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Haleh Heizomi,1 Kamiar Kouzekanani,2 Mohammad Asghari Jafarabadi,3,4 Hamid Allahverdipour5 1Department of Health Education and Promotion, Tabriz University of Medical Sciences, Tabriz, Iran; 2College of Education and Human Development, Texas A&M University-Corpus Christi, Corpus Christi, TX, USA; 3Road Traffic Injury Research Center, Tabriz University of Medical Sciences, Tabriz, Iran; 4Department of Statistics and Epidemiology, Faculty of Health, Tabriz University of Medical Sciences, Tabriz, Iran; 5Research Center of Psychiatry and Behavioral Sciences and Department of Health Education and Promotion, Tabriz University of Medical Sciences, Tabriz, IranCorrespondence: Hamid AllahverdipourResearch Center of Psychiatry and Behavioral Sciences and Department of Health Education and Promotion, Tabriz University of Medical Sciences, Tabriz 14711, IranTel/Fax +98-411-3344731Email allahverdipourh@tbzmed.ac.irBackground: Due to the lack of an instrument to measure mental health literacy among Persian/Farsi speaking people, this study was conducted to examine the psychometric properties of the Persian version of the Mental Health Literacy Scale (P-MHLS).Participants and Methods: The 2019 cross-sectional study with 992 participants was conducted in Tabriz, Iran. Exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) were performed to establish the construct validity of the P-MHLS. The internal consistency/reliability was estimated by computing Cronbach’s coefficient alpha. Feasibility of the scale was examined and item response theory (IRT) models were applied to characterize the test items.Results: An exploratory factor analysis of data resulted in five factors, which included 30 of the 35 items and accounted for 42.00% of the variance. The construct validity of the 5-factor model was supported by the results of our confirmatory factor analysis. The factors were the 1) ability to recognize mental disorders, 2) confidentiality of mental health practitioners, 3) skills of mental health information seeking, 4) beliefs about mental illnesses, and 5) attitudes toward patients with mental illness.Conclusion: The study provides initial support for the use of the MHLS among Persian/Farsi speaking adults to assess mental health literacy.Keywords: mental health literacy, reliability, validity

Hamid Allahverdipour,1 Mohammad Asghari Jafarabadi,2,3 Andrea Burri,4 Zeinab Javadivala5 1Research Center of Psychiatry and Behavioral Sciences, Department of Health Education and Promotion, Tabriz University of Medical Sciences, Tabriz, Iran; 2Road Traffic Injury Research Center, Tabriz University of Medical Sciences, Tabriz, Iran; 3Department of Statistics and Epidemiology, Tabriz University of Medical Sciences, Tabriz, Iran; 4Institute for Sex Counselling and Sexual Sciences (ISCSS), Zurich, Switzerland; 5Department of Health Education and Promotion, Tabriz University of Medical Sciences, Tabriz, IranCorrespondence: Zeinab JavadivalaDepartment of Health Education and Promotion, Tabriz University of Medical Sciences, Tabriz 14711, Iran+98-411-3344731Email zjavadivala791@gmail.comObjective: Menopause-related symptoms can strongly affect health-related quality of life (HRQOL) in most peri-menopausal women. The aim of the present study was to explore the psychometric properties of a culturally adapted and translated Persian version of the Menopause Rating Scale (MRS).Study Design: The study was conducted on a random sample of 270 middle-aged women (age range 40– 60 yrs) selected from 25 urban health service centers across Tabriz, Iran. Content validity was evaluated by a panel of 11 experts. Construct validity was assessed by exploratory factor analyses with Varimax rotation and principal axis factoring extraction method and by confirmatory factor analyses. Internal consistency and test–retest reliability were assessed with Cronbach’s alpha and intra-class correlation coefficient (ICC), respectively. In addition, the feasibility of the measure was judged based on ceiling and floor effects.Results: Content validity of the measure was good with a mean content validity index (CVI) and mean content validity ratio (CVR) of 0.88 and 0.94, respectively. Exploratory factor analyses identified three factors accounting for 47.69% of the variance. Confirmatory factor analyses found the original three-factor model to have the best fit to the data. Cronbach’s alpha coefficient (0.85) and the test–retest reliability score (0.91) indicated good internal consistency.Conclusion: The Persian version of the MRS demonstrated excellent reliability and validity. It can therefore be used in both clinical and research settings to assess menopause-related symptoms and associated quality of life.Keywords: Menopause Rating Scale, psychometric, menopause, Persian

Ali Nezhadali, 1 Towhid Babazadeh, 2 Haidar Nadrian, 3 Hamid Allahverdipour 4 1Department of Health Education and Promotion, Faculty of Health Sciences, Tabriz University of Medical Sciences, Tabriz, Iran; 2Department of Public Health, Sarab Faculty of Medical Sciences, Sarab 14711, Iran; 3Department of Health Education & Promotion, Tabriz University of Medical Sciences, Tabriz 14711, Iran; 4Research Center of Psychiatry and Behavioral Sciences, Department of Health Education & Promotion, Tabriz University of Medical Sciences, Tabriz 14711, IranCorrespondence: Hamid AllahverdipourHealth Education & Promotion Research Center of Psychiatry and Behavioral Sciences, Department of Health Education & Promotion, Tabriz University of Medical Sciences, Tabriz 14711, IranTel/Fax +98-411-3344731Email allahverdipourh@tbzmed.ac.irBackground: Despite the improvement of living standards and public health as well as conducting the specific programs based on pediculosis control guidelines, Head Lice Infestation (HLI) is still a worldwide health concern. The purpose of this study was to investigate the cognitive factors associated to school-age children’s HLI among mothers in an urban community.Subjects and Methods: In this cross-sectional study, a multi-stage cluster random sample of 619 mothers of students in elementary schools of Chaldoran County, located in North-West of Iran, was recruited to participate in the study. Data were collected applying a set of questionnaires including socio-demographic and cognitive-behavioral factors, including Pediculosis Preventive Behaviors (PPBs), HLI knowledge, threat appraisal, as well as HLI prevention perceived self-efficacy, response efficacy, and perceived collective family efficacy.Results: Statistically significant differences were found in the children’s HLI by their mother’s age and performance in PPBs (p-value=0.001). Hierarchical multiple linear regressions were performed with PPBs as outcome variable. According to their natures, the predictors for this outcome variable were classified in two different blocks. Demographic characteristics (p > 0.05), and cognitive constructs (p< 0.001) explained 9% and 21.1% of the observed variance in PPBs, respectively. Pediculosis was found as an epidemic among the students, particularly female students, of Chaldoran County, which call for action by health stakeholders and policymakers.Conclusion: The healthcare providers are recommended to develop HLI prevention programs, within which the mothers and their school-age children as well as school mangers and public places’ employers are considered as the core target groups for interventions. Besides PPBs, response efficacy and perceived collective family efficacy to perform the behaviors should be considered as the core categories while designing such prevention programs.Keywords: pediculosis, family health, school health, head lice, collective efficacy

