Shahid Sadoughi University of Medical Sciences Journal of Social Behavior and Community Health 9 2 2025 11 1 Physical Activity for the Elderly and Different Ways of Their Participation 1607 1608 EN Mojtaba Yassini Department of Psychiatry, Addiction and Behavioral Sciences Research Center, Shahid Sadoughi University of Medical Sciences, Yazd, Iran Physical activity levels have declined in recent decades due to technological advances and the increased use of electronic devices and robots that handle many physical tasks for us. This decrease in physical activity poses health risks for individuals of all ages. For the elderly, engaging in physical activities is important(VaezMousavi et al., 2025), but they often face challenges such as a lack of motivation and insufficient strength to participate in these activities(Izquierdo et al., 2025). It is essential to tailor physical activities to their specific conditions to help improve their overall well-being. Encouraging the elderly to engage in more physical activities presents a significant health challenge, particularly in developing countries(Kohl III et al., 2025). Various solutions have been explored to motivate older individuals to participate in suitable physical activities. Numerous articles have been published on the importance of seeking support and fostering relationships between humans and animals to promote both physical and mental well-being(Kim & Lee, 2025; Martins et al., 2023; Northrope et al., 2025). The relationship between humans and pets varies significantly across cultures and has existed since the dawn of human social life, whether in small or large communities. Coexisting with pets—such as dogs, cats, and birds—is a common practice worldwide. In recent decades, there has been a surge in research focused on using companion animals, particularly dogs, to assist in the physical and mental treatment of the elderly(Friedmann et al., 2025). However, in Iran, cultural beliefs and policies pose challenges to implementing these health-promoting and therapeutic methods for seniors. Despite this, several suggestions can be made to enhance physical activity and overall health for the elderly within this context. Many elderly people may not have the conditions to keep dogs at home, but some solutions can be suggested. For example, we have animal care camps such as dogs in different cities of Iran, which are especially active with the voluntary cooperation of people. By observing cultural and legal issues, it is possible to take the elderly, especially the lonely elderly living in nursing homes, to suitable spaces outside the city and establish contact with dogs that are very social and establish deep and appropriate relationships with humans, and to do attractive walking and physical activity, of course under the supervision and cooperation of family members or volunteers serving in animal protection camps. This activity is a step towards promoting the physical and mental health of the elderly and helping stray dogs by going out and walking in nature, utilizing the effective connection between humans and nature. The current issue features an article discussing the impact of dog walking on the physical activity and health of volunteers at stray dog camps in the United States. Authors interested in this topic are invited to collaborate with us in publishing scientific articles from various perspectives that align with the journal’s mission to promote the health of older adults.  

Shahid Sadoughi University of Medical Sciences Journal of Social Behavior and Community Health 9 2 2025 11 1 Proximity to Fast Food Restaurants and Its Association with Obesity: A Public Health Concern 1609 1610 EN Ameneh Marzban Department of Health in Disasters and Emergencies, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran. payam emami Department of Emergency Medical Sciences, School of Paramedical Sciences, Kurdistan University of Medical Sciences, Sanandaj, Iran. Dear Editor Obesity has emerged as one of the most pressing public health challenges of the 21st century. Its prevalence has escalated globally, affecting both high-income and low- to middle-income countries (Jiwani et al., 2019; Sanchez-Vaznaugh et al., 2019). The consequences of obesity extend beyond individual health, contributing to increased rates of cardiovascular disease, type 2 diabetes, respiratory complications, and certain cancers (Hamano et al., 2018). Moreover, the economic burden is staggering, with obesity-related healthcare costs accounting for a significant portion of national health expenditures estimated at 1.2% of GDP in the United States alone (Van Hulst et al., 2025). While genetic and behavioral factors are often cited in discussions of obesity, growing evidence points to the critical role of environmental determinants (Hamano et al., 2018). Among these, the spatial distribution of fast food restaurants has garnered increasing attention (Jiwani et al., 2019). Studies have consistently shown that individuals residing in close proximity to fast food outlets are more likely to exhibit unhealthy dietary patterns, including higher consumption of energy-dense, nutrient-poor foods and lower intake of fruits and vegetables (Gallego & López-Gil, 2024; Hamano et al., 2018; Van Hulst et al., 2025). This trend is particularly alarming among children and adolescents, whose exposure to fast food near schools and recreational areas