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Aims Because of the direct contact nurses have with patients, they are exposed to more stressful events during the outbreak of infectious diseases, which increases their turnover intention, highly impacting not only nurses, but also patients and organizations. The present study aimed to identify the predictors of turnover intention based on psychosocial factors in nurses of Ardabil pre‐hospital emergency and educational and medical centres during the COVID‐19 outbreak. Design The present descriptive‐analytical study was conducted in June, 2020. Methods A total of 479 nurses working in Ardabil pre‐hospital emergency and educational and medical centres to fight COVID‐19 were recruited for this study using the census method. Data were collected using the Demographic Information Questionnaire, Turnover Intention Questionnaire, Weiss & Marmar Impact of Event Scale‐Revised (IES‐R), General Health Questionnaire (12 C‐GHQ) and Job Content Questionnaire (JCQ). Data were analysed with SPSSv.22 software using correlation, t test, analysis of variance, multiple regression and descriptive tests. Results The mean turnover intention score of nurses was 41.73 with a standard deviation of 12.11. The results of correlation coefficient revealed a positive relationship between PTSD, general health, job demand and job strain with turnover intention (p ≤ .01) and a positive and significant relationship between social support and turnover intention (p ≤ .01). Multiple regression analysis showed that the variables of gender, marital status, work position, decision latitude, social support, job strain, general health and post‐traumatic stress disorder (PTSD) were predictors of turnover intention. Conclusion Job stressors during the COVID‐19 outbreak have led to an increase in nurses’ turnover intention. Identifying and managing the factors related to job stressors will make it possible to prevent nurses’ turnover intention in such critical situations.

Background In this study, we aimed to evaluate the impact of the COVID-19 epidemic on the workload and mental health of Iranian medical staff using the General Health Questionnaire (GHQ-12) and NASA -Task Load Index (NASA-TLX) Questionnaire between March and April 2020, respectively. Methods The present cross-sectional study was conducted from March 5th to April 5th, 2020. To evaluate the workload and mental health of participants NASA-TLX and GHQ-12 online questionnaires were distributed. Data were entered into software SPSS (Version 23) and T-test, ANOVA, Regression methods were used for data analysis. Results Health workers who encountered COVID- 19 patients, were subjected to more task load compared to those who had no contact with COVID- 19 patients at the workplace ( p  <  0.001). In terms of the subscale score of NASA-TLX, nurses had more scores in mental pressure, physical pressure, time pressure (temporal), and frustration compared to the other jobs ( p  <  0.05). Moreover, nurses had significantly more workload compared to the other jobs. Conclusions Type of job, the shift of work, educational level, and facing COVID-19 affected the score of NASA-TLX. NASA-TLX scores were higher in nursing compared to the scores of other health staff groups. The results of this study indicate that the scores of NASA-TLX and GHQ-12 among staff who had contact with COVID-19 patients were significantly higher than those who did not face COVID-19 patients. We suggested that a comprehensive assistance should be provided to support the well-being of healthcare workers especially nurses and healthcare workers who treated COVID-19 patients.

Introduction: Women health volunteers are the link between people and healthcare workers. They play an important role in health education activities, following up families under coverage, and updating the demographic data to health centers. This study was performed to uncover women health volunteers’ activities, reasons for joining and leaving from the program. Methods: A qualitative study design was used to conduct the study. Through purposive sampling technique, twenty -four in-depth semi-structured individual interviews and two focused group discussions with women health volunteers and their supervisors were conducted in Tabriz, Iran. Data analysis implemented thematic analysis, using MAXQDA10. Results: The findings were generally categorized into three major themes, participation in promoting health, perceived benefit, and perceptual- environmental inhibitors. Participation in promoting health consisted of the sub-themes participation in educational programs, participation in health care. The sub-themes of perceived benefit included benefits from health care services and interest in having an active role in the community. The theme perceptual- environmental inhibitors involved the subthemes participation barriers and lack of innovation and inconsistency with social changes. Conclusion: Culture-building about the role of health volunteers, the valuing on their activities in the community, and informing program supervisors about the health volunteer’s duties would help to retain health volunteers and also sustain their activities at the community level.