Hassan Mahmoodi,1 Fatemah Jalalizad Nahand,2 Abdolreza Shaghaghi,2 Shahin Shooshtari,3 Mohammad Asghari Jafarabadi,4 Hamid Allahverdipour2 1Social Determinants of Health Research Center, Research Institute for Health Development, Kurdistan University of Medical Sciences, Sanandaj, Iran; 2Department of Health Education and Health Promotion, School of Public Health, Tabriz University of Medical Sciences, Tabriz, Iran; 3Departments of Family Social Sciences and Community Health Sciences, University of Manitoba; St. Amant Research Centre, Winnipeg, Manitoba, Canada; 4Department of Epidemiology and Biostatistics, School of Public Health, School of Public Health, Tabriz University of Medical Sciences, Tabriz, Islamic Republic of IranCorrespondence: Hamid AllahverdipourDepartment of Health Education & Promotion, Faculty of Health Sciences, Tabriz University of Medical Sciences, Attar-e-Neyshabouri Street, Golgasht Street, Tabriz 5165665931, IranTel +98 41 333 44 731Email allahverdipour@gmail.comBackground: Life course gender-role traits and social stereotypes could affect the pattern of medication adherence in old age.Objectives: The main purpose of this study was to investigate gender based cognitive determinants of medication adherence in a sample of older adults who suffer from at least a chronic condition.Methods: In this cross-sectional design, 455 older adults participated from five health centers in Tabriz city, Iran from June to August 2017 using a random sampling method. Next, required data about medication adherence, knowledge and beliefs about prescribed medications, perceived self-efficacy in medication adherence, illness perception, and reasons for medication non-adherence were gathered using a structured written questionnaire through face-to-face interviews with the attendees.Results: Low medication adherence was reported by 54.5% of the study participants. Perceived self-efficacy for medication adherence (OR = 1.04; 95% CI: 1.00, 1.08) and medication adherence reason (OR = 0.96; 95% CI: 0.92, 0.99) were two identified strong predictors of medication adherence among the studied older men. Illness perception (OR = 1.02; 95% CI: 1.00, 1.02) and beliefs toward prescribed medication (OR = 0.95; 95% CI: 0.93, 0.98) were both recognized as the significant predictors of medication adherence in the older women subgroup.Conclusion: Gender based variations were noted regarding the medication adherence in the studied sample and attributes of cognitive function were the main pinpointed elucidating parameters for the non-conformity. The explicit cognitive processes must be considered in care provision or interventional programs that target medication adherence in older adults.Keywords: chronic disease, Iran, medication regimen adherence, older adults

Hamed Rezakhani Moghaddam, Hamid Allahverdipour, Hossein Matlabi Department of Health Education and Promotion, Faculty of Health Sciences, Tabriz University of Medical Sciences, Tabriz, Iran Background: 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.Subjects and methods: 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.Results: 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.Conclusion: 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. Keywords: health volunteers, Delphi technique, consensus, community health, retention strategies

Leila Savari,1 Maryam Shafiei,2 Hamid AllahverdiPour,1 Hossein Matlabi1 1Department of Health Education and Promotion, Faculty of Health Sciences, Tabriz University of Medical Sciences, Tabriz, Iran; 2Department of Educational Planning and Administration, Shiraz University, Shiraz, Iran Purpose: Applying the Health Education Curriculum Analysis Tool (HECAT), the third-grade curriculum was assessed in accordance with health-related items.Methods: A multimethod research was used to investigate the student textbooks and three modules including healthy eating, physical activity, and safety. Based on purposive sampling, curriculum committees were made up of teachers, elementary school principals, members of the parents–teachers’ associations, and health care experts.Results: Data obtained from the group discussion were analyzed based on the conventional content analysis approach. All modules received coverage percentages of

The prevalence of substance abuse among adolescents from low- and middle-income countries is increasing drastically and requires immediate intervention. The objective of this longitudinal quasi-experimental panel study was to design and implement a skill-based intervention to prevent and reduce substance use among urban adolescents who attended 2 randomly selected high-schools in Tehran, Iran. One-year post intervention data show that substance abuse, knowledge, attitudes, peer resistance skills, level of self-control, self-efficacy, and perceived susceptibility among intervention group were significantly improved, whereas level of self control and attitudes against substance abuse among the control group deteriorated. To efficiently prevent substance abuse among youth primary preventive interventions should be implemented before onset of substance abuse to improve resistance skills and provide adolescents with information and skills needed to develop anti-drug norms. [ABSTRACT FROM AUTHOR]

Objectives: The main purpose was to assess associations between HBM variables and participation in cervical cancer screening programs in a sample of Iranian women.Methods: A total of 333 married women of childbearing age were recruited with cluster sampling. The study was conducted from spring 2002 to spring 2003 and a self-report questionnaire and structured interview were designed to measure the four HBM constructs and Iranian women's knowledge about Pap smear screening.Results: A total of 68.5% reported having undergone at least one Pap test. Women were more likely to participate in Pap smears when they had access to knowledge about cervical cancer and screening programs. Furthermore, the perceived benefit and barrier variables of the Health belief model were two factors related to participation in Pap smear testing.Conclusions: Health care professionals must provide women with more information about cervical cancer and the benefits of participating in cervical cancer screening programs. [ABSTRACT FROM AUTHOR]

