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1.  Women’s perceptions and experiences of the challenges in the process of male infertility treatment: A qualitative study 
Electronic Physician  2017;9(5):4349-4356.
Despite the fact that both men and women are equally subject to infertility, it is usually women who bear the burden of treatment and its consequences, even in cases of male infertility. Therefore, it is more necessary to recognize their health problems in order to help them.
To explore women’s perceptions and experiences of the challenges they face in the process of male infertility treatment.
This qualitative study was conducted during 2014–2015 using content analysis. Thirty semi-structured interviews were conducted with women whose husbands suffered from male infertility. Purposive sampling was conducted until data saturation was achieved. All interviews were recorded, transcribed and analyzed using conventional content analysis adopted by Graneheim and Lundman.
From data analysis, the major category of “treatment-related stresses” and four subcategories of “high treatment expenses”, “inefficiency of healthcare system”, “being captive in the infertility treatment” and “treatment failure” emerged.
Experiences of women who face male infertility indicate their various concerns in the process of treatment. Therefore, it is required to develop emotional and financial support for the clients and to promote their quality of healthcare services. In addition, awareness of treatment challenges of these women can assist proper planning to promote the quality of services they need.
PMCID: PMC5498699  PMID: 28713506
Male Infertility; Women; Treatment Challenges; Qualitative Study; Perception; Experiences
2.  Psychological Empowerment Model in Iranian Pregnant Women  
Women’s empowerment programs during pregnancy focus primarily on increasing women’s health goals and psychological empowerment has been considered important in most issues related to pregnant mothers’ mental health. Using path analysis, this study aims to examine the direct and indirect components of psychological empowerment of pregnant mothers.
This model-testing study was conducted in Gorgan, northwest of Iran during three months in spring of 2015. Through random cluster sampling, a total number of 160 pregnant women were selected from 10 urban medical centers and clinics as primary centers. We used Spritzer’s Psychological empowerment scale. Suitable sampling based on Nunally and Bernstein was followed in the model. The relationships between the dependent variables were then examined by means of path analysis using Amos 18.
The psychological empowerment of pregnant mothers (PEPW) model is impacted by individual factors, such as marriage age and employment, including some subjectively rated factors such as marital satisfaction and experience of violence. The PEPW model was deemed appropriate as optimum conditions indicators of goodness of fit; low index of χ2/df shows little difference between the conceptual model and observed data, while RMSEA value indicated the goodness of fit. Other indicators such as CMIN=0.957, CMIN/DF=0.957, P-CLOSE=0.418, χ2=0.957 and probability level=0.328 the fact that the model is ideal. The mothers’ employment had the highest coefficient in the PEPW path model .731 (0.443, 0.965) bootstrap confidence intervals by 95%, and with a p-value of less than 0.05.
The mothers’ employment is the most important factor in psychological empowerment, but it cannot be addressed quickly. Programming to increase marital satisfaction followed by a decrease in family violence and prevention of early marriage are necessary for promotion of psychological empowerment during pregnancy.
PMCID: PMC5045978  PMID: 27713897
Power (Psychology) ;  Pregnancy;  Health;  Statistical models
3.  Predictors of Prenatal Empowerment Among Iranian Pregnant Women 
Electronic Physician  2016;8(9):2962-2969.
Considering that empowering expectant mothers is an important issue to maintain a healthy pregnancy, this study was conducted to evaluate the predictors of empowerment among Iranian pregnant women.
This cross sectional study was conducted in Golestan, North of Iran in 2015. A total number of 161 pregnant women were selected through random cluster sampling from urban health centers, using PASS software. The socio-political, educational, and mental-financial predictors of empowerment were measured using a self-structured questionnaire during pregnancy and was analyzed by a linear regression model using SPSS version 16.
The findings of linear regression showed that educational dimension of empowerment had the highest coefficient in the regression model, on total empowerment (βeta standardized coefficient [β]=0.696 with DW=1.830 and means error=0). The total empowerment score of pregnant women was controlled by individual factors such as the age of marriage (β-0.228), employment (β-0.210), and educational factors such as participation in prenatal education classes (β-0.246), and moral issues such as sense of spiritual support (β-0.217).
