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Abstract Background Individual attitude is an essential component in facilitating people’s participation in adopting cancer screening behaviors. People’s attitudes toward cancer screening should be evaluated with a valid and reliable scale. Therefore, this study investigated the psychometric properties of the Persian version of the attitude scale for cancer screening. Method In this psychometric study, the Farsi version of the attitude scale for cancer screening was prepared from English to Farsi using the Backward-Forward method. Then content, face, and construct validity, plus reliability, was evaluated by Internal Consistency and Stability methods. Construct validity was investigated using Exploratory Factor Analysis with a sample of 246 adults referring to health centers in the south of Tehran. Data analysis was done using SPSS V24 software. Results All items received an acceptable Content Validity Ratio. The content Validity Index was confirmed for all items with a value greater than 0.79. In the qualitative review of content and face validity, all items were confirmed. Unlike the original version of the scale, which was a single factor, the results of Exploratory Factor Analysis indicated the existence of 2 factors explaining 63.84% of the total variance of the scale. Reliability based on Cronbach’s alpha coefficient for the whole scale was 0.88, and Intraclass Correlation Coefficient for the entire scale was calculated for scale reliability using the single-rating, absolute-agreement, 2-way mixed-effects method as 0.84. Conclusion This study confirmed the validity and reliability of the Persian version of the attitude scale for cancer screening with two factors (Willing Attitude and Unwilling Attitude). Therefore, it can be a suitable and valid scale to evaluate the attitude of the community for cancer screening.

Abstract Aim Health‐promoting behaviours are an important challenge in people living with HIV (PLHIV). Knowing PLHIV's perspective can be helpful for more effective health‐promoting behaviour planning. Therefore, the present study aims to explain PLHIV's perspective on health‐promoting behaviours based on Pender's health‐promotion model. Design A qualitative study with a directed content analysis approach. Methods Altogether, 17 PLHIV referring to the Behavioural Diseases Consultation and Control Center in Tehran, Iran and were selected through purposive sampling. The data were collected through semi‐structured individual interviews and the results were analysed through directed content analysis based on Pender's model. Data management was done by MAXQDA V10. Results Data analysis led to the extraction of 396 codes in 35 subcategories and 15 main categories in 6 constructs of Pender's model, including the perceived benefits (health assurance and optimal disease control), perceived barriers (insufficient knowledge and awareness, lack of motivation, adverse outcomes of the disease and socioeconomic status), perceived self‐efficacy (endeavouring to have a healthy lifestyle, responsibility for one's health and that of others), activity‐related affect (positive and negative feelings), the interpersonal influences (family, friends and relatives and social media) and situational influences (the resources available to the community and community's culture). Patient or Public Contribution In this study, the contribution of PLHIV was used and their perspectives were surveyed. The findings of this study can help policymakers and planners formulate health policies to select the most appropriate strategies and approaches to promoting effective healthy behaviours among PLHIV.

Abstract Background and Aims Health literacy (HL) is an essential determinant of health in children. Inadequate HL causes problems for individuals and society, such as more hospitalizations, medication errors, poor health, and higher mortality and health care costs. A valid and reliable scale is needed to measure this population's HL. This study evaluated the cross‐cultural adaptation and validation of the Persian version of the HL for School‐Aged Children (HLSAC) Scale. Methods In this methodological research, the HL scale of school‐aged children was translated from English to Persian using the Backward–Forward translation protocol. The content validity, face validity, construct validity (Exploratory Factor Analysis [EFA] and Confirmatory factor analysis [CFA]), plus reliability, were evaluated by Internal consistency and stability methods. Two hundred forty samples from south of Tehran were selected by multi‐stage sampling method to assess the construct validity. Data analysis was performed using SPSS v24 and Jamovi v2.2. Results A qualitative evaluation of face and content validity showed that experts and the target group approved all items on the scale. The results of EFA indicated the existence of one factor, explaining 47.17% of the total variance of the scale. The CFA results showed that the one‐factor model of the Persian version of the HL scale for children is almost acceptable. (χ2/df = 2.94, Root Mean Square Error of Approximation = 0.09, Normed‐Fit Index = 0.89, Tucker‐Lewis Index = 0.89, Comparative Fit Index = 0.92). Cronbach's alpha coefficient for the whole scale was 0.80, and the Intraclass Correlation Coefficient value for the whole scale was calculated as 0.78 using the single‐rating, absolute‐agreement, 2‐way mixed‐effects method. Conclusion The study validates the HLSAC Scale, affirming its suitability for assessing HL in Persian‐speaking child populations.