Background Female adolescents have a higher prevalence of psychological disorder especially in the developing countries and tradition communities. Adolescence is due to accompanied with puberty and transitional age are suffering of mental health problems. Main purpose of this study was to assess the effectiveness of “psychological well-being promotion program” on the mental health status of female high school students in Iran. Methods The non equivalent group, pretest-posttest design was applied to conduct this study from November 2013 to December 2013 in Tabriz, Iran on 289 participants (148 in the experimental and 141 in the control groups). One of the sub-regions of Tabriz city was chosen randomly and within the area two high schools were selected with almost same environmental conditions randomly as the experimental and control groups. Participants who were in the 9th grade were recruited randomly and classified in the both groups of intervention and control. After diagnostic evaluation, the planned program was performed based on two approaches of: (1) environmental changes (playing music during breaks, sports competitions, and interior decorating classes); (2) stress management skills development program. Results The results were indicative of the intervention's positive impact. Based on the findings, the mean scores of the happiness significantly increased in the intervention group ( P ≤ 0.001). The mean scores of the stress significantly decreased in the intervention group ( P ≤ 0.001). Conclusion The study results suggested that implementation mental health promotion program improved mental health indices which indicates effectiveness of comprehensive school health programs. [ABSTRACT FROM AUTHOR]

Abstract Background No study has ever explored the prevalence and correlates of video game playing among children in the Islamic Republic of Iran. This study describes patterns and correlates of excessive video game use in a random sample of middle-school students in Iran. Specifically, we examine the relationship between video game playing and psychological well-being, aggressive behaviors, and adolescents' perceived threat of video-computer game playing. Methods This cross-sectional study was performed with a random sample of 444 adolescents recruited from eight middle schools. A self-administered, anonymous questionnaire covered socio-demographics, video gaming behaviors, mental health status, self-reported aggressive behaviors, and perceived side effects of video game playing. Results Overall, participants spent an average of 6.3 hours per week playing video games. Moreover, 47% of participants reported that they had played one or more intensely violent games. Non-gamers reported suffering poorer mental health compared to excessive gamers. Both non-gamers and excessive gamers overall reported suffering poorer mental health compared to low or moderate players. Participants who initiated gaming at younger ages were more likely to score poorer in mental health measures. Participants' self-reported aggressive behaviors were associated with length of gaming. Boys, but not girls, who reported playing video games excessively showed more aggressive behaviors. A multiple binary logistic regression shows that when controlling for other variables, older students, those who perceived less serious side effects of video gaming, and those who have personal computers, were more likely to report that they had played video games excessively. Conclusion Our data show a curvilinear relationship between video game playing and mental health outcomes, with "moderate" gamers faring best and "excessive" gamers showing mild increases in problematic behaviors. Interestingly, "non-gamers" clearly show the worst outcomes. Therefore, both children and parents of non-game players should be updated about the positive impact of moderate video gaming. Educational interventions should also be designed to educate adolescents and their parents of the possible harmful impact of excessive video game playing on their health and psychosocial functioning.

Background: Home-based care is affordable due to population aging, increased chronic disease, and higher hospitalization costs. The objective was to evaluate home-based supportive and health care services provided to older adults and identify possible associations between activities of daily living (ADLs), instrumental ADL (IADLs) classifications, sociodemographic variables, clinical characteristics, and perceived social support among older adults., Materials and Methods: In this cross-sectional study, 700 people aged 60 years and older were selected by stratified cluster sampling. Areas of Tabriz City were selected as clusters, and 55 comprehensive urban health centers were selected as stratifies. Chi-square, Pearson's and Spearman's tests, and multiple linear regression were used for statistical analyses. Statistical analysis was performed using the Statistical Package for Social Sciences (SPSS 24.0, SPSS Inc., Chicago, USA). The study instrument included demographic characteristics of older adults and caregivers, health services provided at home, and two valid questionnaires, including the KATZ index of independence in (instrumental) activities of daily living and a multidimensional scale of perceived social support. Scores on scales and demographic variables were collected during telephone interviews. The study lasted from April 25, 2022, to October 30, 2022., Results: A high level of perceived social support was 56.6%. The study found that 51.3% of participants had family caregivers. Most participants had ADL independence (85.4%), while 22.9% and 24.3% were dependent and needed assistance with IADL, respectively. Women had a lower ADL score and a higher IADL score than men ( P < 0.05). The obtained results of multiple regression analysis revealed a negative and significant association between unemployment, illiteracy, increasing age, five and more medications, and ADL and IADL dependency ( P < 0.05)., Conclusion: Empowering older adults to reduce dependency, and designing a formal home-based care system is recommended., Competing Interests: There are no conflicts of interest., (Copyright: © 2024 Journal of Education and Health Promotion.)

We aimed to develop and test the psychometric properties of the Perceived Barriers of Mammography Scale (PBMS-23). Based on a mixed method design researchers generated item pool through qualitative data and literature review and next, 500 women ages 40 to 69 years completed the questionnaire. Based on exploratory and confirmatory Factor Analysis, 23 items, researchers revealed eight domains of fate and destiny, breast conflict, defense avoidance, inconveniences/difficulties of mammography screening, contrasting/competing priorities, fear, distrust of mammography, and lack of knowledge with appropriate fitness for the data. PBMS-23 is valid and reliable instrument for assessing perceived barriers of mammography.

Background: The COVID-19 pandemic has brought about far more stressful conditions for people worldwide. As a vulnerable group, older adults have suffered various psychological problems, such as stress, because of this pandemic and have applied various strategies to cope with the dire consequences. This study aimed to synthesize qualitative evidence regarding coping strategies for stressful situations among older adults throughout the COVID-19 pandemic., Methods: We searched electronic databases, including Scopus, Embase, PubMed, ProQuest, and the Cochrane Library, based on PRISMA standards. The protocol of this systematic review was registered on the PROSPERO (registration code: CRD42022364831). All relevant English-language articles published between 2019 and November 10, 2022, were searched. We reviewed the reference lists for all the included studies and key references. Two reviewers conducted screening, data extraction, and quality appraisal independently, with disagreements resolved by consensus with all team members. The Joanna Briggs Institute (JBI) checklist was used to assess the quality of studies. A thematic synthesis of the selected studies was conducted., Results: We included 13 studies in our review. Most studies were conducted in the early months of the COVID-19 pandemic. The stress caused by the COVID-19 pandemic was classified into six categories: health management challenges, stress caused by quarantine, economic challenges, media and bad news stress, virus threats, and challenges related to the use of communication technologies. The strategies used by older adults to cope with these challenges were categorized into five categories: protective strategies, avoidance strategies, maintaining social connections, meaning-based strategies, and fun strategies. This research showed that depending on the situation and conditions, older adults use various strategies to cope with COVID-19., Conclusion: Older adults experience much stress during the COVID-19 pandemic. In most cases, older adults can cope with these challenges with simple strategies from previous experiences and learnings. Older people require educational interventions in some cases, such as those involving communication skills. A better understanding of older adults coping strategies may enable policymakers to develop more effective policies and manage the problems of older adults in post-COVID situations., (© 2023. BioMed Central Ltd., part of Springer Nature.)