By recognizing and observing predictors of empowerment during pregnancy, health care providers can increase women’s power over their pregnancy. Educational predictors of empowerment were the most important factors to empower women during pregnancy. The objective of childbirth education classes, therefore, should shift from simply giving information to women, towards giving them appropriate knowledge in order to provide them with empowerment during pregnancy.
PMCID: PMC5074757  PMID: 27790351
Empowerment; Pregnancy; Health
4.  Respect for woman's decision-making in spontaneous birth: A thematic synthesis study 
Participation of woman in decision-making processes is one of the key indicators of an appropriate relationship between a woman and the health care professionals. This study aimed to recognize the factors facilitating respect for woman's decision-making in spontaneous birth.
Materials and Methods:
This paper employed a meta-synthesis on articles published in four biomedical databases including MEDLINE, Web of Science, CINAHL, and Cochrane Library. All qualitative studies published after 1990 and directly or indirectly discussing the women's and the health care professional's attitudes toward respect for woman's decision-making in spontaneous birth were searched. Of 5372 citations, 95 full-text papers were considered, of which 14 satisfied the inclusion criteria.
In this meta-synthesis, initial codes were obtained through meticulous, line-by-line coding of the findings of the primary studies. Then, thematic synthesis was performed on the codes to search for concepts, and 20 descriptive themes were obtained in the second stage. Finally, through an inductive process, five new interpretations were obtained in the last stage of the thematic synthesis. These interpretations included confidence to health care providers, the central role of midwives in maintenance of women's dignity, childbirth as a natural phenomenon, the impact of contextual conditions, and the political and human factors affecting the delivery management and women seek place of safety for childbirth.
Studies suggested that midwifes have a central role in maintenance of women's dignity and their experience of childbirth.
PMCID: PMC5114787  PMID: 27904626
Childbirth; dignity; Iran; qualitative study; thematic synthesis
5.  Tear Deformation Time and optical quality in eyes wearing silicone hydrogel contact lenses 
Journal of Current Ophthalmology  2016;28(4):226-227.
To evaluate tear film stability and optical aberrations in eyes wearing plano Lotrafilcon B contact lenses (CL).
Tear Deformation Time (TDT) and aberrometric parameters were assessed in 86 normal emmetropic eyes before and 6 h after wearing CL.
A statistically significant decrease in TDT and increase in root mean square (RMS) values of higher order aberrations (HOA) were revealed 6 h after CL insertion (both P < 0.001). The low order aberrations (LOA) RMS values measured with CL were higher than those in naked eyes, but the difference was not statistically significant. None of individual Zernike polynomials showed any significant alteration.
Our findings indicated that the Lotrafilcon B contact lens affects HOA more than LOA. The tear film was less stable after wearing CL.
PMCID: PMC5093784  PMID: 27830209
Tear stability; Tear Deformation Time; Aberrations; Optical quality; Silicone hydrogel contact lens
6.  Developing a Questionnaire for Iranian Women’s Attitude on Medical Ethics in Vaginal Childbirth 
Nursing and Midwifery Studies  2015;4(4):e29004.
Vaginal delivery is one of the challenging issues in medical ethics. It is important to use an appropriate instrument to assess medical ethics attitudes in normal delivery, but the lack of tool for this purpose is clear.
The aim of this study was to develop and validate a questionnaire for the assessment of women’s attitude on medical ethics application in normal vaginal delivery.
Patients and Methods:
This methodological study was carried out in Iran in 2013 - 2014. Medical ethics attitude in vaginal delivery questionnaire (MEAVDQ) was developed using the findings of a qualitative data obtained from a grounded theory research conducted on 20 women who had vaginal childbirth, in the first phase. Then, the validation criteria of this tool were tested by content and face validity in the second phase. Exploratory factor analysis was used for construct validity and reliability was also tested by Cronbach’s alpha coefficient in the third phase of this study. SPSS version 13 was used in this study. The sample size for construct validity was 250 females who had normal vaginal childbirth.
