Social Determinants of Health

Background: Subliminal messages (auditory sub-threshold stimuli) are hidden messages embedded within musical notes that the conscious mind cannot perceive. The aim of this study was to examine the effectiveness of subliminal audio in reducing depression and anxiety in women with hypertension, with the goal of providing a foundation for future interventions and physiological evidence supporting sub-threshold perception.

Methods: This quasi-experimental study was conducted using purposive sampling on 30 hypertensive female patients who referred to Seyed-al-Shohada Hospital in Urmia, Iran. Participants were randomly assigned to intervention and control groups. After the pre-test, the intervention group listened to a subliminal audio file for 20 minutes daily over a six-week period. Depression and anxiety levels were assessed and compared before and after the intervention in both groups using the Beck Depression Inventory (BDI; scores ranging from 13 to 63) and the Beck Anxiety Inventory (BAI; scores ranging from 7 to 63).

Results:  The intervention group showed a significant reduction in depression and anxiety scores following the six-week exposure to subliminal audio messages. Depression scores decreased from a mean of 29.13 (SD = 6.82) in the pre-test to 23.73 (SD = 6.76) in the post-test. Similarly, anxiety scores reduced from 17.6 (SD = 6.04) to 15.6 (SD = 7.20). In contrast, the control group exhibited no significant changes in either variable. ANCOVA results confirmed that the reduction in depression (F = 7.536, p = 0.011, η² = 0.218) and anxiety (F = 5.316, p = 0.029, η² = 0.165) in the intervention group remained statistically significant even after controlling for pre-test scores, indicating a moderate and clinically meaningful effect of the intervention.

Conclusion: The findings suggest that subliminal audio messages can be an effective non-pharmacological intervention for reducing depression and anxiety in patients with cardiovascular diseases.

Background: This research explored the relationship between teachers' emotional intelligence (EI) and classroom management in Iran’s distinct educational environment, where organizational hierarchies and systemic challenges may influence EI’s impact differently compared to Western contexts.

Methods: A mixed-methods approach was adopted, involving 400 secondary school teachers (67% female; 36.8% early-career) from five Iranian provinces. Quantitative data were collected using established measures of emotional intelligence and classroom management, analyzed through structural equation modeling. Qualitative insights were drawn from 30 in-depth interviews, thematically analyzed, with methodological triangulation used to enhance reliability

Results: Key outcomes include: Emotion regulation was the strongest predictor of behavior management (β=0.42, p<0.001), though its impact diminished by 31% in overcrowded classrooms; Cultural adaptation was widespread (73%), with educators adjusting Western EI techniques to align with local norms; and Early-career teachers depended more on EI (accounting for 39% of variance) compared to experienced colleagues (28%), despite the latter’s higher overall management scores (3.8 vs. 3.2, p<0.001). Systemic challenges such as large class sizes (65%), exam-centric pressures (92%), and insufficient training (87%) consistently hindered EI application.

Conclusion: While fundamental EI skills retain cross-cultural validity, their efficacy in Iran is heavily influenced by contextual factors. The findings highlight the need for EI training programs that integrate cultural relevance, structural considerations, and career-stage variations. This study advances global EI discourse by illustrating how educational frameworks and cultural dynamics shape the practical use of emotional pedagogy.

Background: Healthcare professionals have been the most severely affected by the global pandemic known as COVID-19. The aim of this study was to explore the experiences and perceptions of healthcare workers in Iran regarding COVID-19 vaccination using a descriptive phenomenological approach to gain a deeper understanding of the challenges and concerns involved.

Methods: A qualitative, descriptive phenomenological approach was employed to carry out the present investigation. Twelve medical doctors and nurses who previously administered the vaccine or are still unsure about administering it have been chosen using a purposive sampling method. The data was acquired by employing a semi-structured in-depth interview, and the data was analyzed using Colaizzi and Max software's 7-step technique.

Results: This study explores health personnel's attitudes toward COVID-19 vaccination. Among 12 participants, common reasons for vaccine hesitancy included distrust, perceived ineffectiveness, and concerns about vaccine safety. Conversely, motivations for vaccination included a sense of social responsibility, disease prevention, and advice from health experts. " Reasons for vaccine hesitancy" (vaccination infrastructure, social infrastructure, and personal infrastructure) and "justifications for administering vaccines" (sense of inevitability, comfort, social accountability, and disease management) are considered as principal and sub-categories classes, respectively.

Conclusion: The health personnel reported diverse experiences related to vaccination. Overall, it can be concluded that as society and even medical professionals have become more accepting of the vaccine, there has been a significant improvement in the attitudes of healthcare professionals toward accepting the COVID-19 vaccine, along with an increase in trust.

Background: Given the importance of problem-solving skills and ambiguity tolerance in students, the use of psychotherapy interventions can help improve these skills.

Objectives: This study aimed to compare the effectiveness of schema therapy and positive psychotherapy based on promoting resilience on problem-solving skills and ambiguity tolerance in technical-vocational students.

Methods: The present research is semi-experimental with a pre-test and post-test design. The statistical population were girl students in the second year of high school referred to education and training counseling centers (due to academic failure) in technical-vocational fields in District 6 of Mashhad. The number of 45 people was randomly selected and assigned in three groups of experimental and control (15 people in each group). The first experimental group received schema therapy, the second group received positive psychotherapy based on promoting resilience, and the third group did not receive any therapy. The Peterson's Problem-Solving Inventory (PSI) and McLain Ambiguity Tolerance Scale–I (MSTAT-II) were used. The data were analyzed using SPSS 24 software and analysis of covariance.

Results: The results showed that the two methods of schema therapy and positive psychotherapy based on promoting resilience have a significant effect on problem-solving skills and ambiguity tolerance in technical-vocational students (P<0.05), while, there was no significant difference between the effectiveness of two therapy methods on problem-solving skills and ambiguity tolerance of students (P>0.05).

