Student satisfaction and academic efficacy during online learning with the mediating effect of student engagement: A multi-country study.

The COVID-19 pandemic caused unprecedented changes to educational institutions, forcing their closure and a subsequent shift to online education to cater to student learning requirements. However, successful online learning depends on several factors and may also vary between countries. As such, this cross-sectional study sought to investigate how engagement of university students, a major driver of online learning, was influenced by course content, online interaction, student acceptance, and satisfaction with online learning, as well as self-efficacy across nine countries (China, India, Iran, Italy, Malaysia, Portugal, Serbia, Turkey, and the United Arab Emirates) during the COVID-19 pandemic. Using a questionnaire-based approach, data collected from 6,489 university students showed that student engagement was strongly linked to perception of the quality of the course content and online interactions (p < .001). The current study also indicated that online interactions are a major determinant of academic efficacy but only if mediated by engagement within the online learning context. A negative correlation between student engagement and satisfaction with online learning was found, demonstrating the importance of students being engaged behaviorally, emotionally, and cognitively to feel satisfied with learning. Academic efficacy and student satisfaction were explained by course content, online interaction, and online learning acceptance, being mediated by student engagement. Student satisfaction and, to a lesser degree academic efficacy, were also associated with online learning acceptance. Overall, the structural equation model was a good fit for the data collected from all nine countries (CFI = .947, TLI = .943; RMSEA = .068; SRMR = .048), despite differences in the percentage variations explained by each factor (no invariance), likely due to differences in levels of technology use, learning management systems, and the preparedness of teachers to migrate to full online instruction. Despite limitations, the results of this study highlight the most important factors affecting online learning, providing insight into potential approaches for improving student experiences in online learning environments.

Retaining nurses via organizational support and pay during COVID-19 pandemic: The moderating effect between intrinsic and extrinsic incentives.

AIM: There has been growing concern about the nurses' turnover intention as well as life satisfaction during COVID-19 pandemic in Iran. The past research has provided evidence on the effect of organizational support on nurses' job satisfaction and turnover intention. However, little is known about the underlying mechanism behind these associations. DESIGN: A cross-sectional survey was undertaken. METHODS: An online survey was conducted in Iran from May to June 2020 through Google Docs Forms. In total, 305 nurses were participated and completed the online survey. Data were analysed using structural equation modelling through (AMOS). This study was checked with the STROBE checklist. RESULT: The results showed that nurses' perception of organizational support was positively related to their job satisfaction which in turn decreases the turnover intention. Likewise, the job satisfaction partially mediated the relationship between organizational support and nurses' life satisfaction.

Concerns regarding the validity of nutrition self-efficacy questionnaire among Iranian elderly population.

There are some statistical concerns regarding a recently published article which has claimed to develop and psychometrically evaluate an instrument to assess the nutrition self-efficacy among Iranian elderly population.

Age Changes and Suicidal Activity in Iran Over the Past Decade: A Systematic Review and Meta-Analysis.

This review study fills an important gap by aiming to determine the age changes in attempted and completed suicide in Iran during the past decade. A systematic review of related articles in international and Iranian databases from January 2008 to January 2020 was first conducted and relevant studies were extracted based on established criteria. Results showed that the mean age of suicide in Iran is 29.8 (range 27.7 - 31.8) years old for men and 27.4 (range 25.8 - 28.9) for women (P < 0.0001). The youngest and oldest populations of completed suicide belong to eastern and central regions of the country respectively. Findings imply the critical importance of increasing awareness through educational programs and public health campaigns to increase awareness and reduce suicidal behavior in Iran.

The role of socioeconomic status in the relationship between social support and burden among cancer caregivers.