correlates with increased intake of sugary beverages and processed snacks (Jia et al., 2021). The proliferation of fast food establishments reflects broader socioeconomic and cultural dynamics (Jia et al., 2021). In many urban settings—particularly in countries such as the United States and the United Kingdom—fast food restaurants are disproportionately concentrated in low-income neighborhoods, where access to fresh produce and healthy food options is limited. For example, in the UK, 29% of people living in the most deprived areas reside in neighborhoods with the highest concentration of fast food outlets, compared to only 11% in the least deprived areas (Sanchez-Vaznaugh et al., 2019). Similarly, a multi-country study across 68 nations found that food insecurity was significantly associated with increased fast-food consumption, especially in low- and middle-income countries (Smith et al., 2022). This imbalance in the food environment exacerbates health disparities and perpetuates cycles of poor nutrition and obesity (Gallego & López-Gil, 2024).Despite public health campaigns which aims at promoting healthier eating habits, the nutritional profile of fast food offerings has remained largely unchanged, and aggressive marketing strategies continue to target vulnerable populations (Gallego & López-Gil, 2024). To address this multifaceted issue, The authors recommend a comprehensive public health approach that includes both regulatory and educational interventions (Jiwani et al., 2019). Zoning policies should be implemented to restrict the establishment of fast food outlets near schools, parks, and residential zones (Van Hulst et al., 2025). Simultaneously, incentives should be provided to encourage the development of supermarkets and grocery stores offering affordable, nutritious food options. Community-based programs that promote food literacy and empower individuals to make healthier choices are also essential (Jiwani et al., 2019). Furthermore, longitudinal research is needed to examine the causal relationship between food environments and obesity outcomes. Such studies should account for confounding variables such as socioeconomic status, physical activity levels, and cultural dietary preferences. By deepening the understanding of these dynamics, policymakers can design targeted interventions that are both effective and equitable. In conclusion, the spatial accessibility of fast food is not merely a convenience; it is a determinant of public health. Tackling obesity requires a shift in how we conceptualize and regulate our food environments. Through coordinated efforts across urban planning, education, and health sectors, we can create communities that support healthier lifestyles and reduce the burden of obesity.  

Shahid Sadoughi University of Medical Sciences Journal of Social Behavior and Community Health 9 2 2025 11 1 How Effective Is Tele-Nursing in Overcoming Psychological Barriers to Colonoscopy Screening? 1611 1614 EN Zohreh Karimiankakolaki Social Determinants of Health Research Center, Shk.C., Islamic Azad University, Shahrekord, Iran Colorectal cancer (CRC) is the third most common cancer and the second leading cause of cancer-related deaths worldwide. According to global statistics, over 1.9 million new cases of this cancer are diagnosed annually, resulting in approximately 935,000 deaths(Miller et al., 2019). The rate of colorectal cancer in Iran over the past years has been reported to be 7 cases per 100,000 people, making it the fourth most common cancer in Iran(Vakili et al., 2014). Colonoscopy remains the gold standard for CRC screening and diagnosis, capable of reducing mortality rates by 40–60% (Miller et al., 2019). Despite its proven efficacy, acceptance rates for colonoscopy, particularly in developing countries and rural areas, remain suboptimal(Wang et al., 2019). Colonoscopy screening represents a powerful tool in the fight against colorectal cancer, offering both early detection and preventive capabilities. While many high-income countries achieve screening coverage of 50–80%, low- and middle-income countries typically report rates below 10% (Dare et al., 2021, Gravitt et al., 2021, Petersen et al., 2022). This disparity reflects significant structural, financial, cultural, and educational barriers that disproportionately affect vulnerable populations(Petersen et al., 2022). In developed countries, psychological factors such as fear of pain, embarrassment, and anxiety about findings represent primary barriers(Miller et al., 2019, Yue et al., 2025). In developing countries, systemic challenges, including limited healthcare infrastructure, financial constraints, and low awareness, play a more significant role(Wang et al., 2019, Travis et al., 2024, Lim et al., 2021, Paudel et al., 2025). Numerous studies have identified fear and anxiety as major barriers to colonoscopy acceptance (Wang et al., 2019, Travis et al., 2024, Lim et al., 2021, Paudel et al., 2025). Accordingly, patients commonly report concerns about pain during the procedure (68% of cases), anxiety about potential complications such as bleeding or perforation (54%), embarrassment due to the invasive nature of the procedure (62%), and worry about possible findings (45%)(Miller et al., 2019, Yue et al., 2025). These psychological factors, combined with insufficient knowledge about the benefits of early detection and health literacy limitations, lead many