In the first phase of this study (tool development), by the use of four obtained categories and nine subcategories from grounded theory and literature review, three parts (98-items) of this tool were obtained (A, B and J). Part A explained the first principle of medical ethics, part B pointed to the second and third principles of medical ethics, and part J explained the fourth principle of medical ethics. After evaluating and confirming its face and content validity, 75 items remained in the questionnaire. In construct validity, by the employment of exploratory factor analysis, in parts A, B and J, 3, 7 and 3 factors were formed, respectively; and 62.8%, 64% and 51% of the total variances were explained by the obtained factors in parts A, B and J, respectively. The names of these factors in the three parts were achieved by consideration of the loading factor and medical ethics principles. The subscales of MEAVDQ showed significant reliability. In parts A, B and J, Cronbach’s alpha coefficients were 0.76, 0.72 and 0.68, respectively and for the total questionnaire, it was 0.72. The results of the test–retest were satisfactory for all the items (ICC = 0.60 - 0.95).
The present study showed that the 59-item MEAVDQ was a valid and reliable questionnaire for the assessment of women’s attitudes toward medical ethics application in vaginal childbirth. This tool might assist specialists in making a judgment and plan appropriate for women in vaginal delivery management.
PMCID: PMC4733499  PMID: 26835464
Medical Ethics; Natural Childbirth; Validation Studies, Attitude; Women
7.  Cognitive emotional consequences of male infertility in their female partners: a qualitative content analysis 
Electronic Physician  2015;7(7):1449-1457.
Infertility, as a global phenomenon and one of the most important issues of reproductive health, affects women more often than men, even when the infertility is due to a male factor. The purpose of this study was to explore the cognitive emotional experiences of women faced with male infertility.
This qualitative study was conducted in 2014–2015 in Mashhad, Iran. The perceptions and experiences of healthy women whose husbands were diagnosed with primary male factor infertility were investigated using a qualitative content analysis approach. Participants were selected through purposeful sampling, and data collection was conducted using in-depth semistructured interviews. Data were analyzed using conventional content analysis with MAXqda software. Study rigor was verified via criteria proposed by Lincoln and Guba.
One main theme emerged through analysis entitled “cognitive emotional reactions confronting infertility diagnosis” with sub-themes of cognitive emotional reactions when confronted with male infertility diagnosis with subthemes of disbelief and denial, fear and apprehension, suffering and emotional distress, disappointment, frustration, confusion, and joy.
The diagnosis of male infertility was associated with important emotional cognitive consequences for their female partners. Emotional support, providing new insights into how to treat the issue, and trying to shorten the process of diagnosis are necessary for these women. This kind of support could reduce the psychological effects of confrontation with the diagnosis of male infertility, including social insecurity for women.
PMCID: PMC4700889  PMID: 26767097
women; male infertility; content analysis; cognition; emotional
8.  Nutritional and Therapeutic Characteristics of Camel Milk in Children: A Systematic Review 
Electronic Physician  2015;7(7):1523-1528.
Camel milk is the closest to a human mother’s milk. Camel milk is different from other milks, however, having low sugar and cholesterol, high minerals (sodium, potassium, iron, copper, zinc and magnesium, and vitamin C). The milk is considered have medicinal characteristics as well. This systematic review is aimed at determining and reporting nutritional values and medicinal characteristics of camel milk in children.
The search strategy of the current review is “(camel AND milk) AND (autism OR food allergy OR milk allergy OR children OR diarrhea.” The search was conducted via PubMed, Scopus, and Google scholar. Also two Persian scientific databases (SID and Iranmedex) and international congresses were investigated. Full-text papers and abstracts on the topic of camel milk, evaluating nutritional value and medicinal properties, were included in this systematic review.
Out of the 472 records found in the resources, 35 related studies were included in the final analysis. The result showed that camel milk is highly nutritious and is safe for consumption by children.
It seems that many researchers did not follow a specific guideline for reporting and confirming the therapeutic properties of camel milk in children, but there is evidence denoting the importance, trials, and investigations of its usability and benefits. Camel milk as a supplemental treatment seems less invasive and costly than specialist care, medications, alternative treatments, and behavioral interventions. Based on our findings, camel milk is safer for children, effective in the treatment of autism, improves general well-being, promotes body natural defenses, is a good nutritional source, and can helps the daily nutritional needs of humans.
PMCID: PMC4700900  PMID: 26767108
camel milk; autism; food allergy; milk allergy; children; diarrhea; intolerant to lactose
9.  Vaccination learning experiences of nursing students: a grounded theory study 
This study aimed to explore the experiences of nursing students being trained to perform vaccinations.