While much research has focused on the direct impact of socioeconomic status on cancer patients, what is not clear is the impact of socioeconomic status on social support and the burden of care for caregivers. In this study, a cross-sectional method, using a convenience sampling approach, was adopted to collect the data of 191 caregivers of cancer patients who were referred to the oncology clinic and cancer institute of hospitals affiliated with Tehran University of Medical Sciences, Iran. The participants completed a questionnaire on basic demographics, the short version of the Burden Scale for Family Caregivers, and Zimet Multidimensional Perceived Social Support. A maximum likelihood exploratory factor analysis with oblique rotation to assess the factor structure of the constructs and the measurement model was conducted. The two-factor model consisting of 22 items explained 65.116% of the variance. There was a significant negative relationship between social support and burden (b = -0.771, P < 0.001) and also between economic status and burden (b = -0.308, P < 0.01). Moreover, there was a significant positive association between the interaction of social support and economic status and burden (b = 0.138, P < 0.05). More specifically, the negative relationship between social support and burden was statistically stronger for participants with weak economic status (b = -0.663, P < 0.001) than those with good economic status (b = -0.356, P < 0.01). Social support and an individual's economic status are essential determinants of caregiver burden. Further studies are recommended to better inform the precise support needed by caregivers to enhance their quality of life, and ultimately, that of the patients under their care.

A time-series prediction model of acute myocardial infarction in northern of Iran: the risk of climate change and religious mourning.

BACKGROUND: Although various studies have been conducted on the effects of seasonal climate changes or emotional variables on the risk of AMI, many of them have limitations to determine the predictable model. The currents study is conducted to assess the effects of meteorological and emotional variables on the incidence and epidemiological occurrence of acute myocardial infarction (AMI) in Sari (capital of Mazandaran, Iran) during 2011-2018. METHODS: In this study, a time series analysis was used to determine the variation of variables over time. All series were seasonally adjusted and Poisson regression analysis was performed. In the analysis of meteorological data and emotional distress due to religious mourning events, the best results were obtained by autoregressive moving average (ARMA) (5,5) model. RESULTS: It was determined that average temperature, sunshine, and rain variables had a significant effect on death. A total of 2375 AMI's were enrolled. Average temperate (°C) and sunshine hours a day (h/day) had a statistically significant relationship with the number of AMI's (ß = 0.011, P = 0.014). For every extra degree of temperature increase, the risk of AMI rose [OR = 1.011 (95%CI 1.00, 1.02)]. For every extra hour of sunshine, a day a statistically significant increase [OR = 1.02 (95% CI 1.01, 1.04)] in AMI risk occurred (ß = 0.025, P = 0.001). Religious mourning events increase the risk of AMI 1.05 times more. The other independent variables have no significant effects on AMI's (P > 0.05). CONCLUSION: Results demonstrate that sunshine hours and the average temperature had a significant effect on the risk of AMI. Moreover, emotional distress due to religious morning events increases AMI. More specific research on this topic is recommended.

Spiritual Well-Being, Social Support, and Financial Distress in Determining Depression: The Mediating Role of Impact of Event During COVID-19 Pandemic in Iran.

This study investigates the relationship between spiritual well-being, social support, and financial distress with depressive symptoms due to the COVID-19 pandemic. A path analysis was used to analyze data collected from 1,156 Iranian participants via an online survey. The results showed that spiritual well-being and social support were negatively related to depressive symptoms and financial distress. The impact of COVID-19 events showed negative associations with depressive symptoms. In addition, the link between spiritual well-being and financial distress with depressive symptoms was partially mediated by the impact of events.

A model of nurses' intention to care of patients with COVID-19: Mediating roles of job satisfaction and organisational commitment.

AIM AND OBJECTIVES: This study aims to test the hypothesis that job satisfaction and organisational commitment might play a mediating roles between workload, quality of supervision, extra-role behaviour, pay satisfaction and intention to care of patients with COVID-19. BACKGROUND: Given the high incidence of coronavirus and shortage of nurses in Iranian hospitals, learning about nurses' intention to care for patients with COVID-19 is important. DESIGN: In this cross-sectional study, 648 Iranian nurses were surveyed during March 2020. The online questionnaire consisted of two parts. The mediating role was explored for the following: job satisfaction and commitment in the association of workload, quality of supervisor, extra-role behaviours, and pay satisfaction with the intention to care. The study adhered to STROBE checklist for cross-sectional studies. RESULTS: The results of this study show that job satisfaction and organisational commitment mediated the relationship of nurses' workload, quality of supervisor, extra-role behaviours, and pay satisfaction with the intention to care for patients with COVID-19. CONCLUSION: The results of the study indicate the importance of job satisfaction and organisational commitment as mechanisms that help to understand the association of nurses' workload, quality of supervisor, extra-role behaviours and pay satisfaction with the intention to care during the COVID-19 pandemic. RELEVANCE TO CLINICAL PRACTICE: Hospital managers need to attend to the role of nurses' job satisfaction and other organisational factors to ensure that they can cope with the challenges of the COVID-19 pandemic.