individuals to avoid this critical screening method(Miller et al., 2019, Wang et al., 2019). Various educational interventions have been proposed to alleviate patient anxiety. Studies such as Shahrbabaki et al. (2022) have demonstrated that structured education programs can reduce patient anxiety by up to 35% (Shahrbabaki et al., 2022). In addition to requiring physical presence, these interventions are costly and time-consuming. Although digital interventions are available, they usually lack personal interaction and ongoing support(Evans et al., 2025). Tele-nursing—structured telephone counseling and education delivered by trained nurses—offers a promising solution to these challenges. Research indicates that tele-nursing interventions can significantly increase colonoscopy acceptance rates by addressing psychological barriers remotely(De Leo et al., 2022, Hsueh et al., 2016, Tsagkaris et al., 2023). This approach has been shown to reduce patient anxiety by providing personalized education and emotional support(Coughtrey and Pistrang, 2018). The method is particularly valuable in contexts with limited healthcare access, such as rural areas and during public health emergencies(Peng et al., 2024). The effectiveness of tele-nursing can be explained through self-efficacy theory. When patients receive targeted education and emotional support through telehealth platforms, their confidence in managing the procedure increases, thereby enhancing their willingness to undergo colonoscopy(Shahrbabaki et al., 2022). This method effectively addresses health literacy gaps and provides continuous support throughout the screening process(Cevheroğlu and Büyükyılmaz, 2024). Despite promising evidence, challenges remain in implementing tele-nursing. Variations in telehealth infrastructure and digital literacy may affect effectiveness across different populations (Shahrbabaki et al., 2022). Additionally, standardizing educational content and training specialized personnel require more attention(Evans et al., 2025). Future research should focus on developing culturally adapted interventions and measuring long-term outcomes in diverse populations(Chen et al., 2023). The study by Mashhadi et al. showed that face-to-face education and educational videos were able to reduce the anxiety of patients who were candidates for colonoscopy, and also emphasized that the implementation of such interventions should be planned according to the time constraints of medical personnel and the conditions of the patients, including cultural differences; their literacy level should also be taken into account(Mashhadi et al., 2020). This point can indicate the importance of distance education and tele-nursing.  

Shahid Sadoughi University of Medical Sciences Journal of Social Behavior and Community Health 9 2 2025 11 1 Relationship between Emotional Exhaustion and Chronic Fatigue in Nurses: The Moderating Role of Health-Promoting Lifestyles 1615 1624 EN Amin Barazandeh Department of Psychology, Faculty of Educational Sciences and Psychology, Islamic Azad University, Isfahan Branch (Khorasgan), Isfahan, Iran Maedeh khorasani Department of Psychology, Faculty of Educational Sciences and Psychology, Islamic Azad University, Isfahan Branch (Khorasgan), Isfahan, Iran Molouk Tahmasebi Department of Human Resources, Faculty of Educational Sciences and Psychology, University of Isfahan, Isfahan, Iran Mohammadhadi Farahzadi Department of psychiatry, Research center of addiction and behavioral sciences, Shahid Sadoughi, University of medical sciences, Yazd, Iran Sara Fazeli Faculty of Educational Sciences and Psychology, Department of Clinical Psychology, Alzahra University, Tehran, Iran Background: The present study aims to investigate the moderating role of health-promoting lifestyle in the relationship between emotional exhaustion and chronic fatigue in nurses. Methods: This was a descriptive correlational study and the statistical population of this study included nurses at Sinai Hospital and Heart Center in Isfahan who were working in the winter of 2022. Based on the Krejci and Morgan’s table, 280 questionnaires were distributed among the sample members, of which 266 questionnaires could be analyzed statistically. The data collection tools included the Maslach Emotional Exhaustion Questionnaire, the Chalder Chronic Fatigue Questionnaire, and the Walker Health-Promoting Lifestyle. Data analysis was conducted using two software programs: SPSS and Smart PLS. Results: The results demonstrated that nurses' chronic fatigue was significantly improved by emotional exhaustion (β = 0.146, p < 0.05). Furthermore, it was discovered that a healthier lifestyle had a greater impact on lowering chronic fatigue (β = -0.393, p < 0.001). An acceptable fit was shown by the model fit indices (SRMR = 0.080, NFI = 0.928, R2 = 0.42). Furthermore, the moderating effect of a healthy lifestyle was validated, showing that increased participation in healthy behaviors lessened the effect of emotional exhaustion on chronic fatigue. Conclusion: The results showed that a health-promoting lifestyle can play a moderating role in the relationship between emotional exhaustion and chronic fatigue in nurses; therefore, paying attention to factors affecting the increase in a health-promoting lifestyle can be considered in improving the conditions of nurses who are exposed to burnout and chronic fatigue and improve their performance.  