Conclusion: According to the results, both schema therapy methods and positive psychotherapy based on promoting resilience can be used to improve the level of problem-solving skills and ambiguity tolerance in technical-vocational students.

Background: Student learning is influenced by numerous factors, with descriptive assessment being one of the key components. This study aims to analyze the effects of descriptive assessment on student learning and its relationship with mental health.

Methods: This descriptive-correlational study employed Structural Equation Modeling (SEM) using AMOS software to analyze the relationships among variables. The statistical population included elementary school students in Tehran during the academic year 2022-2023, from which were selected through simple random sampling. Inclusion and exclusion criteria were applied to ensure data validity, and participants reflected diverse socio-economic backgrounds. Standardized, validated questionnaires were used to measure descriptive assessment, learning outcomes, and mental health, with data collected under controlled classroom conditions.

Results: The results showed a significant relationship between attitudes toward hijab, health-promoting religious behaviors, and social health among female students. Also, descriptive assessment has a significant impact on student learning and mental health, leading to improvements in their understanding, learning outcomes, and mental well-being. Additionally, factors such as motivation, self-assessment, and received feedback play a crucial role in this process. The presented models indicated that descriptive assessment can indirectly improve academic performance and mental health by increasing motivation and enhancing self-assessment.

Conclusion: Descriptive assessment is recognized as an effective tool in the learning process and mental health of students. This study recommends that educational policymakers consider incorporating descriptive assessment as part of the educational evaluation system to improve student learning and mental health.

Background: Mental health among clinical hospital workforce requires thorough assessment due to their vital role in caring for people. Given the scarcity of evidence, our study aims to shed light on various aspects of service utilization within a group of hospital workers and trainees.

Methods: In this cross-sectional study, sampling framework of six governmental hospitals was used. The study population consisted of 300 clinical workers and trainees. Convenience sampling was employed to access study subjects in proportion to the hospital size. All eligible clinical workers within the specified timeframe were enrolled until the predetermined sample size was reached. A self-administered questionnaire was used to collect information.

Results: Among participants who experience some form of mental concern or disorder, 60% do not use any form of care. 29% used psychological drugs (with or without psychiatric prescription), and only 26% utilized mental consultation services. There is no significant relationship between age and service utilization. The main barriers to mental health service use were self-reliance, work overload, and time constraints. Personal concern and belief in treatment effectiveness were key factors that encouraged service utilization.

Conclusion: The findings of this research recognizes that mental health of healthcare providers is not solely a problem within the health sector but a major public health concern. The low rate of mental health care utilization, despite their acquaintance with matter of mental health, highlights the complexity of this issue and need for Further in-depth studies.

Background: With the expansion of digital technologies in healthcare, smart marketing has emerged as a data-driven approach that plays a prominent role in enhancing patient experience and improving interaction with healthcare service brands.

Methods: This descriptive-analytical study was conducted in a field setting. The study population consisted of 220 managers and experts in healthcare marketing from healthcare institutions and health-focused companies. Using Cochran's formula, a simple random sample of 140 participants was selected. The data collection tool was a researcher-developed questionnaire, whose validity was confirmed by digital health experts and reliability was verified with a Cronbach's alpha of 0.87. Data analysis was performed using SPSS software and multiple regression analysis.

Results: The Results showed that smart marketing significantly and positively influences patient (customer) experience, explaining approximately 62% of its variance (β = 0.55, p < 0.01). Additionally, brand interaction contributed to 56% of the changes in patient experience (β = 0.44, p < 0.01), while the use of consumer data accounted for 22% of its variation (β = 0.81, p < 0.01). Furthermore, patient experience itself explained 28% of the variance in advanced Personalization, confirming its mediating role in enhancing personalize healthcare delivery.

Conclusion: Data-driven smart marketing in healthcare can facilitate the design of personalized healthcare services, leading to sustainable patient interactions and gaining a competitive advantage in the healthcare market.

Background: Auditors, especially in health-related sectors, face psychological and organizational barriers when reporting misconduct. While ethical leadership promotes whistleblowing, the moderating role of psychological safety remains underexplored. This study examined how psychological safety influences the relationship between ethical leadership and auditors’ willingness to report professional misconduct.

Methods: This descriptive-correlational survey was conducted among auditors working in the Audit Organization and member institutions of the Iranian Association of Certified Public Accountants in 2025. A simple random sampling method was employed, and a total of 177 valid questionnaires were collected for analysis. Data collection instruments included standardized questionnaires on ethical leadership, psychological safety, and whistleblowing intention, all of which have been previously validated in Iranian contexts, showing satisfactory reliability (Cronbach’s alpha > 0.80) and construct validity through confirmatory factor analysis. Data were analyzed using structural equation modeling with the partial least squares approach (PLS-SEM) via SmartPLS 4 software. PLS-SEM was chosen because it is well-suited for studies with relatively small sample sizes, can handle complex models with multiple latent variables, and does not require strict assumptions about data normality

Results: Ethical leadership was significantly and positively associated with a greater willingness to report professional misconduct (P<0.01). Furthermore, psychological safety strengthened the effect of ethical leadership on whistleblowing intention and served as a significant moderator (P<0.05).

Conclusion: Psychological safety may play a key role in enhancing whistleblowing within auditing institutions, especially in health-related organizations. Unlike prior studies that focused only on direct effects of ethical leadership, examining psychological safety as a moderating factor addresses a scientific gap by showing when and how ethical leadership most effectively promotes whistleblowing. This highlights that a supportive work environment can strengthen transparency and foster a health-oriented organizational culture.

Background: The present study aimed to investigate the effect of mindfulness training on reducing test anxiety and improving the academic performance of high school students.