Healthcare workers (HCWs), as frontline soldiers in the fight against COVID-19, were more exposed to the risk of contracting this disease. In addition to facing psychological, social, and physical trauma and post-traumatic stress due to the corona pandemic, HCWs were also exposed to complications due to the use of personal protective equipment (PPE). The impermeable and confining nature of some PPE poses complications for HCWs that can endanger their physical health, while also affecting the quality of healthcare they provide. Among the complications of using PPE, respiratory problems are more worrisome than other complications. This article makes a suggestion of a breathing room (BR) to improve the health and performance of HCWs in caring for patients with infectious respiratory diseases. A debate on the strengths of the implementation of a BR in hospitals is described.

Abstract Background Providing long-term home care to older adults with chronic diseases may endanger the physical, mental, social, and spiritual health of caregivers and lead to care strain. Objective This study aimed to assess the relationship of caregiver strain with resilience and hardiness in family caregivers of older adults with chronic disease. Methodology This cross-sectional correlational study was conducted in 2020–2021 in Tehran. Participants were 230 family caregivers randomly recruited from 8 urban health care centers. Data were collected using a personal characteristics questionnaire, the Modified Caregiver Strain Index, Connor-Davidson Resilience Scale, Family Hardiness Index, and the data were analyzed by using SPSS 22 version. Pearson’s correlation coefficient was applied for data analysis. P-values ≤0.05 were considered significant. Results A total of 230 caregivers participated in the study. The mean age of participants was (46.65 ± 13.63) years and most of them were female (73.9%). Mean scores of caregiver strain, resilience, and hardiness in family caregivers were 16.23 ± 4.5, 39.89 ± 10.9, and 31.21 ± 7.79, respectively. Pearson correlation showed a significant and inverse correlation between caregiver strain and resilience (r = -0.310, P = 0.002), and also a significant and inverse relationship between caregiver strain and hardiness (r = -0.276, P = 0.001). Conclusion In this study, family caregivers had moderate caregiver strain, low resilience, and high hardness. Caregiver strain in family caregivers of older adults with chronic disease is an important health issue associated with resilience and hardiness. To promote health, effective adaptation to long-term care, and reduce caregiver strain, designing effective interventions to increase resilience and hardiness in family caregivers seems necessary.

Background & Aim: Cultural competence is one of the main components of health care. Attention to cultural competence is essential to reduce healthcare inequalities and identify potential for improving healthcare delivery. The aim of this study was to investigate cultural competence and its related factors in health care providers working in comprehensive health centers affiliated with Tehran University of Medical Sciences (TUMS). Methods & Materials: In this descriptive, cross-sectional study, 250 health care providers working in health centers affiliated with TUMS were selected using the convenience sampling method in 2020. The demographic characteristics form and the cultural competence scale for health workers (CCSN) were used to collect the data. Data were analyzed using descriptive and inferential statistical tests (t-test and ANOVA) through the SPSS software version 16 at a significance level of 0.05. Results: The mean total score of cultural competence in health care providers was 162.66±28.41 (range: 33-231). According to the findings, the mean score of cultural competence for all dimensions was desirable. The mean score of cultural competence had a statistically significant relationship with intra-ethnic marriage (P>0.005) and work experience (P=0.012) while no statistically significant difference was observed with other demographic variables. Conclusion: The study results showed that cultural competence in health care providers was at the desirable level. These results may be useful for managers and planners in the development and management of human resources and quality assurance of health services delivery.

Abstract Aim Cultural competence is a crucial component of nursing competency, and a valid and reliable scale is needed to measure it. This study was conducted to investigate the psychometric properties of the Persian version of the Cultural Competence Scale among Iranian clinical nurses. Design A methodological design was used. Methods The scale was translated into Persian, and its content, face and construct validity, and reliability were examined. Results Two items with a content validity ratio of 0.6 were removed. In the case of the content validity index, one item with a content validity index lower than 0.70 was removed. The mean content validity index for the scale was reported as 0.99. All 31 items with an impact score index higher than 1.5 were approved. The exploratory factor analysis revealed four factors explaining 59.92% of the total variance. Cronbach's alpha and the intraclass correlation coefficient were calculated at 0.95 and 0.94, respectively.