Shahid Sadoughi University of Medical Sciences Journal of Social Behavior and Community Health 9 2 2025 11 1 Physical Activity, Well-Being, and Community Engagement: A Socioecological Examination of Volunteers Walking Shelter Dogs 1625 1633 EN Melanie Sartore-Baldwin Department of Recreation Sciences, College of Health and Human Performance East Carolina University Greenville, NC 27858, United States Bhibha Das Department of Recreation Sciences, College of Health and Human Performance East Carolina University Greenville, NC 27858, United States Background: The purpose of this work is to examine physical activity levels of volunteers who walk shelter dogs at an open-admission animal shelter in the southern United States.  In doing so, shelter dog walking is presented as an activity of relational community engagement that can enhance well-being at all levels.   Methods: For this quasi-experimental study, a purposive sample of volunteer dog walkers in rural North Carolina was asked to record daily activity for a twelve-week period, with a total of 336 days submitted. Descriptive statistics and a paired-samples t-test were analyze the data. Results:  Data from a total of 336 days was collected.  Paired-samples t-test was performed to compare outcomes assessed on days shelter dogs were not walked and days they were walked by volunteers.  Significant differences were demonstrated for the steps taken (t(154) = 9.5, p < .001), the distance walked (t(154) = 9.0, p < .001), and the calories expended (t(154) = 5.2, p < .001).  Conclusion:  The implications of these findings are multi-level and suggest walking shelter dogs can be a beneficial activity for all parties involved.  At the micro-level, volunteers walked further, burned more calories, and accumulated more steps on days they walked shelter dogs.  In turn, shelter staff and the local community benefited at the meso- and macro-levels, respectively.

Shahid Sadoughi University of Medical Sciences Journal of Social Behavior and Community Health 9 2 2025 11 1 Profile of Unintentional Injuries at the Household Level among Under-Five Children in Faridkot, India: An Urban-Rural Comparison 1634 1641 EN Priyanka Singla Dept. of Community Medicine, Maharishi Markandeshwar Institute of Medical Sciences and Research, Mullana (Ambala), Haryana Saras Sanchaya b Dept. of Community Medicine, Gouridevi Institute of Medical Sciences and Hospital, Durgapur, West Bengal Shalini Devgan Dept. of Community Medicine, Guru Gobind Singh Medical College, Faridkot, Punjab Rupali Bhatia Dept. of Community Medicine, Guru Gobind Singh Medical College, Faridkot, Punjab Ramnika Aggarwal Department of Community and Family Medicine, AIIMS Bathinda, Punjab Background: Unintentional injuries, caused by energy transfers, cause over 2 lakh deaths annually, with drowning and falls being top causes in India. In impoverished neighborhoods, inadequate preventive measures, unstable living, and poor educational conditions contribute to the risk. Hence, this study was conducted to estimate the proportion of under-five children having unintentional injuries along with injury profile at household level in urban and rural areas. Methods: A cross-sectional study was conducted in an institution's field practice area from May 2019 to April 2020, focusing on households with under-five children. A total of 280 mother-child duos were included, with a 1:1.7 ratio for representation of both urban and rural populations. The study used a self-designed household survey questionnaire to assess injury profiles among under-five children. Chi-square analysis was used to assess the variation of variables across urban and rural areas. Results: Out of 280 households, injury was present in 115 (100%) urban and          155 (93.9%) rural houses. Overall, 270 (96.43%) of households reported at least one child injury event. Majority i.e. 254 (90.71%) households reported falls with a 907.14 injury rate/1000/year. Conclusions: Falls were the most common type of injury reported, with a high injury rate per 1000 children per year. Health education among adolescents, parents, school teachers, and district health authorities must address causes, severity, complications, and prevention of unintentional injury. Child injuries can be prevented through public health initiatives, requiring collaboration between international communities, governments, and civil society to create safer societies.  