The grounded theory method was applied to gather information through semi-structured interviews. The participants included 14 undergraduate nursing students in their fifth and eighth semesters of study in a nursing school in Iran. The information was analyzed according to Strauss and Corbin’s method of grounded theory.
A core category of experiential learning was identified, and the following eight subcategories were extracted: students’ enthusiasm, vaccination sensitivity, stress, proper educational environment, absence of prerequisites, students’ responsibility for learning, providing services, and learning outcomes.
The vaccination training of nursing students was found to be in an acceptable state. However, some barriers to effective learning were identified. As such, the results of this study may provide empirical support for attempts to reform vaccination education by removing these barriers.
PMCID: PMC4536360  PMID: 26084680
Grounded theory; Iran; Problem-based learning; Nursing students; Vaccination
10.  Current Status of Sexual Health and Rights Indicators in Iran: An Overview 
Sexual health and rights indicators provide essential tools for monitoring the status of individuals’ sexual health and its rights, in various countries. This paper discusses sexual health and rights indicators in Iran. The indicators under study are derived from similar indicators developed by Asian-Pacific Resource and Research Center for Women, for the 15th anniversary of the International Conference on Population and Development monitoring project. Four HIV-related and three other indicators, including legal age of marriage, median age of women at marriage, and status of violence against women (VAW) were examined in this study. Iran has made several achievements in combating HIV/AIDS, with the focus on injectable drug users, and has countered a series of challenges in the determination of VAW prevalence, the increase of high risk behavior in adolescents, and sexual education for this group. The most important message of this paper is that special attention to challenging issues in Iranian individuals’ sexual health could promote their current status.
PMCID: PMC4552958  PMID: 26328067
Violence; Acquired Immunodeficiency Syndrome; Health Status Indicators
11.  Relationship between gender role attitude and fertility rate in women referring to health centers in Mashhad in 2013 
Fertility rate apparently is a non-interventional behavior, but in practice, it is influenced by social values and norms in which culture and traditional beliefs play a significant role. In this regard, some studies have shown that gender roles can be associated with reproductive behaviors. With regard to the importance of annual reduction of population growth rate and its outcomes, the present study was performed to determine the relationship between gender role attitude and fertility rate in women referring to Mashhad health centers in 2013.
Materials and Methods:
The present study is an analytical cross-sectional and multistage sampling study performed on 712 women. Data were collected by a questionnaire consisting of two sections: Personal information and gender role attitude questionnaire that contained two dimensions, i.e. gender stereotypes and gender egalitarianism. Its validity was determined by content validity and its reliability by internal consistency (r = 0.77). Data were analyzed by SPSS software version 16.
Initial analysis of the data indicated that there was a significant relationship between acceptance of gender stereotypes (P = 0.008) and gender egalitarianism (P < 0.001), and fertility. There was also a direct association between acceptance of gender stereotypes and fertility rate (r = 0.13) and an indirect association between egalitarianism and fertility rate (r = −0.15).
The results of the present study indicate that there is an association between gender role attitude and fertility. Paying attention to women's attitude is very important for successful planning in the improvement of fertility rate and population policy.
PMCID: PMC4387654  PMID: 25878707
Attitude; fertility rate; gender role; Iran
12.  The Shadow of Silence on the Sexual Rights of Married Iranian Women 
BioMed Research International  2015;2015:520827.
There has been a recent shift in the field of sexual health, representing a move away from biomedical concerns to sexual rights frameworks. However, few studies on sexuality are based on a rights framework. The unspoken nature of sexuality in Iranian culture has led to a lack of national studies on the topic. The objective of this study was to explore the perceptions and experiences of married Iranian women on sexual rights in their sexual relationships. In this grounded theory study, 37 participants (25 married women, 5 husbands, and 7 midwives) were selected. Data were collected through in-depth interviews and analyzed through open, axial, and selective coding using MAXQDA software version 2007. The analysis revealed the core category of “sexual interaction in the shadow of silence.” The interrelated categories subsumed under the core category included adopting a strategy of silence, trying to negotiate sex, seeking help, and sexual adjustment. The silence originating from women's interactions with their families and society, from girlhood to womanhood, was identified as the core concept in Iranian women's experiences of sexual rights. A focus on husbands' roles seems salient because they can direct or alter some learned feminine roles, especially silence regarding sexual matters, which then affects the realization of women's sexual rights.