Background: Brucellosis is an endemic disease in many countries, especially in the Mediterranean region, as well as countries such as the Islamic Republic of Iran. Despite the preventive measures against brucellosis adopted in different countries throughout the world, the disease is still a public health concern. Aims: Our aim in the present study was to examine the cognitive factors associated with Brucellosis Preventive Behaviours (BPBs) among diagnosed patients utilizing Empowerment Model. Methods: In 2013, applying a cross-sectional study, all 238 patients with brucellosis in Chaldoran County, Islamic Republic of Iran, were recruited to answer a researcher-made EM-based questionnaire and BPBs Scale through interview. Results: Hierarchical multiple linear regressions were performed with BPBs as the outcome variable. Predictors for this variable, according to their natures, were classified in two different blocks. In the first block, significant effect was found on BPBs by demographic variables ([DELTA]R2 = 0.301). In the second block, the level of education, knowledge, and self-efficacy were significant predictors (P < 0.001) of BPBs ([DELTA]R2 = 0.808). Conclusions: The Empowerment Model was found as a helpful framework in predicting the risk factors of BPBs. Health care providers in low- and middle-income countries should consider the patients' knowledge on the disease and their level of self-efficacy to perform BPBs as the core categories of empowerment while designing brucellosis prevention programmes. Keywords: Brucellosis, preventive behaviours, knowledge, self-efficacy, Empowerment Model Citation: Babazadeh T; Nadrian H; Ranjbaran S; Rezakhani-Moghaddam H; Aghemiri M. Cognitive factors associated with Brucellosis preventive behaviours among diagnosed patients: an application of Empowerment Model. East Mediterr Health J. 2019;25(8):567-574. Received: 04/10/16; accepted: 28/11/17

Nursing is a practice-based discipline. Clinical education is one of the most important parts of nursing education; nurses play an important role in the learning of nursing students. This study was carried out to unveil the challenges of nursing students' learning through working with nurses. A qualitative design was used to conduct the study in city of Khalkhal, Ardabil province, Iran. In order to collect data through purposive sampling, twenty students were interviewed using in-depth semi-structured individual techniques. Data analysis was done using MAXODA 12. Challenges of nursing students' learning were generally categorized into three main themes including inappropriate social norms, inadequate organizational atmosphere, and inadequate resources. It seems that inappropriate organizational culture in the clinical setting and wrong distribution of resources will lead to disruption of student-nurse relationships and ultimately disruption of clinical education.

Background Given the effective role of a mobile applications in disease management, disease monitoring, and self-care in patients with COVID-19 disease, we aimed to design, development and evaluation of a self-care Mobile app for COVID-19 patients not requiring hospitalization. Methods The design, development and evaluation the usability of the self-care and education mobile app for patients with COVID-19 disease were conducted in two main phases at 2021 in Northwest of IRAN; (1) Determine the features and capabilities and (2) Design, development and evaluation of self-care mobile App. JAVA programming languages and Android Operating System were used and selected to design and development of a mobile app. There were 25 participants who conducted evaluations of the mobile app’s usability and impact using the mobile health app usability a Questionnaire of User Interface Satisfaction was administered to assess the usability of the developed application. The results were analyzed via Excel 2013. Results The model of developing a mobile app as an Information System was the Waterfall model. The smartphone application based on a set of capabilities and features was designed and consists of two main parts: the login screen for user registration, and the main home menu. The user interface includes three main pages or activities; (a) Main Menu for quick access to all of the pages, (b) Symptom management and monitoring to monitor the signs and symptoms during the illness, and (c) Set Reminders and Alarms to notify patients. The users’ mean score of the application usability was calculated as 7.91 out of 9 indicating a good level of satisfaction. Conclusion This app can be a guideline and a useful tools for managing and monitoring symptoms, reminding medications, and implementing self-care instructions in outpatients. The authors suggest evaluating the efficacy and functionality test of mobile-based applications for COVID-19 in clinical trial studies.

Women health volunteers (WHVs) are a link between people and healthcare workers. Despite their key role in promoting community health, strategies are rarely designed to keep them volunteering. The aim of this research was to find successful strategies to overcome barriers to recruitment and retention of the volunteers in assigned activities. A three-round online national Delphi technique was used to ask the opinions of Iranian health volunteers' supervisors and the relevant researchers. At the first round, the participants were asked ten open-ended questions across four barriers: inadequate capability of the volunteers and trainers, inadequate acceptance of the volunteers, restrictive social norms, and organizational problems. At the second round, with the questionnaire consisting of closed-ended questions, the experts were asked to rank the feasibility of each strategy using a seven-point Likert scale. Items along with the feedback received from the second round were included in the third-round questionnaire. Strategies with a median of 6 or higher and with an interquartile range ≤1 were regarded to be feasible. Consensus was obtained on 100 of the 133 strategies. A mixture of improving group work, implementing motivation tactics, assessing the needs of people/WHVs, reforming policy, monitoring and evaluation of WHVs/trainers, mobilizing the community, empowering WHVs/trainers, rationalizing WHVs/trainers/people, improving intersectional collaboration, implementing problem-based approaches, allocating proper resources, appropriate recruitment of WHVs, using social networks, and information dissemination were found to be the effective strategies to overcome the barriers to active participation. The highest consensuses among experts were on implementing motivation tactics and mobilizing the community. It seems that community mobilization, incentives, and logistical supplies such as providing prizes and transportation facilities for volunteers are mechanisms that can help retain WHVs and also overcome barriers to their active participation.