Background: Proper elucidation of medication non-adherence reasoning especially in older adults might pave the way for an auspicious therapeutic outcome. The main aim of this study was to develop and psychometrically test the Medications Non-adherence Reasoning (MedNARS) questionnaire for application in research and probably practice settings., Methods: A mixed methods design was utilized to develop the MedNARS. The item pool was mainly generated based on a qualitative query and literature review. The expert panel approved version of the MedNARS was psychometrically assessed on a convenience sample of 220 older patients with chronic disease. The internal consistency, test-retest reliability, content and face validity of the scale were appraised and its construct validity was assed using exploratory and confirmatory factor analyses., Results: A nine-item version of the MedNARS was drafted based on the classical item analysis procedures and its estimated internal consistency measure of the Cronbach's alpha (0.85) and test-retest reliability (0.96) were in the vicinity of acceptable range. The exploratory factor analysis (EFA) output revealed a unidimensional structure for the MedNARS and the conducted confirmatory factor analysis (CFA) indicated an acceptable data fit for the extracted one-factor model. The goodness of fit indices were as the followings: χ 2 /df=1.63(90% CI: 0.02 to 0.11), root mean squared error of approximation (RMSEA)=(0.07), comparative fit index (CFI)=0.95, Tucker-Lewis index (TLI)=0.93 and standardized root mean squared residual (SRMSR)=(0.05)., Conclusion: The study findings were indicative of MedNARS's applicability and feasibility for use in assessment of medication non-adherence reasoning among the elderly patients with chronic diseases. The MedNARS as a brief and elder-friendly instrument can be applied both in research and practice settings to enhance efficiency, safety, and health outcomes of the therapeutic recommendations., Competing Interests: Hamid Allahverdipour is the editor-In-chief, Abdolreza Shaghaghi and Mohammad Asghari-Jafarabadi are also associate editors of the Health Promotion Perspectives. Other authors declare no conflicts of interest in performing this research and preparation of the final report., (© 2023 The Author(s).)

Background: Due to the increasing Iran's aging population, designing a home care model is necessary. However, the data on designing the home care model for elderly adults among developing countries are limited. This study will be carried out to develop a formal home-based care model for elderly adults in Iran., Methods: This multi-method study will include three phases: First, Mixed-methods sequential explanatory study including two steps: One, survey to determine the prevalence of dependence on formal and informal caregivers among people aged ≥ 60 years living in Tabriz metropolis; and two, content analysis approach includes face-to-face, semi-structured interviews with the older adults receiving formal care at home, their caregivers and relevant key informants on the characteristics of care and caregiver, challenges and expectations of standard care. In phase 2, a scoping review will be used to find out the components of home care in other countries, such as care provider organization, caregivers training, and financing. PubMed, Scopus, Web of Science, EMBASE, Google scholar databases and grey literature will be run to retrieve relevant evidence using proper MeSH terms. In phase3, the triangulation method (using the results of the previous phases, reviewing national upstream documents and the focus group discussion) will be done to reach consensus and design the initial model for the Iranian context. In the following, a Delphi study will be conducted on the validation and feasibility of the developed model., Discussion: The current health infrastructure in Iran is focused on caring for younger people, despite the near future population aging. Most studies have addressed the challenges of geriatric care, but no study has addressed the various dimensions of home care in Iran and how to provide this service to elderly adults. Providing a comprehensive model of home care for the elderly can improve the quality of life and satisfaction of the elderly and their caregivers., Competing Interests: NO authors have competing interests., (Copyright: © 2023 Mobasseri et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Potentially inappropriate prescribing (PIP) is a major public health concern with several undesirable health consequences for older adults. In this overview, we aimed to map and gather information from existing literature to provide a better insight into the prevalence of PIP among community dwellers. Electronic databases were searched from their inception to April 2022. The quality of the included systematic reviews (SRs) was assessed using the assessment of multiple systematic reviews checklist. The degree of overlap within the SRs was also evaluated (2% overlap). All SRs on the prevalence of PIP in older individuals in community settings were included, and a narrative approach was used to synthesize data. Nineteen SRs comprising 548 primary studies met the inclusion criteria, and the average quality of the included SRs was moderate. More than half (50.5%) of the primary studies were conducted in Europe, followed by the United States (22.8%), and Asia (18.9%). Thirty different criteria were used in the primary studies to estimate the prevalence of PIP. The most widely used criteria were those presented in Beers (41.8%) and STOPP (Screening Tool of Older Persons' Prescriptions)/START (Screening Tool to Alert to Right Treatment) (21.8%) criteria. Benzodiazepines, nonsteroidal anti-inflammatory drugs, and antidepressants were the most frequently reported PIPs. A considerable variation in the prevalence of PIP ranging from 0% to 98% was reported by SRs. However, there is a high degree of uncertainty regarding the extent of PIP in community settings. To identify knowledge-to-action gaps, SR authors should consider the differences in prevalence of PIP according to settings, applied tools, data sources, geographical areas, and specific pathologies. There is also a need for primary and SR studies from low- and middle-income countries regarding the prevalence of PIP.

Available evidence indicates insufficient knowledge about the status of andropause and sexual quality of life among Iranian older men. The study aimed to investigate the prevalence of andropause and its relationship with sexual quality among older adults. This descriptive-analytical study was conducted among 576 older people referred to urban health centers in Mashhad, Iran. The eligible samples were selected through the cluster sampling method. To collect data, the male andropause symptoms' self-assessment questionnaire and the sexual quality of life-male were used. Forty-seven of the respondents ( n = 271) were diagnosed with a "moderate" level of andropause. A strong negative correlation was identified between the sexual quality of life and the severity of andropause ( r = -.366, p < .001). Sexual quality of life and andropause was also affected by age, marital status, health status, and exercise. Thirty-six percent of the changes in the quality of sexual life of older men were influenced by the independent variables (adjusted R 2 = .36; R 2 = .40; R = .63). The findings indicated that andropause has highly prevailed among the participants. There was a meaningful association between andropause and sexual quality of life among older men. Further studies are recommended to investigate sexual orientation qualitatively and to discover other factors influencing andropause among adult men.