PMCID: PMC4331327  PMID: 25705669
13.  Help Seeking Behavior of Women with Self-Discovered Breast Cancer Symptoms: A Meta-Ethnographic Synthesis of Patient Delay 
PLoS ONE  2014;9(12):e110262.
Background and Objective
Patient delay makes a critical contribution to late diagnosis and poor survival in cases of breast cancer. Identifying the factors that influence patient delay could provide information for adopting strategies that shorten this delay. The aim of this meta-ethnography was to synthesize existing qualitative evidence in order to gain a new understanding of help seeking behavior in women with self-discovered breast cancer symptoms and to determine the factors that influence patient delay.
The design was a meta-ethnography approach. A systematic search of the articles was performed in different databases including Elsevier, PubMed, ProQuest and SCOPUS. Qualitative studies with a focus on help seeking behaviors in women with self-discovered breast cancer symptoms and patient delay, published in the English language between 1990 and 2013 were included. The quality appraisal of the articles was carried out using the Critical Appraisal Skills Programme qualitative research checklist and 13 articles met the inclusion criteria. The synthesis was conducted according to Noblit and Hare’s meta-ethnographic approach (1988), through reciprocal translational analysis and lines-of-argument.
The synthesis led to identification of eight repeated key concepts including: symptom detection, initial symptom interpretation, symptom monitoring, social interaction, emotional reaction, priority of medical help, appraisal of health services and personal-environmental factors. Symptom interpretation is identified as the important step of the help seeking process and which changed across the process through active monitoring of their symptoms, social interactions and emotional reactions. The perceived seriousness of the situation, priority to receive medical attention, perceived inaccessibility and unacceptability of the health care system influenced women’s decision-making about utilizing health services.
Help seeking processes are influenced by multiple factors. Educational programs aimed at correcting misunderstandings, erroneous social beliefs and improving self-awareness could provide key strategies to improve health policy which would reduce patient delay.
PMCID: PMC4254513  PMID: 25470732
14.  Teaching methods in community health nursing clerkships: experiences of healthcare staff in Iran 
Healthcare staff educate nursing students during their clerkships at community health nursing programs. Their teaching methods play an important role in nursing students’ acquisition of competencies; however, these methods have not been studied thoroughly. Thus, this study aims to describe, interpret, and understand the experiences of healthcare staff’s teaching methods in clerkships at a community health nursing program.
This study was conducted using purposeful sampling and semi-structured interviews with 13 members of the staff of three urban healthcare centers in Iran. The data were analyzed through qualitative content analysis and thematic analysis.
Multiplicity of teaching was identified as the main category of teaching method, and the five subcategories were teaching through lecture, demonstration, doing, visits and field trips, and readiness. The most common method used by the healthcare staff was lecturing.
The healthcare staff used multiple methods to teach students in the nursing clerkship of the community health program, which was the strength of the course. However, they should be familiar with, and utilize additional methods, such as discussion rather than lecture.
PMCID: PMC4309929  PMID: 25273853
Clinical clerkship; Community health nursing; Content analysis; Staff; Teaching
15.  Anxiety, Depression, Coronary Artery Disease and Diabetes Mellitus; An Association Study in Ghaem Hospital, Iran 
There is an increasing trend in the prevalence of coronary artery disease (CAD) in Iran.
The present study aimed to investigate the relationship of anxiety, depression, diabetes and coronary artery disease among patients undergoing angiography in Ghaem Hospital, Mashhad, Iran.
Patients and Methods:
This case-control study was conducted between September 2011 and August 2012 among 200 patients undergoing coronary angiography for symptoms of coronary disease at Ghaem Hospital, Mashhad, Iran. The control group consisted of 697 healthy adults recruited from the individuals who attended the clinic for routine medical checkups or pre-employment examinations. The Beck anxiety and depression inventory scores and fasting blood glucose results were assessed in all the subjects. Data were analyzed using SPSS version 16. P < 0.05 was regarded as statistically significant.