Abstract Background and aim The nature of pediatric settings may encounter nurses with more complicated ethical issues. A code of ethics guides nurses to act and decide ethically as a profession. Also, there is always a need to evaluate amount nurses adhere to this code of ethics, using valid and reliable instruments. This study aimed to develop a questionnaire and assess its psychometric properties to measure pediatric nurses' adherence to the code of ethics. Methods In this methodological research study, firstly, the questionnaire was developed based on an extensive review of the related literature and the theoretical framework of nursing ethics. A panel of experts (n = 12) reviewed the preliminary questionnaire qualitatively and quantitatively (using CVI and CVR). A conveniently selected sample of 156 nurses working in pediatric wards in three hospitals filled out the questionnaire. The psychometric process included determining sample size and data adequacy using KMO and Bartlette's test of sphericity; exploratory factor analysis (principal component method with Promax rotation); item analysis; and Cronbach's alpha coefficient. Also, the Interclass Correlation Index (ICC) value was determined using a two-week interval test–retest method on 30 eligible nurses. Results The CVI and CVR for the entire questionnaire were 0.85 and 0.78, respectively. The CVI and CVR of all items were reported higher than 0.59 and 0.8, respectively. Cronbach's alpha of the 28-items instrument was 0.92. Extracted six factors explained 65.31% of the total variance, and the values of the item correlations with the total questionnaire showed good internal consistency (0.52 to 0.90). The items of each factor were evaluated to determine the values they represent. Accordingly, the factors were named beneficence, nonmaleficence, human dignity, autonomy, informed consent, and honesty. The ICC value was 0.99. Conclusions The developed instrument is acceptable and has good reliability and validity. It can be used to assess the amount of pediatric nurses' adherence to the code of ethics by managers, teachers, and researchers.

Background: Arthritis is one of the most common diseases among the elderly, which is affected by adherence to treatment and self-efficacy. The purpose of this study was to determine relationship of adherence to treatment and self-efficacy among the elderly with arthritis. Methods: This descriptive–correlational study was conducted in 2019. Based on the convenience sampling method, 200 eligible elderly patients were recruited from three clinics affiliated with Tehran University of Medical Sciences in Tehran, Iran. Data were collected using the Modanloo adherence to treatment questionnaire and the perceived self-efficacy scale. Data were summarized using descriptive statistics (mean, frequency percentage, and standard deviation) and analyzed using inferential statistics (the Pearson correlation coefficient) in SPSS software (version 16). The statistical significance level was set at 0.05. Results: The mean age of patients was 67.97±5.32 years. The mean scores of self-efficacy and adherence to treatment among the elderly with arthritis were 119.8±35.3 and 123.88±23.04, respectively. There was a statistically significant correlation between adherence to treatment and self-efficacy (r=0.648). The strongest positive correlation (r=0.693) was observed in the subscale of adherence to the treatment, and the weakest positive correlation (r=0.228) was observed in the subscale of indecisiveness for applying treatment with pain. Conclusion: Because of the direct relationship between treatment adherence and self-efficacy in the elderly with arthritis, healthcare policymakers and planners should develop and implement programs to increase self-efficacy and treatment adherence among the elderly with arthritis and other chronic diseases.

Abstract Background and Aim Assessing health promotion among adolescents is vital to identify healthy and unhealthy behaviors and to evaluate health promotion interventions. This study aimed to determine the validity and reliability of the Persian version of the Short‐Form Adolescent Health Promotion scale. Methods Three hundred and twenty‐seven adolescents were recruited through a multistage sampling method in this methodological study. The original version of the Adolescent Health Promotion scale was translated from English to Persian using the Backward–Forward translation protocol. Then, the scale's validity and reliability, including the face, content, construct validity, and reliability indices, were evaluated. The statistical analysis was performed using SPSS software version 24. Results The mean CVI and CVR were 0.99. The exploratory factor analysis revealed four factors covering 42.57% of the total variance. The factor loading order of the items did not exactly correspond to the order obtained in the English version of the scale's validity and reliability analysis. The obtained factors called included: life appreciation, stress management, nutrition, and health responsibility. In the current study, both Cronbach's ɑ and the intraclass correlation coefficient were calculated at 0.84 and 0.99. Conclusion The Persian version of the Adolescent Health Promotion scale developed in the present study is acceptable for the validity of the content, face, and reliability. However, the construct validity of this scale should be checked in other samples.

Background: Health-promoting lifestyle (HPL) is a major health concern among adolescents. Family function (FF) has potential effects on adolescents’ lifestyle and health. Objectives: This study aimed to evaluate the correlation between FF and HPL among female adolescents. Methods: This correlational study was conducted from January to February 2020 on 356 female adolescent students randomly recruited through multistage cluster sampling from four public junior high schools in the south of Tehran, Iran in 2020. Data were collected using a personal characteristics questionnaire, the Adolescent Health Promotion Short Form, and the McMaster Family Assessment Device. Data analysis was performed through Pearson’s correlation coefficient, the one-way analysis of variance, the independent-samples t test, and the linear regression analysis. Results: The average age of adolescents was 14.16 ± 0.76 years. The total mean scores of participants’ HPL and FF were 75.36 ± 12.43 (in the possible range of 21–105) and 3.02 ± 0.37 (in the possible range of 1–4), respectively. There was a significant positive correlation between FF and HPL (r = 0.399, P < 0.001). Among demographic characteristics, adequacy of family income, and among dimensions, the problem-solving, behavioral control, roles, and affective involvement dimensions of FF were significant predictors of HPL, explaining 24.5% of its total variance. Conclusion: The mean HPL and FF were greater than the possible median scores. Also, adequacy of family income and FF were significant predictors of HPL among female adolescents. Healthcare authorities and policymakers are recommended to pay greater attention to FF in developing health-promoting programs for adolescents.