Shahid Sadoughi University of Medical Sciences Journal of Social Behavior and Community Health 9 2 2025 11 1 Fourth-Generation Multi-Theory Model (MTM) of Health Behavior Change as a Novel Strategy for Sustainable Health Promotion: A Systematic Review 1642 1662 EN Manoj Sharma Department of Social and Behavioral Health, School of Public Health, University of Nevada Las Vegas, Las Vegas, USA Asma Awan Department of Social and Behavioral Health, School of Public Health, University of Nevada Las Vegas, Las Vegas, USA Ana Gonzalez Department of Social and Behavioral Health, School of Public Health, University of Nevada Las Vegas, Las Vegas, USA Sidath Kapukotuwa Department of Social and Behavioral Health, School of Public Health, University of Nevada Las Vegas, Las Vegas, USA MdSohail Akhter Department of Social and Behavioral Health, School of Public Health, University of Nevada Las Vegas, Las Vegas, USA Background: Health promotion has evolved significantly since its conceptualization, emphasizing the need for sustainable interventions to address population health challenges. This systematic review explored the effectiveness of the multi-theory model (MTM) of health behavior change in promoting sustainable health behavior. Methods: Following PRISMA guidelines, a comprehensive search was conducted across MEDLINE, CINAHL, APA PsycINFO, and Academic Search Premier databases. From 883 records sourced after removal of duplicates, abstracts were screened and followed by complete article reading and screening. Eight experimental studies (four randomized controlled trials and four quasi-experimental studies) published between 2016 and 2024 were included. Data extraction focused on study design, population, interventions, and outcomes, with risk of bias assessed using Cochrane tools (RoB 2 and ROBINS-I). Results: The findings revealed significant improvements in health behaviors, including reduced water pipe smoking, increased physical activity, healthier diets, and enhanced quality of life. MTM constructs—particularly participatory dialogue, behavioral confidence, emotional transformation, and practice for change—showed strong, statistically significant effects (p < 0.001). Process evaluations confirmed high intervention fidelity, strong engagement, and feasibility for community implementation. Despite small sample sizes, biases, and heterogeneous designs, the interventions effectively promoted sustainable, equitable behavior change across diverse populations. Overall, the results demonstrate the MTM’s potential for long-term health promotion through integrated behavioral and environmental strategies that align with public health sustainability goals. Conclusion The review underscores MTM's potential as a robust framework for sustainable health promotion. By integrating environmental sustainability principles and fostering community engagement, MTM-based interventions can address social determinants of health and promote long-term behavior change. Future research should focus on scaling MTM interventions, addressing methodological limitations, and exploring its integration with other sustainability frameworks to enhance public health outcomes.  

Shahid Sadoughi University of Medical Sciences Journal of Social Behavior and Community Health 9 2 2025 11 1 The Effectiveness of Visual-Auditory Perception Training on Working Memory and Attention in Children with Dyslexia 1663 1673 EN Najmeh Sadat Department of Psychology, Faculty of Educational Sciences and Psychology, University of Birjand, Birjand, Iran Mehdi Rezaei Department of Psychology, Faculty of Educational Sciences and Psychology, University of Birjand, Birjand, Iran Mohammad Hosien Salarifar Department of Psychology, Faculty of Educational Sciences and Psychology, University of Birjand, Birjand, Iran Background: Attention and working memory are impaired as reading correlates in children with dyslexia. This study was conducted with the aim of determining the effectiveness of auditory-visual perception training on attention and working memory in these children. Methods: The present research was a quasi-experimental study using a pretest-posttest design. The statistical population consisted of students referred to the learning disorders centers of Afagh, Shahid Hosseinzadeh, and Arvandroud in Birjand during the academic year 2024–2025. A total of 30 dyslexic students were selected through convenience sampling and randomly assigned into experimental group (n=15) and a control group (n=15). The experimental group participated in 16 sessions of auditory-visual perception training, while the control group received no intervention. To collect data, the Diagnostic Questionnaire for Specific Learning Disorders, the abbreviated form of the Stanford-Binet Intelligence Scale (ABIQ), the N-Back test, and the Continuous Performance Test (CPT) were used. Finally, data were analyzed using multivariate analysis of covariance (MANCOVA). Results: The results indicated a significant improvement in working memory (F =73.97, p<.001) and attention scores (F=43.61, p< .001) in the experimental group compared to the control group in posttest. Conclusions: These findings suggest that auditory-visual perception training can be effectively used as an intervention method to enhance attention and working memory in children with dyslexia.  