Methods: This quasi-experimental study used a pre-test–post-test control group design. The study population included all 10th-grade students from high schools in Tehran during the 2024–2025 academic year. A total of 60 students were selected through cluster random sampling and randomly assigned to the experimental (n=30) and control (n=30) groups. The experimental group participated in eight 90-minute sessions of mindfulness training based on Kabat-Zinn’s model, while the control group did not receive any intervention. Data were collected using the Spielberger Test Anxiety Inventory and students’ final semester grade point average (GPA) as an indicator of academic performance. Data were analysed using independent t-test, paired t-test, and analysis of covariance (ANCOVA) in SPSS-26.

Results: The results indicated that the mean score of test anxiety in the experimental group significantly decreased after the intervention (P<0.001), while no significant difference was observed in the control group. The mean academic performance of the experimental group improved significantly (P=0.002). The ANCOVA results showed that mindfulness training had a significant effect on both test anxiety and academic performance.

Conclusion: Mindfulness training can be used as an effective intervention to reduce test anxiety and enhance students’ academic performance. Implementing mindfulness-based educational programs in schools can play a key role in improving students’ mental health and promoting effective learning outcomes.

Background: This study was conducted with the aim of designing the architectural model of human resources of universities of medical sciences in southeastern provinces of Iran with the intelligent approach.

Methods: This study was of a mixed method.The statistical population in the qualitative part was 20 experts of medical sciences managers in the southeastern provinces of Iran, namely Sistan and Baluchistan, Kerman, Hormozgan and South Khorasan. Also, 264 people were selected using G*Power for quantitative part. Sampling of this part was random cluster sampling. The data collection tool was a researcher-made questionnaire containing 77 items that included six dimensions of intelligent human resources architecture and six dimensions of intelligentization. The software used was Smart-PLS and SPSS-16.

Results: The proposed model identified six main dimensions of human resource intelligentization, including intelligent systems and management (0.960), intelligent learning (0.955), intelligent architecture strategy (0.953), core technology (0.945), and knowledge management (0.451). The key components within these dimensions included intelligent performance evaluation, job task specialization, fostering creativity, and organizational efficiency. The model's validity was confirmed in terms of reliability (Cronbach's alpha and CR above 0.7), convergent validity (AVE above 0.5), and appropriate R² and t-values. The findings indicated that the model's dimensions and components align with the needs of medical universities.

Conclusion: University managers should try to draw and compile the horizon of intelligent organizational architecture and in line with the implementation policies of intelligentization and plan to acquire new technologies in the field of artificial intelligence and use it.

Background: This study aimed to identify the management challenges of the health sector in the local press of Iran.

Methods: A qualitative design was employed using thematic analysis to explore the data. Participants included university professors, award holders, responsible managers, chairpersons, and editors of local Iranian press outlets. Purposeful sampling continued until theoretical saturation was reached (20 participants). Data were analyzed using the constant comparison method with MaxQDA Pro software. Thematic analysis was chosen to systematically identify, organize, and interpret patterns (themes) within the data, providing both depth and clarity to the findings.

Results: The analysis identified 83 unique basic themes and 9 organizing themes as challenges facing the health sector in the local press. These challenges encompassed economic issues, transportation, public interest, content creation, human resources, facilities, education, legal frameworks, and stalls. Additionally, 41 unique basic themes and 6 organizing themes were identified as strategies, which included content development, human resources, infrastructure, economic improvements, legal reforms, and strategic planning. Two overarching themes—challenges and strategies—were extracted to provide a holistic understanding.

Conclusion: The local press serves as a vital tool for advancing health, cultural, and social development, particularly within specific geographical and socio-cultural contexts. To ensure their economic sustainability and survival amidst current challenges, strategic planning is crucial. Moreover, comprehensive support from cultural institutions is essential to empower the press in fulfilling its developmental role effectively.

The community medicine

Background: A robust sense of self facilitates emotional comprehension, stress management, and adaptive lifestyle behaviors. Incorporating spiritual or religious dimensions can enhance self-awareness and resilience. This study developed and validated a faith-based self-awareness intervention grounded in Islamic epistemology, assessing its effects on cognitive emotion regulation among adolescents.

Methods: Employing a sequential mixed-methods design, the qualitative phase utilized Attride-Stirling’s thematic analysis framework to examine library resources, identifying constructs for a self-awareness package rooted in Islamic epistemology, with subsequent expert validation by psychologists. The quantitative phase evaluated efficacy in 30 female secondary students (aged 13–16 years) from Shadegan via a pre-test-post-test control group design. Participants were purposively selected and randomly allocated; the experimental group underwent eight 90-minute sessions, whereas controls received no intervention and were wait-listed. Cognitive emotion regulation was measured using the Cognitive Emotion Regulation Questionnaire (CERQ), with data analyzed via repeated-measures ANOVA in SPSS-23.

Results: Qualitative analysis yielded a faith-based self-awareness framework rooted in Islamic epistemology, comprising one overarching theme, five organizing themes, and 22 basic themes. Content validity was affirmed (CVI=0.79; CVR=0.75). Quantitatively, the experimental group exhibited significant gains in adaptive emotion-regulation strategies relative to controls (P<0.001, η²=0.45), confirming intervention efficacy.

Conclusion: This mixed-methods investigation validates an Islamic epistemology-based self-awareness package, evidencing improved adaptive emotion regulation in adolescents. Results underscore the promise of epistemologically aligned interventions for bolstering psychological well-being and interpersonal functioning.

Background: Emotional empathy is a critical determinant of marital satisfaction and conflict resolution, necessitating effective premarital education. This study examined the efficacy of premarital programs integrating Dialectical Behavior Therapy (DBT), Acceptance in Caregiving Relationships (ACR), and Attachment Narrative Therapy (ANT) in enhancing emotional empathy among young couples preparing for marriage.