Health promotion is the process of enabling people to increase control over their health and its determinants, and thereby improve their health. Through the Ottawa Charter, World Health Organization (WHO) defined health promotion as “the process of empowering individuals to increase their control and improve their health”.1 WHO and the United Nations Educational, Scientific and Cultural Organization (UNESCO) have launched a new initiative called “Making Every School a Health Promotion School” through the development and promotion of global standards for health promotion in schools. The initiative will help more than 2.3 billion students and the WHO to achieve the motto of “one billion healthy lives” by the end of 2023.2 Today, 1.2 billion adolescents in the world make up more than one-sixth of the world’s population; also, more than 80% of them are teenagers and spend one-third of their time in school.2 Highlighting the issue of health for this group, especially the adolescents, is important because their physical, mental, and social health guarantees the current and future health status of the society. Therefore, the purpose of school health is to provide, maintain, and improve the physical and mental health of adolescents and ultimately communities. Adolescents need to know how to take care of themselves and what measures to take for their health.3 Given that the WHO aims to promote health among children and adolescents, special emphasis should be placed on the implementation of health promotion programs. Teaching based on the appropriate approaches to promote health and to care for adolescents will improve the health of the community. In addition, it can help reduce the financial costs of chronic diseases and their growing prevalence.4 For this purpose, the Health and Welfare Office of the Ministry of Education in Iran in cooperation with the Education and Health Promotion Office of the Ministry of Health and Medical Education (MOHME) has signed an executive agreement in the form of a program for student health ambassadors. This program was designed to provide grounds for mobilizing students and to provide health ambassadors with a plan to make efforts to comprehensively implement biological and physical training. The program is based on the peer education approach, which is a coherent program designed to build an effective peer network to encourage students to improve their health. Accordingly, 10% of the diligent, interested, and volunteer students in the school and also at least one qualified student from each class will be selected by the healthcare provider or the coordinator. They will be provided with a self-care booklet and a healthy lifestyle. Then, the healthcare providers in each school are asked to provide the necessary information to the health ambassadors through holding special training sessions (group discussion, workshop, panel, and role play). Consequently, they should transfer health information to their peers at school. Student Health Ambassadors are referred to those volunteer students who are interested in group activities in various fields of health (physical, psychological, social, and spiritual). They should be able to play a pivotal and effective role in promoting health and self-care not only in schools, but also among their families. This is a newly established program that was endorsed in 2016-17. The “Health Ambassadors” program was developed for the elementary and secondary schools in urban and rural areas in cooperation with the Office of Health for Population, Family and School and Education and Health Promotion Office in the MOHME.5 This program is also faced with many challenges, indeed. Given the need for an educator and the establishment of an intimate and friendly relationship between the educator and the audience as the main principles of health education, it seems that the presence of a health educator or a school nurse is one of the priorities and underlying foundations of the project. Therefore, the appropriate physical and human context for health education and promotion should be provided to be used efficiently. Despite the measures taken, the “Health Ambassadors” program still seems to be in the pilot stage; however, it has been welcomed by many schools and students as a health ambassador. Developing a sense of responsibility for one’s health as well as the health of others is one of the main objectives of this program. Therefore, after evaluating and resolving its challengesas a start-up project, the “Health Ambassadors” project can have significant short-term and long-term consequences. Therefore, developing a plan such as the “Student Health Ambassadors Project” is a dynamic way of thinking in pursuit of sustainable development in society. It is noteworthy that such a proposal can be implemented in other countries as well. However, it seems that highlighting the presence of an expert in health education and promotion is one of the most important issues that should be taken into account by the executives in order to improve the implementation of the Health Ambassadors Project. Community health nurses with sufficient knowledge about the developmental stages of adolescents, principles of school health, nursing procedure, communication process, and educational methods can provide adolescents with the necessary health education in schools. Accordingly, we recommend employing community health nurses in schools to achieve more desirable results in terms of the implementation of school health programs including the “Health Ambassadors Project” in the future. Consequently, this will lead to better health education as well as the promotion of healthy behaviors.