Shahid Sadoughi University of Medical Sciences Journal of Social Behavior and Community Health 9 2 2025 11 1 Navigating the Care Landscape for Spinal Cord Injury: A Sociological Insight 1674 1689 EN Kafayat Aminu Department of Sociology, Faculty of the Social Sciences, University of Ibadan, Nigeria Background: Spinal Cord Injury (SCI) is a major global public health concern, with a disproportionate burden in low- and middle-income countries (LMICs), particularly in Africa. In Nigeria, most research has emphasized clinical and rehabilitative outcomes, with limited attention to sociocultural aspects of SCI care. This study examined how people living with SCI and their caregivers navigate the healthcare landscape, and the sociocultural factors shaping their choices and experiences. Methods: This hospital-based, cross-sectional study was conducted between February 2018 and February 2019 at the University College Hospital, Ibadan, using a mixed-methods design. Data were collected through surveys with 108 informal caregivers, in-depth interviews with 30 SCI patients and caregivers, and 6 key informant interviews with traditional healers. Quantitative data were analyzed using univariate and bivariate statistics, while qualitative data was analyzed thematically. Results: Biomedical care was the most common initial response to SCI, driven by its acute presentation and availability of specialized services. Many participants later concurrently or sequentially utilized alternative care, including traditional bone setting (25.9%) and spiritual healing (71.3%). Medical tourism was reported in a few cases, and decision-making was heavily influenced by family, friends, and spiritual advisors. Despite skepticism, some caregivers reported psychological and cultural value in alternative therapies. No significant associations were found between caregivers’ socio-demographic characteristics and alternative care use. Conclusion: Healthcare-seeking for SCI in Nigeria reflects a complex blend of biomedical, traditional, and spiritual practices. Integrating culturally sensitive, community-based rehabilitation strategies with evidence-based care is critical for improving outcomes and ensuring continuity of care in LMICs.  

Shahid Sadoughi University of Medical Sciences Journal of Social Behavior and Community Health 9 2 2025 11 1 Beliefs and Behaviors toward Breast Cancer Screening among Women in Rural Southern Iran: A Health Belief Model Approach 1690 1699 EN Shahrzad Aseel Department of Behavioral and Environmental Health, School of Public Health, Jackson State University (JSU), Jackson, Mississippi, USA. Graduated Mahkameh Moradimehrabadi Technical Manager, Darugostar Medicine Distribution Center, Shiraz, Iran Masoumeh Karimi School of Nursing, University of Mississippi Medical Center, Jackson, MS, USA Adnan Ahmadiazad Faculty Member and Clinical Lecturer of Psychiatric, Clinical Science Department, Gulf Medical University, Ajman, UAE Mohammad Shahbazi Department of Behavioral and Environmental Health, Jackson State University, Jackson,MS,USA Background: Early detection of breast cancer through screening significantly improves survival rates; however, there is limited understanding of rural Iranian women’s beliefs and behaviors related to breast cancer screening. This study explores these beliefs and behaviors among women in the Khonj region of Iran, using the Health Belief Model (HBM) as a framework. Methods: A cross-sectional survey was conducted with 394 women aged 20–68 using a structured questionnaire assessing demographics, HBM constructs (perceived susceptibility, severity, benefits, barriers, self-efficacy, cues to action), and screening behaviors (BSE, CBE, mammography). Pearson correlations and logistic regression analyzed relationships between beliefs, risk factors, and screening behaviors. Results: The HBM focuses on the beliefs of the individual about health conditions to predict health-related behaviors. The model predicts that the higher the perceived susceptibility, severity, and benefit of a desired health behavior, the higher the likelihood of engagement in health-promoting behavior. This study revealed that participants had a low perceived susceptibility towards breast cancer (mean=2.34± 2.48) and a low confidence in doing a breast self-examination (mean=5.47± 4.68). However, they had a relatively high perceived benefit towards clinical breast examination (mean=15.15± 5.85) and mammography (mean=17.21± 7.91). Overall, participants perceiving the severity of breast cancer positively affected their perception of the benefits of getting breast self-examination (r =.119, p <.05), clinical breast examination (r =.276, p <.05), and mammogram (r =.238, p <.05). Conclusions: Women recognized the seriousness of breast cancer and the benefits of screening, but low perceived susceptibility and limited self-efficacy restricted participation in preventive behaviors. Accordingly, interventions targeting self-efficacy, BSE skills training, and provider-led CBE programs were recommended. Since early detection is the key to survival rate, raising awareness of breast cancer can positively affect the quality of life for women