The mean age of patients was 57.52 ± 9.33 years old and for the control group it was 55.35 ± 8.45 years; there was no significant difference between the subjects (P = 0.647) regarding age. There was also no significant difference in gender distribution between the patients and control groups (P = 0.205). There was however a significant difference in anxiety and depression scores between the patients and healthy controls (P < 0.001). There was a significant positive correlation between anxiety score and depression score in both groups when data were analyzed by Pearson test. (P < 0.001, r = 0.604 and r = 0.521). Moreover, there was a significant positive linear correlation between the depression/anxiety scores and fasting blood glucose concentrations in the patients group (r = 0.3, P < 0.001) and a weak negative correlation in the healthy controls (r = -0.096, P < 0.05).
Depression and anxiety are potentially important factors among patients with angiographically-defined CAD. There appear to be significant associations between glucose tolerance and anxiety and depression in these patients.
PMCID: PMC4270671  PMID: 25593715
Coronary Artery Disease; Anxiety; Depression; Angiography
16.  Serum Inflammatory Cytokines and Depression in Coronary Artery Disease 
Severe depression may be accompanied by immune dysregulation and is also associated with increased risk of coronary artery disease (CAD).
We investigated serum levels of 10 cytokines and their relationship with depression in patients with cardiovascular diseases as well as healthy subjects in northeast of Iran.
Patients and Methods:
The study was carried out on 462 subjects (120 healthy subjects and 342 candidates undergoing angiography). The healthy subjects were referred for routine annual checkups or pre-employment examinations; they did not have clinically evident CAD. A questionnaire was used to obtain demographic data and the Beck depression inventory (BDI) was applied to assess depression. The Evidence Investigator® platform was used for cytokines assays for IL-1α, IL-1β, IL-2, IL-4, IL-6, IL-8, IL-10, TNF-α, MCP-1 and IFN-γ, using sandwich chemiluminescent method. The statistical analysis was performed using SPSS version 11.5.
The mean age was 53.3 ± 11.5, 54.8 ± 11.3, and 59.5 ± 11.3 in healthy, angiography (-), and angiography (+) subjects, respectively (P < 0.05). There were significant differences in serum levels of IL-4, IL-6, IL-10, and MCP-1 cytokines, comparing subjects with CAD and healthy persons (P < 0.05). When all subjects were divided to with and without depression regardless of their cardiovascular status, there was a significant difference in serum levels of IL-8 and IL-6 between the groups (P < 0.05). When the subgroup with features of CAD was selected and divided to those with and without depression, there was also a significant difference in serum levels of IL-8 and TNF-α (P < 0.05).
The positive interaction between depression and CAD was probably mediated by inflammatory mechanisms.
PMCID: PMC4166097  PMID: 25237578
Coronary Artery Disease; Depression; Cytokines; Tumor Necrosis Factor; Interleukin-8
17.  Skype interviewing: The new generation of online synchronous interview in qualitative research 
The most commonly used method for data collection in qualitative research is interviewing. With technology changes over the last few decades, the online interview has overcome time and financial constraints, geographical dispersion, and physical mobility boundaries, which have adversely affected onsite interviews. Skype as a synchronous online service offers researchers the possibility of conducting individual interviews as well as small focus groups, comparable to onsite types. This commentary presents the characteristics of the Skype interview as an alternative or supplemental choice to investigators who want to change their conventional approach of interviewing.
PMCID: PMC3991833  PMID: 24746247
Interview; qualitative research; researcher; Skype
18.  Pictorial Health Warning Labels on Cigarette Packages: An Investigation on Opinions of Male Smokers 
Health warning labels on cigarette packages are among the most straightforward and important tools to communicate with smokers and various studies have illustrated their efficacy.
The current study aimed to investigate the opinions of male smokers in Mashhad city about the efficacy of health warning labels printed on cigarette packages on the smoking status of smokers.
Patients and Methods:
This cross-sectional descriptive study was conducted in 2013 using a questionnaire. The research population included the male smokers of Mashhad. The participants were selected from the customers referring to the newsstands for cigarettes. The obtained data were analyzed employing SPSS software Version 16, and the statistical tests including Kruskal-Wallis, Spearman, and correlation coefficient of Pearson, Chi Square, Mann-Whitney, and Bonferroni correction were used in this regard.