Background: There is a great need for a valid hearing loss measurement tool in the Persian language to help identify hearing handicaps and potential communicational difficulties among Persian-speaking older adults. The present study aimed to validate and adapt the original English version of the Hearing Handicap Inventory for the Elderly (HHIE) into the Persian language., Methods: A tool development study was designed and data were collected from August to November 2019 in Tabriz, Iran among the older adults aged 60 years and above whose hearing loss had been confirmed by audiometry. The construct validity was assessed using Confirmatory Factor Analysis (CFA). The reliability of the tool was calculated by internal consistency and test-retest reliability. The statistical analysis was performed using SPSS 26.0 (SPSS and STATA 14)., Results: The CFA was conducted to examine the construct validity of the HHIE-S. According to the results, the model fit indices were acceptable (TLI = 0.93, CFI = 0.97, RMSEA = 0.07 (90% CI: 0.04 to 0.10), and SRMR = 0.03). Cronbach's alpha coefficient (0.85) and the test-retest reliability score (0.73) indicated good internal consistency., Conclusion: The results showed that HHIE-S is a valid and reliable tool for assessing hearing handicaps among Persian-speaking and Iranian older adults., Competing Interests: Declaration of Competing Interest The authors declare they have no conflict of interest., (Copyright © 2022. Published by Elsevier Inc.)

Introduction: Mild cognitive impairment (MCI) is a progressive age-related condition caused by physiological and structural changes in the brain, such as neurodegeneration and hypometabolism. Transcranial photobiomodulation (tPBM) is a neuromodulation technique that improves brain metabolism and oxygenation by irradiating red to near-infrared light on a specific area of the head. This study aimed to investigate the effect of multi-session tPBM on the cognitive capacities and attentional function of older women with MCI., Material and Methods: In this randomized controlled trial, 42 older women with MCI were randomly assigned to 2 equal groups: real and sham. The mini-mental state examination (MMSE) and the attentional Go/No-Go task were used to examine the patients. On the right frontal-pole of the cortex, 5 sessions of 850 nm tPBM were given. Re-examinations were conducted on the participants. For the Go/No-Go task, the reaction time to the target (RTT), the percentage of correct trials (PCT), and the efficiency score (ES) were measured., Results: The findings revealed a significant interaction between group × time for MMSE ( F (1, 40) = 20, p < 0.001, h 2 = 0.33), and the post-hoc paired-samples t -tests revealed a substantial rise in the mean MMSE in the real group ( t = 15.9; p = 0.001; d = 9.3). Additionally, for ES ( F (1, 40) = 19, p < 0.001, h 2 = 0.32), RTT ( F (1, 40) = 17, p < 0.001, h 2 = 0.38), and PCT ( F (1, 40) = 13, p < 0.001, h 2 = 0.31), a significant group × time interaction was discovered, and post-hoc paired-samples t -tests revealed a significant improvement in attention performance of the real group for increases in the mean of ES ( F (1,40) = 20, p < 0.001, h 2 = 0.33), ( t = 5.3, p < 0.001, d = 0.034), decreases in the mean of RTT ( t = 4.8; p = 0.001; d = -37.4), and increases in the mean of PCT ( t = 2.67; p = 0.015; d = 6.3)., Conclusions: According to the findings of this study, tPBM had a positive effect on older people's attention and cognitive abilities., Competing Interests: The authors report no conflict of interests., (Copyright © 2022 Termedia.)

Introduction: Isolation and self-quarantine can expose individuals, particularly older people, to cognitive and physical decline. Due to a reduction in their musculoskeletal and neural flexibility, older adults are more likely to be affected by quarantine limitations. This study aimed to investigate the effect of self-quarantine on cognitive and balance performance of older women during the COVID-19 outbreak., Material and Methods: In a convenience sampling method, a total of 75 older adult women were recruited in this ex post facto study. The mini-mental state exam, single leg stance test, and timed up and go test were used to assess cognitive functions, static, and dynamic balance, respectively. Fall risk was measured by the Johns Hopkins assessment tool. Evaluations were performed before and after 7 months of quarantine due to the COVID-19 outbreak (November 2019 - June 2020), in which volunteers were at the lowest level of physical and social interaction., Results: No significant difference was observed in the mean static balance performance of the older adult women between the baseline and quarantine phases [ p = 0.095, t (df) = -1.69]. The dynamic balance performance [ p < 0.001, t (df) = 5.6] and cognitive status ( p < 0.001, t = -7.4) decreased and the fall rate increased [ p < 0.001, t (df) = 7.35] after 7 months of quarantine., Conclusions: It seems that self-quarantine can cause a decline in cognitive functions and dynamic balance performance of older women. It implies that the decrease in social interactions and physical activities caused by the limitations of self-quarantine put individuals at greater risk of cognitive impairment and increase their falling rate by impairing dynamic balance., Competing Interests: The authors report no conflict of interest., (Copyright © 2022 Termedia.)

Identifying retained activity participation to old age can improve age-related changes in balance and cognition function. Subjects ≥ 60 years were enrolled in this study. Balance and Cognitive function include working memory, executive function, and sustained and divided attention was evaluated with “Fullerton advanced balance”, “n-back”, “Wisconsin card sort”, “sustain and divided attention test”, respectively. In addition, retained activity participation was measured using the Activity Card Sort questionnaire. The univariate and multivariate regression analyses of different domains of retained activity participation were used as independent variables, including instrumental activity, low-effort leisure, high-effort leisure, and social activity on balance and specific domains of cognition. Seventy-seven subjects (65.3 ± 4.4 years, 61% female) were included. About 47% of older adults had a college education, 32.3% had a diploma, and 20.7% had elementary−middle education. These results show that retained instrumental activity had a relationship with working memory (β = 0.079, p < 0.05). In addition, we found that retained high-effort leisure activity can increase balance, divided attention, and executive function score (β = 0.1, β = 0.05, β = 0.02, p < 0.05). Moreover, there was a positive relationship between retained low-effort activity and sustained attention (β = 0.08, p < 0.05). In addition, the coefficient of determination (R2) for balance, working memory, executive function, sustained, and divided attention were 0.45, 0.25, 0.13, 0.11 and 0.18, respectively. The study suggests that retained activity participation types may have various effects on balance and some selective cognitive components in older people.