Shahid Sadoughi University of Medical Sciences Journal of Social Behavior and Community Health 9 2 2025 11 1 The Relationship between Loneliness and Emotion Regulation in Predicting Internet Addiction among Men and Women in Yazd, Iran 1700 1708 EN Hasan Zareei mahmoodabadi Department of Psychology and Educational Sciences, Yazd University,Yazd, Iran Arezoo Jabin pour Department of Psychology and Educational Sciences, Yazd University,Yazd, Iran Zahra Esfahani Department of Psychology and Educational Sciences, Yazd University,Yazd, Iran Background: Cyberspace is a new form of social interaction that, despite its relatively short history, has successfully become integrated into people’s daily lives. Maladaptive patterns of Internet use and excessive engagement can lead to behavioral addiction and ultimately to internet addiction. The present study aimed to investigate the relationship between loneliness and emotion regulation and the tendency toward Internet addiction among men and women in the city of Yazd,Iran. Methods: The research method was a survey. The population included all men and women in Yazd in 1403, from which 300 people (150 men and 150 women) from different age groups were selected by random sampling. In this way, the link to the online questionnaire (Porsline) was placed on local social networks and popular groups in Yazd and in public places such as parks, universities and cultural centers, for optional completion by individuals. The quality of entry included participating, residing in Yazd, and having a minimum level of literacy. The output included incomplete or invalid responses in the questionnaires. Young's Internet Usefulness, Russell's Loneliness, and Gross's Emotion Regulation questionnaires were administered to the subjects. Then, the data were analyzed using SPSS26 software. Results: The results of the present study showed that there was a positive and significant relationship between loneliness and relationship (r=0.407, p<0.001). Also, a negative relationship was observed between emotion regulation and Internet use (r=-0.211, p<0.001). These results were felt in both sexes, with the difference that the correlation coefficient was stronger in men (men: r=0.503, p<0.001; women: r=0.307, p<0.001). F=35.802, p<0.001). In this model, loneliness was a positive and significant predictor of Internet use (β=0.389, p<0.001) and emotion regulation was a significant predictor (β=-0.171, p<0.001). In other words, increasing loneliness significantly increased the likelihood of using the Internet, and increasing pressure on other regulation significantly reduced Internet use. Conclusion: In summary, it can be concluded that loneliness and dysfunctional emotion regulation are good predictors of Internet use tendencies.  

Shahid Sadoughi University of Medical Sciences Journal of Social Behavior and Community Health 9 2 2025 11 1 Quality of Care, Physician–Patient Communication, and Patient Satisfaction: A Cross-Sectional Study in Selected Hospitals of Dhaka City, Bangladesh 1709 1722 EN Labony Khatun Department of Sociology and Anthropology, Shanto-Mariam University of Creative Technology, Uttara, Dhaka 1230, Bangladesh Shah Ehsan Habib bAustralian College of Community and Health Services, Parramatta, NSW 2150, Australia Background: Physician-patient relationships play an important role in the delivery of high-quality medical care. There are many concerns reported by patients about service quality, communication with healthcare providers, and overall hospital experiences in Bangladesh. Despite government efforts to improve public hospital management in Bangladesh, patient-centered care remains overlooked. This study assesses care quality, physician–patient communication, and factors influencing patient satisfaction. Methods: This study used a quantitative approach. Data were collected from 125 outdoor patients from two public hospitals. Survey interviews were conducted using a structured questionnaire based on convenience sampling. Chi-square test was used to determine the association of patient satisfaction in relation to care quality and physician–patient communication. Statistical significance is determined by P > 0.05. Results: A total of 125 patients (45.6% male, 54.4% female) were analyzed (mean age = 26.62 years; SD = 5.95 years). The mean score of patients' satisfaction with quality of care and physician-patient communication were 2.56 and 2.49, respectively, indicating lower satisfaction. The majority (60%) of patients reported that doctors did not attentively listen, with 64.8% had consultations lasting less than five minutes. A significant association was found between the number of patients seen together and satisfaction (𝜒2 = 8.82; p = 0.03). Additionally, consultation time had a strong effect (𝜒2 =21.199; p=0.000), where patients with consultations under five minutes (81.63%) were more likely to express dissatisfaction than those who had consultations lasting over 15 minutes (1.02%). Conclusion: The findings call for policies that foster patient-centered care by improving staff attitudes, consultation time, ethical oversight, and access to essential medicines to enhance trust and satisfaction in public healthcare.  