Methods: This quasi-experimental study employed a four-group design to evaluate the efficacy of premarital education interventions based on DBT, ACR, and ANT, against a control group. Data were collected via pre-test, post-test, and one-month follow-up. One hundred twenty young adults (30 per group) preparing for marriage were conveniently sampled from Isfahan's psychological centers in 2023 and randomly assigned. The Basic Empathy Scale (BES-A) measured the outcome. Intervention groups completed eight 90-minute sessions. Data were analyzed using SPSS version 26 with descriptive statistics and repeated measures ANOVA.

Results: Between-group analyses indicated that all three interventions—DBT, ACR, and ANT—produced substantial increases in emotional empathy scores at post-test relative to the control condition (partial η²=0.67). Gains were sustained at one-month follow-up. No significant inter-intervention differences emerged immediately post-treatment; however, DBT exhibited superior longevity compared to ANT at follow-up.

Conclusion: Premarital programmes grounded in DBT, ACR, or ANT significantly bolster emotional empathy in young adults. These evidence-based approaches offer valuable frameworks for counselling, enhancing emotional attunement, conflict management, and relational resilience. While all proved efficacious short- and medium-term, DBT demonstrated greater durability than ANT. Findings support integrating these modalities into premarital education to cultivate enduring, empathetic partnerships.

Background: Bereaved parents of child organ donors often experience profound psychological distress. This study aimed to evaluate the effectiveness of a comprehensive psychological empowerment program designed to enhance quality of life and cognitive empowerment for this vulnerable population.

Methods: A mixed-methods study combined qualitative grounded theory with a quasi-experimental pre-test/post-test control group design to evaluate a psychological-cognitive empowerment program. Qualitative sampling used a purposive method until theoretical saturation. For the quantitative phase, 30 participants were selected via convenience sampling from the organ procurement unit. Mental health was measured using the SCL-90 questionnaire and quality of life was assessed with the WHOQOL-BREF instrument.

Results: Findings from the qualitative phase revealed that the psychological-cognitive empowerment program consisting of eight 90-minute sessions focusing on cognitive behavior therapy using Lawshe's seven-step technique was validated. Moreover, repeated-measures ANOVA demonstrated statistically significant improvements in both mental health (p = 0.005) and quality of life (p = 0.013) scores at post-test.

Conclusion: The comprehensive psychological-cognitive empowerment program was effective in improving the mental health and quality of life of bereaved parents of child organ donors. These findings underscore the importance of targeted psychological support for this population.

Background: This study explores the integration of biophilic elements in contemporary commercial centers and their impact on customer well-being and spatial experience. With increasing recognition of the importance of natural environments in urban life, biophilic design has emerged as a key approach in commercial architecture.

Methods: In the first phase, a thematic analysis of existing literature was conducted to identify relevant themes, categories, and relationships, leading to the development of a conceptual model. In the second phase, a survey-based study was carried out among 119 visitors to nominated commercial centers to validate and generalize the findings. Structural analysis of the collected data was performed using SPSS and SmartPLS (v.3), confirming that the conceptual framework of biophilic design in commercial spaces is shaped by six key factors.

Results: The results indicate strong and meaningful interactions among these factors, reinforcing the significance of biophilic principles in shaping customer behavioral well-being. Furthermore, the study highlights how integrating biophilic elements into commercial environments can enhance both mental and physical well-being, ultimately fostering more positive customer experiences.

Conclusion: These findings underscore the need to prioritize human-centered and environmentally conscious design strategies in commercial space development.

Background: The worldwide reduction in fertility, change in demographic policies, rise in divorce ages, urbanization, and growth of the nuclear family require greater attention. Having an only child in the context of child-rearing seems to be a strategy for creating a balance between individual, marital, family, and environmental conditions, leading Iran to become an aging country in the future.

Methods: This qualitative study is based on semi-structured interviews with 11 married women with only one child.

Results: We used the grounded theory method to investigate the factors influencing Iranian mothers' decision to have an only child. We extracted 571 initial concepts, 55 subcategories, and 23 main categories by coding the interviews. The findings are classified into five categories shaping the final theoretical model. The results show that people can fall into groups, "forced only-child" and "voluntary only-child," regarding their attitudes toward having an only child.

Conclusion: Participants' decision to have an only child is influenced by external factors related to society's economy, politics, and culture. On the other hand, this decision also reflects the individuals' circumstances shaped by internal factors that impact the participants. Furthermore, maintaining the decision is influenced by factors that directly affect the causal conditions and ultimately result in having an only child.

Background: The aim of the present study was to design and validate a family-centered psychological intervention program based on spiritual therapy and cognitive behavioral therapy and its effectiveness on the lifestyle of patients with type 2 diabetes.

Methods: The method of the present study was a combination based on a guided exploratory approach with a classification model, whose qualitative phase was based on the grounded theory method and its quantitative phase was based on a quasi-experimental design based on a pre-test-post-test-follow-up design with a control group. The sampling method for the qualitative part was purposive based on theoretical saturation and the sampling method for the quantitative part was available to 30 people. The instrument used was the Lali et al. lifestyle questionnaire.

Results: Findings related to the qualitative section showed that the family-centered psychological intervention program based on spirituality and cognitive behavioral therapy for patients with type 2 diabetes included 12, 60-minute sessions, which was validated based on the seven-step technique of Lawshe. Also, findings related to the repeated measures variance test showed that the intervention program had a significant effect (p<0.01) on increasing lifestyle scores in the post-test and maintaining scores in the follow-up phase.

Conclusion: Overall, the results of the present study showed that the family-centered psychological intervention package based on spirituality and cognitive behavioral therapy for patients with type 2 diabetes can be used as a complementary technique alongside drug therapy to improve lifestyle and treatment process of diabetic patients.