Reminiscence has a positive role in improving memory performance. It may increase the attention of the older adults to themselves, helping them to cope with the crises and the process of aging. We aimed to investigate the impacts of memory recalling, sharing life experiences and stories confidently from the past on promoting numerous domains of quality of life (QoL), among institutionalized older people in the Ilam province of Iran. The study was carried out, using a quasi-experimental approach (a pre- and post-one group design). The statistical population consisted of all older people who were institutionalized in nursing homes. Based on inclusion and exclusion criteria, 43 potential participants were recruited, and the status of QoL was assessed, using the Iranian short-form health survey (SF-36) and face to face interviews. Then, eight sessions were designed and implemented. The participants expressed their memories such as bitter and sweet memories at various periods of life, and finally, the QoL of the participants was re-evaluated according to the same questionnaire, three months after the intervention. There was a significant difference between the scores of pre- and post-intervention in most of the sub-scales of QoL, including physical functioning, role limitations due to physical health and emotional problems, emotional well-being, social functioning, and general health. Reminiscence may, in certain circumstances, be an effective care option for people living in long-term care with the potential to impact positively on the QoL of residents.

BACKGROUND:Understanding the reasons for not getting the COVID-19 vaccine can help to increase acceptability and tackle vaccine hesitancy and consequently reach high coverage for this new vaccine. Using an ecological approach, the reasons for not getting the vaccine in the Iranian population was investigated.METHODS AND MATERIAL:This study was conducted from October to December 2021 on 426 participants who had not received the COVID-19 vaccine. The following subsets of questions were included in the questionnaire: intrapersonal level factors, interpersonal level factors, group and organization, and society and policy-making. Multivariable logistic regression was used, and the odds ratio (OR) and 95% confidence intervals (CIs) were estimated for vaccine hesitancy (dependent variable) according to the reasons for not getting COVID vaccine scores (independent variable) using multivariable logistic regression in 3 different models, including Model 0: unadjusted, Model 1: adjusted for age, gender, and underlying disease, and Model 2: adjustment for age, gender, underlying disease, education, place of living, income, marital status, and employment.RESULTS:A significant difference was found regarding gender between likely and not likely groups (P = 0.016). A significant association was observed between the vaccine hesitancy and interpersonal (unadjusted model: OR = 0.833 (CI: 0.738–0.942), P for trend = 0.003; model 1: OR = 0.820 (CI: 0.724–0.930), P for trend = 0.002; model 2: OR = 0.799 (CI: 0.703–0.909), P for trend = 0.001) and group and organization (unadjusted model: OR = 0.861 (CI: 0.783–0.948), P for trend = 0.002; model 1: OR = 0.864 (CI: 0.784–0.952, P for trend = 0.003; model 2:OR = 0.862 (CI: 0.781–0.951, P for trend = 0.003). There was no significant association between vaccine hesitancy and intrapersonal and society and policy-making (P > 0.05).CONCLUSIONS:We found that a high score of “interpersonal” and “group and organization” factors were associated with lower intention to COVID vaccine. Moreover, women had higher vaccination intentions than men.

Background: In this study, we aimed to evaluate the impact of the COVID-19 epidemic on the workload and mental health of Iranian medical staff using the General Health Questionnaire (GHQ-12) and NASA -Task Load Index (NASA-TLX) Questionnaire between March and April 2020, respectively. Methods: The present cross-sectional study was conducted from March 5th to April 5th, 2020. To evaluate the workload and mental health of participants NASA-TLX and GHQ-12 online questionnaires were distributed. Data were entered into software SPSS (Version 23) and T-test, ANOVA, Regression methods were used for data analysis. Results: Health workers who encountered COVID- 19 patients, were subjected to more task load compared to those who had no contact with COVID- 19 patients at the workplace (p<0.001). In terms of the subscale score of NASA-TLX, nurses had more scores in mental pressure, physical pressure, time pressure(temporal), and frustration compared to the other jobs (p<0.05). Moreover, nurses had significantly more workload compared to the other jobs. Conclusions: Type of job, the shift of work, educational level, and facing COVID-19 affected the score of NASA-TLX. NASA-TLX scores were higher in nursing compared to the scores of other health staff groups. The results of this study indicate that the scores of NASA-TLX and GHQ-12 among staff who had contact with COVID-19 patients were significantly higher than those who did not face COVID-19 patients. We suggested that a comprehensive assistance should be provided to support the well-being of healthcare workers especially nurses and healthcare workers who treated COVID-19 patients.