Background: Early Marriage (EM) and associated Stressful Life Events (SLEs) and consequences such as psychological and physical well-being issues can lead to suicide and suicide attempts (SA). The study aimed to investigate the risk of suicide and SA among early married people who experienced SLEs., Methods: A case-control study was conducted based on the registry for suicide in Malekan county in Iran during 2016-18. Cases included 154 SAs and 32 suicides. Simultaneously, 201 outpatients from the emergency department were chosen as controls. Holms and Rahe life event questionnaire was used to assess SLEs. Sub-group analysis (Mantel-Haenszel) by sex and age groups and multiple logistic regression were used to calculate adjusted Odds Ratios (ORs) with 95% Confidence Intervals (CIs) for the association between EM and suicide risk after adjusting for the potential confounders., Results: The proportion (female vs male) of EM among suicides, controls, and SAs was 31.25% (18.7 vs 12.5%), 15.92% (11.9 vs 4.0%), and 13.0% (11.7 vs 1.3%), respectively. In subgroup analyses by sex, EM was associated with an increased risk of suicide in both females and males 2.64 and 2.36 times, respectively. Likewise, subgroup analysis by age groups revealed that EM increased suicide risk in subjects aged 10-15 years, while no association was found for age groups of 26-40 and > 40. After adjusting for the potential confounders, EM (OR: 3.01; 95% CI: 1.15 -7.29), financial problems (OR = 4.50; 95% CI: 1.83 -9.07), and family problems (OR = 2.60; 95% CI: 1.19-9.59), were associated with an increased risk of suicide. However, no association was found between EM, various types of SLEs, and the risk of SA., Conclusions: We found EM and SLEs were correlated with suicide risk, while no evidence found that EM increased the risk of SA. Progress in reducing EM and addressing its serious consequences can occur by a stronger political commitment and by sharing the experiences and voices of the early married. Our study provided preliminary findings to guide future studies; however, methodological and longitudinal studies are needed to understand and address the effect of EM on suicidal behaviors., (© 2022. The Author(s).)

Introduction: The Internet is an important source for health information and a medium for older adults' empowerment in health decision-making and self-caring. Therefore, we aimed to identify the potential motivators and probable barriers of e-health information-seeking behaviors (e-HISB) among older Iranian adults., Methods: A cross-sectional study assessed the usefulness of self-efficacy, perceived encouragement, positive attitude toward e-HISB, perceived usefulness, challenges of being visited by physicians, and perceived barriers in predicting e-HISB in a sample of 320 older adults in Tabriz, Iran., Results: The self-efficacy for online information seeking, positive attitude toward e-HISB, and perceived usefulness increased the odds of e-HISB by 12.00%, 24.00%, and 15.00%, respectively. In addition, e-health literacy, conflicting information, distrust of online information, and web designs that were not senior-friendly were the major barriers to e-HISB., Discussion/conclusion: The theoretical and practical implications of the motivators and barriers of e-HISB can be instrumental in designing and executing programs aimed at improving e-health literacy among older adults especially during the COVID-19 pandemic., (© 2022 S. Karger AG, Basel.)

Background: Pregnancy is a high-risk period for vitamin D (Vit D) deficiency, and there is a direct relationship between Vit D deficiency during this period and maternal and fetal complications. Therefore, this study aimed to assess the knowledge, attitude, and practice of pregnant women concerning the adoption of behaviors to prevent Vit D deficiency and identify the determinant factors of such behaviors., Methods: In this cross-sectional study, 185 pregnant women with a mean age of 27.52 ± 5.9 years were selected from the Health Centers in Tabriz, Iran, using the stratified random sampling between 2018 September 23 and 2019 June 21. Data were collected using a researcher-made questionnaires comprising demographic information, knowledge, attitude, and practice of pregnant women towards Vit D deficiency. The chi-square test and Fisher's exact test were used to determine the relationship between the demographics of pregnant women and their knowledge and attitude. Moreover, the general linear model test was used to determine the predictors of performance. The p-value< 0.05 was considered to be significant in this study., Results: The findings showed that 85.6% of pregnant women were well aware of the importance and role of Vit D in pregnancy. In addition, 76.7 and 75% of the participants had good knowledge of getting enough Vit D from sunlight and preventing Vit D deficiency in pregnancy, respectively. Moreover, 91.7% of the pregnant women believed that Vit D has a vital role in maternal and fetal health, and 61.1% showed a high level of perceived self-efficiency in preventing Vit D deficiency. In addition, 67.2% of women regarded the unpleasant taste and price of Vit D rich foods, such as seafood, as barriers to get Vit D, and 91.7% mentioned the lack of public places specific to women and living in apartments as barriers to getting enough Vit D from sunlight. According to the results, 57.8 and 79.4% of pregnant women performed at a moderate level in getting Vit D from food and sunlight, respectively. In general, educational attainment (Pvalue = 0.02, B = 0.56), pregnancy age (Pvalue = 0.04, B = -0.26), parity (Pvalue = 0.03, B = -0.45), and perceived self-efficacy of mothers (Pvalue < 0.001, B = 0.340) were the determinant factors of getting Vit D from food and sunlight as behaviours to prevent Vit D deficiency in pregnancy., Conclusion: The findings of the current study revealed that despite the good knowledge of women about the Vit D deficiency during pregnancy, their performance was moderate. The unpleasant taste and high price of seafood were barriers to using them, and the lack of public places specific to women and living in apartments, were barriers to using sunlight. The most important determinant of preventive behaviours was perceived self-efficacy. Developing an awareness program to promote best practices in pregnant women is essential to prevent vitamin D deficiency., (© 2021. The Author(s).)