Background: The current investigation set out to investigate the effects of compassion for oneself, sense of mission, and health knowledge on the standard of life of students at the Tehran campuses of Islamic Azad University.

Method: The present research used a correlational and descriptive approach. All master's and doctorate students in humanities fields (literature, history, philosophy, and sociology) enrolled in the Islamic Azad University branches in Tehran during the 2024–2025 academic year, totaling over 50,000 students, made up the estimated population. The World Health Organization Quality of Life questionnaire, the Ryff goal in life scale, the Neff self-compassion scale, and the Montazeri et al. health awareness questionnaire were among the instruments used for gathering the data. Following the completion of the surveys, structural equation modeling tests and SPSS-24 and Smart-PLS software were used to evaluate the data.

Results: The findings showed that students' quality of life is substantially enhanced by health knowledge, compassion for oneself, and a sense of purpose. In particular, students' quality of life was higher when they had greater levels of compassion for oneself, goals, and health awareness.

Conclusion: Enhancing these variables among students can contribute to improving their quality of life, and these variables have a major impact in enhancing the quality of life of students.

Background: Employees are the driving force behind economic growth and development. Creativity, innovation, and enhancing employee competencies in various fields require the presence of human capital. Given this, the main objective of the study was to examine the lived experiences of Bank Melli employees regarding meritocracy and the factors influencing it.

Methodology: This study was qualitative in nature and was based on the grounded theory method. The target population included all employees of Bank Melli in Kerman (2024). Using purposive sampling, 17 participants were selected based on: (1) ≥3 years of experience, (2) direct roles in customer service/digital banking, and (3) willingness to participate. Selection ensured diversity in roles (tellers, managers, IT) and gender. Semi-structured interviews were employed as the data collection tool. To ensure reliability, three methods were applied: member checking, analytical comparisons, and the audit technique.

Results: The results identified several influencing factors. Causal conditions included participatory management, skill enhancement, and administrative system integrity. Contextual conditions included a culture of competency, scientific and technological education, and a culture of accountability. Intervening conditions encompassed adherence to job regulations, motivation, and the desire for career advancement. Organizational talent development was identified as a key strategy, while job alienation emerged as a significant consequence.

Conclusion: Organizational competency requires appropriate social and cultural infrastructures. Without the establishment of a meritocracy and talent development culture at the socio-cultural level, discussions of organizational competency remain ineffective.

Background: This study aimed to identify the key factors Influencing the application of smart technologies to improve patient communication, increase satisfaction, and strengthen brand image within the healthcare system

Methods: This study employed a mixed-methods approach (qualitative–quantitative). In the qualitative phase, semi-structured interviews were conducted with 15 key informants, including hospital managers, digital health marketers, and AI/data specialists. Participants were selected through purposive. Thematic analysis was carried out using Braun and Clarke’s six-step framework. Coding was performed manually, and themes were validated through member checking and peer review. In the quantitative phase, data were collected using a structured questionnaire developed based on the themes identified in the qualitative stage. Path analysis and correlation tests were used to examine the relationships among variables. 200 participants were selected among hospital managers, health marketing specialists, and data analysts working in digital health settings.. Data analysis was conducted using SPSS version 23 and SmartPLS version 3.

Results: Most experts validating the qualitative phase were male (62.5%), aged 30–40 (69%), held a master’s degree (77.5%), and had 5–10 years of experience (73%). Thematic analysis identified customer data analysis and content personalization as key AI-driven components in health marketing. Quantitative findings showed significant positive relationships between AI, advanced marketing, behavioral change, and branding strategies. Path analysis confirmed all hypotheses, with AI indirectly influencing branding via marketing and behavioral shifts. The model showed strong fit (GOF = 0.62) and acceptable reliability and validity.

Conclusion: Integrating AI technologies into healthcare marketing not only improves patient experience but also enhances the branding position of healthcare organizations in competitive environments.

Background: Healthy nutrition and social health are key components of sustainable community development. However, cultural and economic barriers, along with generational differences, can significantly affect dietary patterns and levels of social health in urban Iranian households. This study aimed to provide an anthropological-cultural analysis of nutritional barriers and their relationship with social health across different generations.

Methods: This mixed-method study included both quantitative and qualitative approaches. The quantitative phase involved a survey of 400 individuals from urban households representing three age groups (youth, middle-aged, and elderly). The qualitative phase included semi-structured interviews with 20 participants. The number of interviewees was determined based on the principle of data saturation, whereby new interviews no longer produced additional themes or insights. Saturation was reached after approximately 17 interviews, and three further interviews were conducted to confirm this point. Participants were selected purposefully to ensure diversity in age, gender, and socio-economic background. Data were analysed using regression analysis in the quantitative phase and thematic analysis in the qualitative phase.

Results: The findings showed that cultural barriers (β = -0.42, p < 0.001) and economic barriers (β =-0.38, p=0.004) had significant negative effects on social health. In addition, the generational variable was positively associated with social health (β = 0.21, p = 0.026). The qualitative analysis supported these results, indicating that older generations maintained stronger adherence to traditional dietary patterns and family interactions, whereas younger generations demonstrated a tendency toward fast food consumption and individualistic lifestyles.

Conclusion: The results highlight the need for urban health policies to focus on nutrition education, revitalization of family-oriented food culture, and reduction of cultural and economic barriers to healthy eating. Considering generational differences is essential in designing effective interventions.

Background: This study aimed to investigate how self-compassion affected the quality of sleep and overall well-being of moms whose children had been diagnosed with ADHD (Attention Deficit Hyperactivity Disorder).

Methods: This was a quasi-experimental study. Thirty mothers were randomly divided into an experimental group (15 participants) receiving self-compassion training and a control group (15 participants) receiving no intervention. Data collection tools included the Pittsburgh Sleep Quality Index, the WHO Quality of Life questionnaire, quantitative electroencephalography, and a self-compassion protocol. Data analysis was performed using SPSS-24, with descriptive statistics and multivariate analysis of covariance (MANCOVA).