In this research, there were 500 participants with the average age of 25 years. The initiation age of smoking was eight years while the maximum age was reported as 45 years. Results of this research about the effect of these labels on decreasing cigarette consumption rate showed that almost half of the participants believed that these labels were ineffective for them (52.2%) and other smokers (53.8%).Furthermore, significant relationship was found between the age and opinion of the smokers about the influence of these labels on reducing their cigarette consumption (P < 0.001).
To promote the effect of printed images on cigarette packages, it is recommended to consider the suitability of labels in the targeted culture. In addition, to be more effective consultation sites to quit smoking should be introduced under the images.
PMCID: PMC4005439  PMID: 24829777
Smoking; Tobacco Products; Iran
19.  Clarifying the Role of Schools in Tendency or Lack of Tendency Toward Smoking among Teenage Boys (11-14) in Mashhad, Iran 
Recent studies show that the prevalence of tobacco use among teens and students is increasing, and the initiation age of tobacco use has decreased.
The current research aimed to signify the role of schools in the process in which student teenage boys became smokers in 2012 in Mashhad.
Materials and Methods:
The current study was part of a qualitative research conducted by content analysis method and purposive sampling, performing 35 in-depth interviews, and 2 focused group discussions. The participants in this research included teenagers, teachers, students` parents , psychologists, and experts in the field of fighting against tobacco use, those who either had the experience of exposure to cigarettes at school, or were well-informed persons about tobacco use.After performing each interview, the interview was transcribed, and analyzed before the next interview. The data were under continuous consideration and comparative analysis in order to achieve data saturation.
After analysis and codification of data, four concept categories were achieved to clarify the role of schools in student smoking: 1) School purity or impurity to high-risk behaviors; 2) Directive or nondirective schools for controlling tobacco; 3) Preventive or predisposing schools for smoking behavior, and 4) Perceived positive outcomes from smoking at school. Each main category was divided into three subordinate themes.
With regard to decrease of cigarette use initiation age and the great influence of schools on teenagers’ behavior, it is recommended to perform special screening programs based on the achieved themes in this research to reduce tobacco use. It is also suggested that school staff pay more attention to students’ communication networks and pressures that are imposed on a student for smoking cigarettes during the school time.
PMCID: PMC3964423  PMID: 24719706
Smoking; Adolescent; Tobacco; Schools
20.  The process of community health nursing clinical clerkship: A grounded theory 
The performance of the community health nurse depends on a combination of scientific and practical competencies acquired by educational experiences during the nursing course. Curriculum planners of nursing education need to understand nursing education to train professional and community-oriented nurses. The aim of this article is to explore the experiences of nursing students during their community health nursing clinical clerkship courses.
Materials and Methods:
A grounded theory approach was used to conduct this study. Twelve nursing students, 13 health-care staff members, and 10 nursing instructors were interviewed individually in 2011-2012. The interviews were tape-recorded and later transcribed verbatim. The transcriptions were analyzed using the method of Strauss and Corbin.
Ambivalence of motivation was the main category and included five subcategories: Professional identity, educational atmosphere, educational management, motivation-based approaches, and inadequate productivity. This paper presents the aspects of the community health nursing clerkship course from the viewpoint of students in areas such as the role of the community health nurse, attitude toward the course, medical orientation, prerequisite skills/knowledge, poor administrative planning, rotation of students, insufficient activity for students, passiveness, providing service to clients, responsibility, and inproductivity. These categories could explain the nature of the community health nursing clerkship of the Mashhad Faculty of Nursing and probably others in Iran.
The findings revealed inadequate productivity of the community health nursing education; so, it is suggested to define a position for nurses in this setting and remove barriers and provide conditions for them to play more important roles in the promotion of community health.
PMCID: PMC3917128  PMID: 24554943
Clinical clerkship; community health; grounded theory; Iran; nursing students
21.  The influence of social network on couples’ intention to have the first child 
Background: Recently, the relevance of social interactions as determinants of behavioral intentions has been increasingly perceived, but there is a lack of knowledge on how and why it interacts with couples’ fertility intentions.
Objective: This qualitative study was conducted to explore the influence of social network on couples’ intention to have their first child in urban society of Mashhad, Iran in 2011.