Psychometric evaluation of the comprehensive score for financial toxicity scale among Iranian cancer patients.

OBJECTIVES: This study aims to evaluate the psychometric properties of the Persian version of the financial toxicity (COST) scale in a sample of cancer patients in Iran. In less developed societies where patients generally encounter more difficulties managing the various cost of treatment, the COST measure should be verified according to the context. METHODS: A total of 398 cancer patients completed a demographic questionnaire and the 11-item Persian COST. Performing a Maximum likelihood exploratory factor analysis, extracted three factors of financial worry (four items), financial distress (three items), and direct and indirect cost of control (three items), accounting for 65.204 % of the variance. The results of conducting confirmatory factor analysis indicated that the three-factor measurement model had a good fit. RESULTS: The highest load was related to financial distress, and the lowest was related to direct and indirect costs concerns. Moreover, the measurement model showed good items consistency, good construct reliability, and good construct validity in terms of convergent and discriminant validity. This study highlights the importance of validating the scale in different contexts as the structure and loadings of the factors have appeared diffidently in various countries. CONCLUSION: The validated Persian COST can be used in future studies in Iran as a reliable and valid scale to measure financial toxicity among cancer patients. POLICY SUMMARY: This study evaluated the validity of the Persian version of the financial toxicity (COST) scale among Iranian cancer survivors. The findings emphasize using appropriate and valid measures adjusted to the context.

The Relationship Between Spirituality Dimensions and Death Anxiety among Iranian Veterans: Partial Least Squares Structural Equation Modeling Approach.

The purpose of the present study was to examine the relationship among spiritual intelligence, spiritual well-being and death anxiety among Iranian veterans. In this predictive correlational study, 211 veterans completed King and DeCicco's Spiritual Intelligence Scale, Paloutzian and Ellison's Spiritual Well-being Scale and Templer's Death Anxiety Scale-Extended. After confirming the reliability of the constructs using intra-class correlation coefficient, partial least squares structural equation modeling method was utilized to assess the impact of spiritual well-being and spiritual intelligence on death anxiety. This study found a significant positive relationship between spiritual intelligence and death anxiety after controlling for the effects of age, education level and disability. However, there was a significant negative relationship between spiritual well-being and death anxiety among Iranian veterans. Negative relationships were found between spiritual well-being and death anxiety among Iranian veterans. However, spiritual intelligence had a positive impact on death anxiety.

Prioritizing Factors Affecting Deceased Organ Donation in Malaysia: Is a New Organ Donation System Required?

PURPOSE: The gap between the demand and the supply of human organs for transplantation is on the rise in Malaysia, despite the efforts of governments to promote donor registration. Factors affecting willingness to donate are contextual and vary from country to country. This research mainly focuses on the selection of most suitable organ donation system through factors affecting willingness to donate in Malaysia. The objectives of this study are to prioritize those factors acting as the pillars of the organ donation system and further to select the most suitable organ donation system for Malaysia. PATIENTS AND METHODS: The data were collected from 35 experts by using a bipolar questionnaire. The study applied an analytical hierarchal process (AHP) for prioritization factors contributing to willingness to donate and then selection of a suitable organ donation system based on prioritized factors. RESULTS: Based on the AHP results, it is evident that donation perception (0.36) has the highest priority in influencing organ donation rates, followed by socioeconomic status (0.32), demographic factors (0.23), and financial incentives (0.09). Further, our results challenge the existing opt-in donation system in Malaysia and present a presumptive approach as a suitable system for increasing deceased donation rate in Malaysia. Presumptive approach promotes the role of health-care professionals in securing the family consent. CONCLUSION: This approach is a person-oriented rather than process-oriented strategy and it relies on designated requesters' skills to evoke altruism among bereaved families. Based on results, the authors recommended that relevant government agencies focus on training nurses to discuss donation with bereaved families and raising public awareness.