Results: Results showed no substantial differences between groups in the pre-test phase. However, post-test results revealed significant improvements in the experimental group. Self-compassion interventions significantly enhanced sleep quality (F=45.64, P<0.01), life quality (F=275.12, P<0.01), and alpha wave activity (F=176.64, P<0.01). These improvements highlight the effectiveness of self-compassion training in reducing stress and anxiety, leading to increased satisfaction and calmness.

Conclusion: Self-compassion-based programs can serve as a beneficial approach to enhancing sleep quality and overall life quality in mothers of children with ADHD. This research underscores the potential of self-compassion interventions in promoting mental well-being and improving physiological and psychological outcomes.

Background: The challenges associated with integrating metaverse technology into tourism are multifaceted, encompassing technical barriers, ethical considerations, social acceptance issues, and market dynamics. Aim of this study was identifying the Challenges of Metaverse Technology for The Tourism Industry.

Methods: Qualitative interviews were generally conducted in person. The statistical population of this research is tourism industry experts and metaverse technology experts. Data were collected through semi-structured in-depth interviews with participants and field notes kept by the researchers.

Results: The findings are presented in three themes, including discussion in relation to relevant research: Stakeholder Perceptions and Adoption Barriers, Ethical and Privacy Concerns, Economic Implications, Future Directions and Opportunities, Digital Addiction and Mental Health, Cultural Authenticity and Representation, Control and Governance Issues and Ethical Use of Technology.

Conclusion: The integration of metaverse technology into the tourism sector presents various challenges that stakeholders must navigate. These challenges can be categorized into technical, ethical, and social dimensions.

Background: This study investigated the impact of discount messages and individual self-control on arousal and Impulse buying behavior during purchasing processes.

 Methods: A laboratory experiment was conducted using a 2×3 between-subjects factorial design with 99 participants (mean age = 24.5, SD = 3.2; 52% female), randomly assigned to six experimental groups. The independent variables were self-control and discount message type (product-based discount, percentage discount, or no discount). Participants completed a simulated online shopping task while EEG data were recorded from 19 channels (10-20 system), focusing on frontal beta-to-alpha power ratios as a neural marker of arousal. Impulse buying was measured via post-experiment purchase intentions and actual checkout behavior. Data were analyzed using mediation analysis (PROCESS Model 4) with bootstrapping (5,000 samples).

Results: The findings indicate that arousal did not significantly mediate the relationship between self-control and impulse buying. However, arousal significantly mediated the effect of product discount on impulse buying but not percentage discount. Furthermore, product discounts had a direct positive effect on impulse buying, while percentage discounts did not significantly influence impulse buying. These results highlight that discount type plays a crucial role in triggering arousal-driven impulse buying behavior. EEG analysis revealed that heightened arousal levels (beta-to-alpha ratios in frontal regions) corresponded with increased impulse Buying, reinforcing the role of arousal as a driver of emotional decision-making.

Conclusion: These insights emphasize the need for marketing strategies that balance emotional engagement and consumer self-regulation. Businesses should consider differentiating discount types and promotional techniques to sustain consumer interest while mitigating post-purchase regret.

Background: Nowadays, in the evaluation of urban quality, urbanization is considered as one of the key factors affecting individual and social health. In this regard, just as human health is largely influenced by city programs and goals, urban life also depends on improving the overall quality of health. Therefore, attention must be paid to environmental quality and the enhancement of social health within residential complexes.

Methods: This study examined the impact of environmental quality components on improving social health in residential complexes in Ardabil City, specifically in the Laleh Sabalan and Honarmandan complexes. This research employed a mixed-methods approach. In the qualitative phase, data were collected through interviews and focus group discussions, while in the quantitative phase, survey methods using both standardized and researcher-made questionnaires were utilized. Participants in the qualitative phase were selected through purposive sampling among architecture experts and academics. In the quantitative phase, stratified random sampling was used, with a sample size of 271 residents from the mentioned residential complexes. For data analysis, SPSS and LISREL software were employed, along with regression analysis, Pearson tests, and structural equation modeling.

Results: The findings revealed that environmental quality components—such as economic factors, socio-human aspects, environmental dimensions, functional and physical characteristics of residential units, aesthetics, visual appeal, use of natural elements, lighting, safety, and perceptual meanings—significantly impact social health enhancement. Notably, components like the use of natural elements, economic dimension, and safety had the most substantial effects on residents' social health. Overall, each dimension of environmental quality was found to meaningfully contribute to improved social health in residential complexes.

Conclusion: Based on these findings, it can be concluded that to increase social health within residential areas, greater attention must be paid to environmental quality indicators.

Background: In today’s complex and competitive organizational environments, designing competency systems that enhance performance while upholding employee dignity has become a strategic priority in HR management. Employee dignity, defined as the recognition of individual worth, respect, and fair treatment in the workplace, is a multidimensional concept influencing motivation and organizational commitment. This study, using the grounded theory approach, aimed to develop a competency system model that integrates and promotes the principles of employee dignity within organizational practices.

Methods: This research employed a mixed-methods design (qualitative–quantitative). In the qualitative phase, grounded theory (Strauss and Corbin approach) was used to analyse data from semi-structured interviews with 18 HR managers and experts. In the quantitative phase, the proposed model was tested using structural equation modelling (SEM) on a sample of 260 employees, and further validated through a nonlinear Bayesian model. Model fit was assessed using indices such as RMSEA, CFI, and TLI. Integration of qualitative and quantitative findings was performed through a comparative analysis, ensuring theoretical saturation aligned with empirical validation.