Background: Patients with a type D personality have worse social functioning and mental health and more affective constraints than non-type D personalities. They have a negative outlook on life and health-related issues. The aim of this study was to examine the mediating role of stress and anxiety in the relationship between type D personality and COVID-19 by adjustment of the effect of demographic characteristics and perceived symptoms as confounder variables., Participants and Procedure: A total of 196 patients out of those suspected of having COVID-19 and visiting the reference hospitals were selected. They had completed the type D personality and the anxiety and stress scales along with their hospital admission form before undergoing COVID-19 testing. After their COVID-19 test, the participants were divided into two groups based on their disease, an infected group ( n = 90) and a non-infected group ( n = 106)., Results: Type D personality has no significant direct effect on infection with the disease, but taking into account the mediating variable of stress, the odds of an event in those with type D personality is 2.21 times higher than those without this personality ( p = .027) and, taking into account the mediating variable of anxiety, having a type D personality increases the odds of an event by 2.62 times ( p = .011), holding demographic characteristics and perceived symptoms constant., Conclusions: Given the indirect relationship between COVID-19 and type D personality, the mediating variables of stress and anxiety can be considered full mediating variables., (Copyright © Institute of Psychology, University of Gdansk.)

Objective: The aim of this study is to examine the effects of cognitive and physical loads on dynamic and static balance performance of healthy older adults under single-, dual-, and multi-task conditions., Background: Previous studies on postural control in older adults have generally used dual-task methodology, whereas less attention has been paid to multi-task performance, despite its importance in many daily and occupational activities., Method: The effects of single versus combined (dual-task and multi-task) cognitive (to speak out the name of the weekdays in a reverse order) and physical (with three levels including handling weights of 1, 2, and 3 kg in each hand) loads on dynamic and static balance performance of 42 older adults (21 males and 21 females) aged ≥60 years were examined. Dynamic and static balance measures were evaluated using the Timed Up and Go (TUG) and stabilometer (sway index) tests, respectively., Results: The TUG speed of female participants was generally slower than that of male participants. Age had no effect on balance performance measures. Under dual-task conditions, cognitive load decreased the dynamic balance performance, while the physical task levels had no effect. The dual-task conditions had no impact on the static balance performance. The effects of cognitive and physical loads on dynamic balance performance varied under dual- and multi-task conditions., Conclusion: The findings highlight differences between dual- and multi-task protocols and add to the understanding of balance performance in older adults under cognitive and physical loads., Application: The present study highlights differences between dual- and multi-task methodologies that need to be considered in future studies of balance and control in older adults.

Adolescence is a period of transition for developmental and social domains that may also be accompanied by behavioral problems. Aggressive behavior may be a mental health concern for young teens and is defined as a behavioral and emotional trait that may be distressing for others. This study aimed to understand the factors associated with aggressiveness among young teenage girls. A cross-sectional study was conducted among a sample of 707 female middle school-aged students using multistage random sampling in Tabriz, Iran. The variables of interest were aggressiveness, general health status, happiness, social acceptance, and feelings of loneliness. Structural equation modeling was employed to analyze the data. Low parental support, low satisfaction with body image, high sense of loneliness, and lower perceived social acceptance were found to be the factors influencing aggressiveness. The current study found that the school environment, home environment, individual and interpersonal factors all play a part in aggressiveness. As a result, the contributing elements must be considered when creating and executing successful interventions to improve this population's psychological well-being.

Background: There is a lack of scientific literature on the application of fear appeals theories to evaluate lung cancer risk perception among smokers. The aim of the present study is to apply the Extended Parallel Process Model (EPPM) to discover the perception of the smokers about their lifetime risk of developing lung cancer (perceived susceptibility), their perception of lung cancer survival (perceived severity), response efficacy, self-efficacy, and readiness to quit., Methods: In this cross-sectional study, 215 eligible smokers (aged 45 years and over who have smoked at least 1 pack per day in the last 5 years) were recruited. The data collection tool was designed using validate self-report questionnaires and it was contained items on the perceived risk of a smoker contracting lung cancer and perceived lung cancer survival rate. It also had questions to measure the main constructs of the EPPM and Readiness to quit ("Low&#95;Readiness", and "High&#95;Readiness"). To test how the data support conceptual EPPM to data, Generalized Structural Equation Modeling (GSEM) was used., Results: Findings showed a significant relationship between Perceived&#95;Susceptibility and Perceived&#95;Response Efficacy; (B = 1.16, P < 0.001); between Perceived&#95;Susceptibility and Perceived&#95;Self Efficacy, (B = -0.93, P < 0.001), Perceived&#95;Severity, and Perceived&#95;Response Efficacy (B = 1.07, P < 0.001). There was also a significant relationship between Perceived&#95;Threat and Perceived&#95;Response Efficacy; between Perceived&#95;Threat and Perceived&#95;Self Efficacy. The relationship between High&#95;Readiness and Perceived&#95;Self Efficacy, and between High&#95;Readiness and Perceived&#95;Severity also were significant. However, the relationships between High&#95;Readiness and Perceived&#95;Threat were not significant (P > 0.05)., Conclusion: Perceived&#95;threat and Perceived&#95;efficacy were important for smokers with low readiness to quit, while Perceived&#95;efficacy was most important for smokers with high readiness to quit. These findings could be used in promoting lung cancer awareness and designing smoking cessation programs based on smokers' stages of change., (© 2021. The Author(s).)

One of the major smoking prevention strategies has been to educate the public and increase people's awareness, using health-warning messages. However, many young people continue smoking without paying attention to health risk messages on cigarette packets in Iran. Hence, this study was conducted to examine the processing route of anti-smoking messages and influencing cognitive factors based on the Elaboration Likelihood Model. This cross-sectional study was correlational in nature. The non-probability sample consisted of 387 tobacco smokers in the age range of 18 to 30 years old. The study was conducted between July and November of 2018 in Tabriz, Iran. A researcher-designed questionnaire was used for the purpose of data collection. No causal inferences were drawn due to the non-experimental nature of the investigation. It was found that tobacco smokers often processed the health warning messages through the central route. Perceived severity, smoking abstinence self-efficacy, and psychological dependence were predictors of message processing through the central route. The results supported the conceptual model of cognitional predictors of the processing route. To design and execute effective health warning messages to quit smoking, it is recommended to consider cognitive factors as a means to enhance critical thinking about the content of the health-warning message., Competing Interests: Conflict of interest statement The authors declare no conflict of interest., (©2021 Pacini Editore SRL, Pisa, Italy.)