Construct validity of the Herth Hope Index: A systematic review.

OBJECTIVE: The psychological construct of hope is an important determinant for mental health and well-being. The availability of valid and reliable instruments to measure hope is, therefore, critical. Despite a large number of psychometric studies on the Herth Hope Index (HHI), its construct validity has not yet been determined. Therefore, this paper aimed to conduct a systematic review of the psychometric properties of the HHI. METHODS: Databases such as PubMed, Science Direct, Google Scholar, Magiran, SID, IranDoc, and IranMedex were evaluated systematically using the terms "HHI," "psychometric," "validity," "reliability," and related terms (with the use of OR and AND operators) and no restrictions on the year of publication. A total of 13 eligible studies were found published between 1992 and 2018 in the USA, Portugal, Switzerland, Iran, Germany, Petersburg, Japan, the Netherlands, Lima, Peru, and Norway. The methodology used in the available studies included principal component analysis (n = 6), maximum likelihood estimation (n = 5), and principal axis factoring (n = 1). One study did not point the methodology. RESULTS: Four studies reported the total extracted variances to be less than 50%, six studies reported variance between 50% and 60%, and three papers reported variance that exceeded 60%. Of the papers that examined the factor structure of the HHI, two studies reported a one-factor solution, seven reported two factors, and four reported a three-factor solution. Although the HHI is the most widely translated and psychometrically tested tool in languages other than English, psychometric variations in factor solutions remain inconsistent. CONCLUSION: Findings highlight the need for future research that appraises the validity of the HHI in different countries, and how the measure relates to other scales that evaluate hope.

Fear of negative appearance evaluation and attitude towards mammography: Moderating role of internal health locus of control,cancer worry and age.

Background: Mammography screening tends to reduce mortality rate through early detection. One of the barriers to mammography screening is fear of negative appearance evaluation(FNAE). This study investigated the impact of internal health locus of control, breast cancer worries and age on the relationship between FNAE and attitude towards mammography. Methods: A cross-sectional, questionnaire-based survey design was used. Samples were Iranian women, living in Iran, aged at least 30 years old, without any history of cancer, and had not performed mammography previously based on self-report. In total, 823 samples were collected through conducting an online survey from April to June 2016. The questionnaire consisted of several instruments including attitude toward breast cancer screening procedures scale, FNAEscale, the internal dimension of the multidimensional health locus of control, and two items to measure breast cancer worry. Using covariance-based structural equation modeling the model was tested. Results: The interaction of FNAE with internal health locus of control (ß = -0.128, P<0.05,CI: -0.200, -0.056), breast cancer worry (ß = 0.090, P<0.05, CI: -0.162, -0.017), and age (ß =-0.095, P<0.05, CI = -0.163, -0.026) was significant. The three tested moderators dampened the positive relationship between FNAE and negative attitude towards mammography. Conclusion: More information about the screening procedure should be given to women to overcome their fear. The findings indicate the need for interventions seeking to shift women's health locus of control from external to internal. Women with low level of cancer worry need more attention.

Can financial rewards complement altruism to raise deceased organ donation rates?

BACKGROUND: Organ supply-demand in developing countries worldwide has continued to widen. Hence, using a large survey (n » 10,412), this study seeks to investigate whether human psychology could be used to inculcate philanthropy to raise deceased organ donation rates. METHODS: Three models were constructed to examine multidimensional relationships among the variables. Structural equation modeling was applied to estimate the direct and indirect influence of altruism, financial incentives, donation perception, and socioeconomic status simultaneously on willingness to donate deceased organs. ETHICAL CONSIDERATIONS: The study was approved by the University of Malaya ethics committee. RESULTS: The results show that altruism amplifies the impact of socioeconomic status and donation perception on willingness to donate. Also, the results show that financial incentives cannot complement altruism to raise organ donation rates. Hence, investing in education and public awareness enhances altruism in people, which then increases the propensity to donate. CONCLUSION: Evidence suggests that governments should allocate resources to increase public awareness about organ donation. Awareness programs about the importance of philanthropic donations and the participation of medical consultants at hospitals in the processes form the foundation of such a presumptive approach.