Results: The qualitative results led to the identification of seven causal categories within the competency system, including professional, cognitive, and organizational competencies. In the quantitative prioritization, professional, cognitive, and organizational competencies received the highest weights. Path analysis revealed that these competencies significantly impacted job dignity and, subsequently, organizational performance. Model fit indices confirmed the high predictive power and accuracy of the conceptual model.

Conclusion: The developed model presents a comprehensive and localized framework for a competency system that can serve as a foundation for human resource policies aimed at enhancing employee dignity and productivity.

Background: Uncontrolled population growth, urban sprawl, economic inequality, and unbalanced development have intensified challenges in deteriorated urban areas. Urban acupuncture—a low-cost, localized strategy—targets specific “pressure points” to stimulate broader improvements. By enhancing social, institutional, and infrastructural capacities, it strengthens community participation, governance, and essential services, thereby increasing resilience. In border cities, where vulnerabilities and resource constraints are high, urban acupuncture can effectively promote adaptive capacity and support sustainable urban transformation

Methods: This study is qualitative in nature and follows Morse’s "Parallel Single-Method" typology, chosen because it allows simultaneous exploration of both theoretical constructs and empirical evidence. Data were collected through documentary studies and semi-structured interviews. Analysis was conducted concurrently using meta-synthesis to develop the theoretical framework and content analysis to extract empirical components, supported by NVivo software. This approach enables a comprehensive understanding of the phenomenon by integrating conceptual insights with real-world observations.

Results: Based on qualitative analysis, an initial conceptual model of resilience was developed comprising three core dimensions: "Governance," "Social Equity," and "Physical-Historical." Further content analysis of interviews led to the coding of 528 references, from which 22 primary codes and 8 central categories were identified. According to the results, the final model of resilience of dysfunctional fabrics was presented with an emphasis on the acupuncture approach and vulnerability in border cities, and based on the star seed model.

Conclusion: The urban acupuncture approach presents an effective, targeted, and cost-efficient strategy for enhancing resilience in deteriorated urban fabrics. The proposed model offers practical applicability for urban planners to facilitate site-specific interventions and strengthen resilience capacities in vulnerable urban environments.

Background: In today's world, various unforeseen events can threaten material and human resources, and in the meantime, hospitals and health care center employees are directly affected by events and crises. Nevertheless, there is no comprehensive and integrated study on the various mechanisms of crisis management for nurses' moral distress; therefore, the current study was conducted to design a model of crisis management with the moral distress management approach for nurses in the hospitals of the Iranian Universities of Medical Sciences, with a mixed approach.

Methods: The present study is an applied research project in terms of its purpose and is exploratory in nature, having been analyzed using a mixed (qualitative-quantitative) approach. In the first stage, the qualitative method and in-depth interviews were used to identify the model components. In the qualitative part, 16 university experts were selected by a purposive sampling method. The theme analysis method was employed to analyze the qualitative data using MAXQDA software. Next, in order to fit the model designed in the qualitative part, the structural equation modeling approach was used in the quantitative part.

Results: According to the results of the qualitative section, 7 main themes, including job burnout, the coronavirus disease situation, strategy, professional ethics, job stress, moral distress, crisis management, and 15 sub-themes were identified. In the quantitative section, it was found that there is a significant relationship between the leadership of digital transformation and the factors, and the designed model has an acceptable fit.

Conclusion: moral distress has always been associated with a negative effect on mental health in the form of anxiety and failure in the professional life of nurses, and in the absence of compatibility, the negative effects of moral distress are revealed in their professional life in the form of feelings of worthlessness, anger, depression, shame, and discomfort in life.

Background: Social determinants of health (SDH) are an emerging concept with significant influence on health and may have an impact on children presenting with acute illnesses including those with hypoglycemia. Herein, we explored the relationship between SDH and the prevalence of hypoglycemia and outcomes among children presenting with acute emergencies in northwestern Nigeria. 

Methods: This was a descriptive cross-sectional study of children admitted into the emergency ward of a tertiary hospital in Nigeria. At the presentation, we obtained socio-demographics, clinical features, diagnosis, random blood sugar, and outcomes (duration of hospitalization, death or discharged) and analyzed them with SPSS.

Results: We included 597 children with a median (interquartile range) age of 3.5 (1.3 to 8) years. Most children were under 5 (337; 56.64%), and males (328; 54.9%). Most mothers of the children included had no formal education, 76.7% (458). The prevalence of hypoglycemia (< 2.8 mmol/L) was 8.2% (49/597), with a 99% confidence interval (CI) of 6.3 to 10.7%.  Based on the age, children aged 13 to 59 months had the highest prevalence of hypoglycemia (11.0%) with 99% CI of 7.4 to 16.1%. At presentation, gender, parents' occupations, parents' education levels, and socio-economic classes were not associated with hypoglycemia. The case fatality rate for hypoglycemia was 16.3% (8/49), which was higher than children without hypoglycemia (4.1%; 20/482), p<0.05.

Conclusion: This study shows that among the SDH evaluated, only children aged 13–59 months were associated with hypoglycemia. In addition, the presence of hypoglycemia increased the odds of death by 4.5.

Background: Tobacco consumption remains a foremost cause of preventable illness and death worldwide. A study analyzing NFHS-5 and GATS-2 data indicates that men's tobacco usage in urban areas declined from 38.9% to 25.4% between NFHS-4 and NFHS-5, while women's usage decreased from 4.4% to 3.3%. These findings suggest a positive trend in reducing tobacco consumption in urban regions.To evaluate the patterns of using tobacco and assess the awareness of graphic health warnings among tobacco users in urban Patna, focusing on their understanding of health risks associated with tobacco.

Methods: 224 tobacco users in the urban Patna community participated in this 12-month cross-sectional study. Purposive sampling was used to choose the participants, and a pre-designed, pre-tested questionnaire was used for the interviews. PSPP software was used to analyze the data using frequency and percentages.