Background: This study aimed to investigate the asthma profile among children/adolescents and the relationship of the prevalence of air pollution profiles using latent class analysis (LCA)., Objectives: In this cross-sectional study, a case rural community was selected in an industrial area, and two rural control communities were selected in unexposed areas., Methods: Hourly concentrations of PM 10 , SO 2 , NO 2, and total volatile organic compounds were obtained from the records of a fixed air quality monitoring station, and the concentrations of benzene, toluene, xylenes styrene were measured during six campaigns. Asthma data was collected using the International Study of Asthma and Allergies in Childhood in 7-18 years old children/adolescents. The modeling was conducted using LCA., Results: A higher amount of air pollution indices were observed in the case than both control communities. LCA divided the participants into three clusters; "healthy" (92.8%), "moderate" (2.8%), and "severe" (4.4%). A higher probability of severe asthma (6.8%) was observed in the case than control communities (2.6% and 1.8%). Additionally, after adjusting for possible confounders, the odds of asthma was lower in the control communities than the case in both moderate and sever classes (Odds Ratios in the range of 0.135-0.697)., Conclusions: This study indicates asthma profiles of children/adolescents and the higher prevalence of severe class in the area, explaining the possible effect of air pollution., (Copyright © 2021. Published by Elsevier Inc.)

(1) Background: The older adult population of society is exposed to multiple stressors daily, such as the loss of loved ones, dysfunctional mobility, financial dependence, and suffering from numerous chronic illnesses. The present study aimed to assess the psychometric properties of the Anxiety about Aging Scale among older adults in Iran. (2) Methods: A sample of 703 community-dwelling older adults was recruited and screened using a standardized tool. The mean age of participants was 69.4 ± 8.1 years. The majority of participants were male (59.2%), married (66.6%), and illiterate (79.7%). A 'forward-backward' translation method was used in developing the Iranian version of the AAS for assessing the psychometric properties among older adults. Confirmatory factor analysis (CFA) and the Rasch model were used for construct validity. (3) Results: Applying CFA indicated that the model's four original factors are the best solution, representing 55% of the total variance. The result of the CFA showed that this four-factor model had a good fit for the data. The findings were also confirmed by Rasch analysis. (4) Conclusions: The Persian version of the AAS is valid and reliable for measuring aging anxiety among Iranian older adults.

Background: The aspects of marriage and relationship and their effect on couples' satisfaction are essential and critical aspects to be explored in this globalized and contemporary world. Since there are no reported meta-analysis and systematic reviews conducted in the last two decades in this area, we aimed to investigate the effect of marriage and relationship programs (MRP) on couples' relationship satisfaction (CRS) and couples' relationship communication (CRC) and also to determine the gender differences if any., Method: In this systematic review and meta-analysis, the randomized clinical trials (RCTs) published between 2000 and July 26, 2019, were retrieved from several online electronic databases such as Medline, Embase, ProQuest, and Cochrane Library. Inclusion and exclusion criteria were developed using the PICO (Population, Intervention, Comparison, Outcome) framework of PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses). The mean differences (MDs) and 95% confidence intervals (CIs) were calculated. The reported summary statistics were calculated as random effects models based on the heterogeneity between the studies model. Funnel plots and the Egger regression test was used to confirm the presence of any publication bias., Results: Of the total 12 intervention studies included, five (5) are education/communication skills programs, three (3) enrichment programs, and four (4) therapy programs. The impact of these programs was investigated on CRS and CRC. Therapy programs had a larger effect than other programs (pooled MD: 0.53 (95% CI = 0.35 to 0.71, I 2 = 71.5% p = 0.0001) and had a larger effect size on wives (pooled MD: 0.53 (95% CI 0.25 to 0.80, I 2 = 74.1% p = 0.0001) than husbands RS (pooled MD: 0.26 (95% CI 0.25 to 0.76, I 2 = 72.4% p = 0.0001). In RC (relationship communication) area, the Enhancement programs showed the small to large effect on CRC (pooled MD: 1.31 (95% CI = 0.13 to 2.50, I 2 = 94.7% p = 0.0001)) and educational programs showed small to medium effect (pooled MD: 0.32 (95% CI = 0.13 to 0.50, I 2 = 74.5% p = 0.0001) on women and no effect on men., Conclusion: Due to the high effect of the therapy programs on CRS and enhancement program on CRC in the current meta-analysis, the priority of their utilizations in interventions, especially by psychologists and mental health professionals, should be emphasized. Therefore, mental health planning in communities to develop MRP and care for couples' health should be given special attention to men's health. Due to the high heterogeneity of the results and with scanty literature in this specific domain, we are uncertain about their actual effect. However, well-designed RCTs with a larger sample size would be beneficial in closely examining the effect of MRPs on CRS and CRC.

Background: To end the COVID-19 pandemic, a large part of the world must be immune to the virus by vaccination. Therefore, this study aimed to gauge intent to be vaccinated against COVID-19 among ordinary people and to identify attitudes towards vaccines and barriers for vaccine acceptance. Methods: The study population comprises 1880 people residing in different countries that answer a prepared questionnaire. The questionnaire topics are demographics, historical issues, participants' attitudes and beliefs regarding vaccines, concerns, and vaccine hesitancy. Results: Attitudes and beliefs relating to vaccines in general, and the COVID-19 vaccine, were ascertained. Overall, 66.81% of the contributors would like to be vaccinated against COVID-19, while %33.19 did not intend to be vaccinated. Reasons for COVID-19 vaccine hesitancy included concern regarding vaccine side effects, fear of getting sick from the uptake of the vaccine, and the absence of accurate vaccine promotion news. Individuals with higher education believe that India (68.6%) produces the best vaccine ( P <0.001), while healthcare workers think the Chinese vaccine (44.2%) is the best ( P =0.020). Individuals with higher education have not been vaccinated, not be healthcare workers, and females were the most contributors to effective of the vaccine in reducing mortality from COVID-19 disease. Conclusion: Given the degree of hesitancy against COVID-19 vaccination, a multifaceted approach to facilitate vaccine uptake that includes vaccine education, behavioral change strategies, and health promotion, is paramount., (© 2021 The Author(s).)