and can be used to improve their health. Parents, teachers, managers and other professionals can learn from these trainings.

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Background and Aim: Good governance results in better health outcomes for the society thorugh improving health system performance. The governance of Iran health stsyem faces some challenges. Hence, this study aimed to propose and verify a model for strengthening Iranian health system governance.
Materials and Methods: This descriptive study was conducted in 2016 using the Delphi method. A health governance model with six dimentions including sturucture, communication, regulation, policy making and planning, stewardship and evaluation and accreditation has been proposed. Then, the proposed model verified using 25 Iranian healthcare experts’ opinions in two rounds.
Results: Developing an integrated health system model comprising health system enablers and results, downsizing and reducing the number of directorates in ministry of health,determining basic principles for regulation, enhancing communication with other external organizations affecting people health, using more evidence in policy making and planning, developing a strategic plan and national health policy, enhancing leadership, management and stewardship; and developing comprehensive systemic standards for evaluation and accreditation of healthcare organizations are recommended to enhance the effectiveness and efficiency of Iran health system governance.
Conclusion: Iran health system governance faces numerous challenges. Using successful countries’ experience and internal health care experts’ opinions help to reduce the current challenges and achieve health system goals.
 

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Background and Aim: Referral system is one of the principles and foundations of primary health care services. One of the most important challenges and problems of the referral system is the lack of knowledge of people and patients of its nature, services and benefits. The purpose of this study was to identify the factors affecting the acceptance of the referral system by patients.
Materials and Methods: This was a qualitative study conducted in 2021 using the framework (structural) analysis method. The participants were 18 experts in the field of referral system and 14 patients referred to the outpatient and inpatient wards of Imam Khomeini Hospital Complex in Tehran selected by purposive sampling. Data were collected by Semi-structured interviews and analyzed using the MAXQDA.
Results: Based on the findings in this study, Factors influencing the acceptance of the referral system by patients were found to be the following: (1). Factors related to the stewardship and governance of the health system (responsibility and accountability, appropriate levels of health services, patient-centered care, and rules and regulations); (2). Factors related to the health services access (financial, physical and cultural); (3). Factors related to service providers (trusting healthcare staff, professional skills of service providers, and their behavioral and communication skills); (4). Factors related to the service delivery process (quality of service delivery, attention to patients' wants and needs, use of technology in service delivery, monitoring service delivery, and service coverage); (5). factors related to the recipients of the services (satisfaction, education, awareness and communication).
Conclusion: Considering the importance and key role of patients in the success of the referral system, health planners and policy makers should pay special attention to the factors identified in this study.

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Background and Aim: Clinical Practice Guidelines (CPGs), are "recommendations intended to optimize patient care based on systematic reviews of available evidence and assessment of the benefits and harms of alternative care options". CPGs play an important role in improving the quality of care, reducing the diversity of treatment methods, reducing medical errors, managing health costs and increasing patient safety. This study was conducted with the aim of analyzing the decisions, consequences and policy trends of using CPGs in Iran during the period 2001-2021.
Materials and Methods: This study was a type of health policy analysis, carried out using analysis of the policy process approach. Data were collected through reviewing policy documents (n=79) and qualitative interviews (n=27). Analysis of policy documents was done using the content analysis method, the software used being Excel software, while for analysis of the interviews the framework analysis method was used, the software being the MAXQDA10 software.
Results: The policy of using CPGs in Iran started in 2001 and has improved over the past two decades. During the period 2016-2021 a total of 836 CPGs (knowledge products) were published, but according to the participants, many of these CPGs or knowledge products did not have the necessary quality and were not used by physicians. The findings of this study also showed that in Iran there is a suitable atmosphere for implementing CPGs and the policies of using them are sound policies; however, there is a huge gap between the development and implementation of CPGs.
Conclusion: Although the process of applying CPGs has improved in Iran, their implementation faces challenges and, thus, they have not been fully implemented. Therefore, there is a need to adopt new standard methods and approaches to improve the quality and reliability of CPGs. Certainly, the support of the government, Ministry of Health and Medical Education, the medical community, insurance organizations and other stakeholders, along with proper collaboration and appropriate policy formulations, are essential to achieve success.
 

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Background and Aim: Self-care behaviors are the most common behavioral response in attempts to prevent corona stress in patients with diabetes. Therefore, this study aimed to compare the effectiveness of positive thinking skills training and behavioral activation therapy on self-care and corona stress in patients with diabetes mellitus.
Materials and Methods: This was a semi-experimental study using a pretest-posttest and follow-up design with experimental and control groups. The statistical population included all the diabetic patients referring to the Vanoshe Diabetes Clinic in Qaemshahr city, Iran in 2020-2021, from among whom 45 patients were selected by accessible sampling technic based on the inclusion and exclusion criteria and randomly divided into three 15-member groups, namely,  positive thinking skills training, behavioral activation therapy and a control group. The first and second experimental groups received positive thinking skills training in six 60-minute virtual sessions and behavioral activation therapy training in eight 70-minute virtual sessions, respectively, and the control group was in the waiting list. Data were collected using the Corona Stress Scale "CSS-18" and the Summery of Diabetes Self-Care Activities "SDSCA" and analyzed using the repeated measures of variance analysis and the Bonferroni post hoc test with SPSS-22.
Results: The findings revealed that there was a significant difference between the two experimental groups and the control group. Both the positive thinking skills training and behavioral activation therapy interventions reduced corona stress (F= 15.73) and increased self-care (F= 16.17) in the patients, and the effects of the interventions in the follow-up phase were found to be continuing (p <0.05). In addition, the results of Bonferroni post hoc test showed that positive thinking skills raining was more effective than behavioral activation therapy on corona stress reduction (IJ= 9.02), while as regards self-care the behavioral activation therapy (IJ= 12.93) was more effective (p <0.05).
Conclusion: Based on the findings it can be concluded that positive thinking skills training and behavioral activation therapy interventions can be effective in improving self-care and corona stress reduction among diabetic patients. It is recommended that therapists and counselors use, in addition to other treatment methods, these therapies to improve the self-care and corona stress reduction in diabetic patients.