Results: Mean age of the participants was 38.12 ± 12.087. Out of 224 participants, majority of the participants use smokeless tobacco form. 89.2% participants said pictorial + written warnings are more understandable but 86.5% did not know which kind of warning has more impact on smokers.

Conclusion: Despite growing awareness of health risks, tobacco use remains prevalent due to various socioeconomic and cultural factors, highlighting the need for more effective public health interventions.

Background: Reducing self-differentiation and marital frustration in couples weakens the marital bond. The aim of the study was to compare the effectiveness of schema-based couple therapy (SBCT) and emotion-focused couple therapy (EFCT) on self-differentiation and marital frustration in couples.

Methods: This study was a quasi-experimental design involving couples referred to counseling centers in Mashhad Regions 1 and 2 due to marital dissatisfaction in 2023. Of these, 45 couples were randomly selected as a sample and placed in two experimental groups and a control group. The experimental group 1 received SBCT, the experimental group 2 received EFCT, and the control group received only general counseling. The research tools included the Self-Discrimination Questionnaire (DSI) by Skowron and Friedlander (1998) and the Kaiser Marital Dissatisfaction Questionnaire (1993) and afterward, a post-test was administered. The data were analyzed using SPSS software (version 24) and a multivariate analysis of covariance (ANCOVA) test.

Results: The results of the pairwise comparison showed that there is no significant difference between the mean scores of self-differentiation as a result of SBCT and EFCT (P>0.05), while SBCT had a greater effect on marital disillusionment than EFCT (P < 0.05).

Conclusion: Based on the results, SBCT can be effective in reducing marital disillusionment among couples.

Background: Employee empowerment in healthcare organizations, which refers to providing staff with the autonomy, authority, and confidence to make decisions and take initiative in their roles, plays a crucial role in enhancing both productivity and the quality of health services. This study aims to design an employee empowerment model for the Iranian Social Security Organization to improve organizational performance.

Methods: This applied research uses a mixed-methods approach. In the qualitative phase, meta-synthesis of 25 purposively selected studies and thematic coding led to an initial model of employee empowerment. In the quantitative phase, data from 210 healthcare employees were collected via a structured questionnaire. ISM was used to determine component relationships, and the model was validated using PLS-SEM in SmartPLS.

Results: The results revealed that the employee empowerment model in healthcare organizations consists of 10 dimensions and 57 components. Additionally, findings indicated that "employee empowerment for organizational productivity" had the most significant impact on other variables, suggesting that improving this factor could enhance overall organizational performance. Key factors identified for employee empowerment included leadership development, organizational support, reward management, feedback and evaluation, decision-making autonomy, and effective communication. Finally, recommendations were provided to enhance employee capabilities and improve the productivity of healthcare organizations.

Conclusion: Employee empowerment, driven by factors such as organizational culture, leadership, and training, plays a crucial role in increasing productivity and organizational commitment. Organizations that invest in human resource development not only achieve better performance but also foster innovation, sustainability, and growth.

Background: Understanding the complex interplay between academic behaviors, mental health challenges, and familial dynamics is crucial for promoting adolescent psychological well-being and scholastic success. This study investigated direct associations among academic incivility, suicidal ideation, and academic procrastination in female adolescents aged 13–15 in Ahvaz, Iran, while assessing the mediating effects of parent-child conflict on these pathways.

Methods: Employing a descriptive correlational design with path analysis, this research targeted first-year high school girls in Ahvaz during the 2023–2024 academic year (population: 3,587). A cluster-randomized sample of 384 participants was recruited from six schools in one district. Instruments included the 12-item Academic Procrastination Questionnaire (α=0.82), 21-item Academic Incivility Questionnaire (α=0.86), 19-item Beck Scale for Suicidal Ideation (α=0.76), and 15-item Parent-Child Conflict Questionnaire (α=0.86). Analyses encompassed descriptive statistics, Pearson correlations, and structural equation modeling via SPSS-27 and AMOS-24, with bootstrapping (5,000 resamples) for mediation testing.

Results: Significant direct paths emerged (all P<0.001): academic incivility to parent-child conflict (β=0.19), suicidal ideation to parent-child conflict (β=0.56), suicidal ideation to academic procrastination (β=0.32), and parent-child conflict to academic procrastination (β=0.25). No direct incivility-procrastination link was found (β=0.10). However, parent-child conflict mediated indirect effects from incivility to procrastination (β=0.02, P=0.007) and from suicidal ideation to procrastination (β=0.17, P<0.001). The final model exhibited excellent fit (χ²/df=1.32, CFI=0.99, RMSEA=0.04).

Conclusion: Among adolescents, parent-child conflict mediates the influences of academic incivility and suicidal ideation on procrastination, underscoring family dynamics' pivotal role. Targeted interventions enhancing familial communication could alleviate procrastination and bolster mental health outcomes.

This paper applies a Foucauldian discourse analysis to examine how political determinants, particularly governance, shape health outcomes in society, with a focus on the COVID-19 pandemic. Politics, as a form of power/knowledge, regulates health-related norms, policies, and institutional practices, thereby influencing the distribution of key social determinants such as environment, housing, education, and healthcare access. Empirical evidence indicates that democratic stability and good governance—characterized by transparency, accountability, participation, and organizational integrity—are critical for effective health system stewardship and equity. The COVID-19 pandemic vividly demonstrated these dynamics: countries with robust governance structures managed the crisis more successfully, while political instability, misinformation, and lack of accountability exacerbated health inequities and mortality. Foucault’s concepts of regime of truth and bio politics are used to analyse how governments exercised power over populations through public health measures, normalization of behaviours, and surveillance. This analysis underscores the need for health researchers and policymakers to critically engage with political determinants and governance structures to address health inequities and promote social justice in health.