Materials and Methods: In this exploratory qualitative study in-depth interviews were conducted with 24 participants including 14 fertile women, two parents, three husbands and five midwives and health care providers. The sample was selected purposively in urban health centers, homes and workplaces until data saturation was achieved. Data analysis was carried out adopting conventional content analysis approach through giving analytical codes and identification of categories using MAXqda software. Study rigor verified via prolonged engagement, validation of codes through member check and peer debriefing.
Results: Findings from data analysis demonstrated four major categories about social network’s influence on couples’ intention to have their first child including 1) perception of fertility relevant social network, 2) occurrence of various types of social influence 3) subjective judgment to the benefits of social network and its fitness to personal life, and 4) couples’ interaction with social network.
Conclusion: Managing the fertility behaviors need to include the consideration of personal social networks surrounding the couples. It is important to apply the study findings in providing family planning services and dissemination of appropriate fertility behaviors through community-based reproductive health care delivery system.
PMCID: PMC3943220  PMID: 24639748
Fertility; Childbirth; Social network; Qualitative study; Content analysis
22.  Socio-cultural challenges to sexual health education for female adolescents in Iran 
Background: Despite clear reasons for necessity of sexual health education for adolescents, it is a contested issue and has faced challenges in most cultures. Providing sexual education for non-married adolescents is culturally unacceptable in most Muslim societies.
Objective: This qualitative study addressed socio-cultural challenges to sexual health education for female adolescents in Iran.
Materials and Methods: Qualitative data from female adolescents (14-18 yr), mothers, teachers, authorities in health and education organizations, health care providers and clergies were collected in two large cities of Iran including Mashhad and Ahvaz through focus group discussions and individual in-depth interviews. Data were analyzed using conventional qualitative content analysis with MAXqda software.
Results: Our results revealed that the main socio-cultural challenges to sexual health education for adolescents in Iran are affected by taboos surrounding sexuality. The emergent categories were: denial of premarital sex, social concern about negative impacts of sexual education, perceived stigma and embarrassment, reluctance to discuss sexual issues in public, sexual discussion as a socio-cultural taboo, lack of advocacy and legal support, intergenerational gap, religious uncertainties, and imitating non-Islamic patterns of education.
Conclusion: It seems that cultural resistances are more important than religious prohibitions, and affect more the nature and content of sexual health education. However, despite existence of salient socio-cultural doubtful issues about sexual health education for adolescents, the emerging challenges are manageable to some extent. It is hoped that the acceptability of sexual health education for adolescents could be promoted through overcoming the cultural taboos and barriers as major obstacles.
PMCID: PMC3941358  PMID: 24639734
Female adolescents; Sex education; Qualitative research
23.  Female adolescents’ experiences and perceptions regarding sexual health education in Iranian schools: A qualitative content analysis 
Despite so many unmet sexual health education (SHE) needs of adolescents, socio-cultural challenges have caused this issue to be ignored in different scoieties. This study investigated Iranian female adolescents’ experiences and perceptions with respect to SHE that they received at schools, and what they really needed, expected, and preferred.
Materials and Methods:
In this qualitative study, seven focus group discussions (44 adolescents) and 13 individual in-depth interviews were conducted among female adolescents aged 14-18 in Mashhad and Ahvaz, Iran, to explore adolescents’ experiences and perceptions towards SHE in Iranian schools. Data were analyzed using qualitative content analysis.
Analyzing adolescents’ perspectives and experiences revealed their great dissatisfaction with SHE in schools. Emerged categories included: lack of obligation and priority for SHE, sexual reticence and evading, making adolescents frightened of sexual issues, inconsistency of SHE with adolescents’ needs, unqualified educators, and lack of appropriate educational materials.
This study found some similarities between expectations of Iranian adolescents and those of adolescents from other cultures about an SHE program. Adolescents showed great abilities to appraise health services delivered for them, and so any program for sexual health promotion in adolescents ought to address adolescents’ needs, demands, and aspirations. Their contribution can provide insights for tailoring SHE programs for adolescents.
PMCID: PMC3730460  PMID: 23922603
Adolescents; female; Iran; qualitative research; reproductive health; sexual health education

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