Shahid Sadoughi University of Medical Sciences Journal of Social Behavior and Community Health 9 2 2025 11 1 Challenges of Educating Single-Child Students: Perspectives of First-Grade Elementary Teachers in Yazd, Iran 1723 1734 EN Delaram Darvishpour Department of Psychology and Educational Sciences, Yazd University, Yazd, Iran Hossain Hassani Department of Educational Sciences, Faculty of Psychology and Educational Sciences, Yazd University, Yazd, Iran Veronese Guido Department of Human Sciences and Education Background: The aim of the current research is to study the views of first grade elementary school teachers in Yazd about the challenges of working with single-child students. Methods: In this qualitative descriptive study, 15 primary school teachers were selected through theoretical sampling. The criteria for determining sample size were achieving the theoretical saturation in extracted categories. The inclusion criteria were willingness to participate and at least one academic year of teaching experience with single-child students in the classroom. Data were collected through semi-structured face-to-face interviews conducted over a period of 3 months. Data were analyzed using qualitative content analysis with a conventional (inductive) approach. To ensure research rigor, the authors addressed trustworthiness through four criteria: (1) credibility (via member checking and peer debriefing), (2) transferability (thick description of context), (3) dependability (audit trail of research process), and (4) confirmability (researcher reflexivity journals). Triangulation was achieved through multiple data sources and analyst cross-checking. Results: Three core themes emerged from the analysis, with twenty distinct subthemes illuminating the challenges faced by single-child students in classroom settings:Social Competency Deficits (Social isolation, peer incompatibility, egocentric behaviors, conflict resolution difficulties, rule-compliance challenges, friendship formation barriers), Developmental Vulnerability Traits (Depressive tendencies, obsessive behaviors, low self-efficacy, poor resilience, indecisiveness, digital overreliance, self-regulation gaps, delayed social acceptance, passive listening, accountability deficits),Emotional Regulation Difficulties (Separation anxiety, perceived deviance distress, emotional dysregulation, excessive validation-seeking).    Conclusion: The study reveals that single-child students' developmental trajectories are significantly shaped by their limited peer socialization opportunities, which  are manifested in three interrelated domains: underdeveloped social competencies, heightened vulnerability in personality development, and impaired emotional regulation capacities. These findings suggest that the absence of sibling relationships may create distinct socialization challenges that classroom environments must intentionally address through targeted pedagogical interventions.  

Shahid Sadoughi University of Medical Sciences Journal of Social Behavior and Community Health 9 2 2025 11 1 The Critical Role of Programming Languages among Healthcare Data Scientists: A Systematic Review of Trends, Applications, and Future Directions 1735 1747 EN Seyedeh Nahid Seyedhasani Department of Medical Informatics, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran Afrooz Arzehgar Department of Medical Informatics, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran Mohamad Amin Bakhshali Department of Medical Informatics, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran Mostafa Sohrabifar Department of Medical Informatics, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran Seyyed Mohammad Tabatabaei Applied biomedical Research Center, Basic Sciences Research Institute, Mashhad University of Medical Sciences, Mashhad, Iran. Background: Artificial intelligence (AI) and data science have transformed healthcare by enabling advanced analytical techniques. AI-driven solutions rely on sophisticated algorithms that require specialized programming languages. Understanding the most commonly used programming languages is essential for healthcare data scientists in order to navigate this domain effectively. This study explores the trends and applications of programming languages in healthcare data science, highlighting their roles in machine learning (ML) and related methodologies. Methods: A systematic search was conducted in PubMed/MEDLINE, Scopus, and Web of Science (WoS) covering the period 2010–2023. Keyword combinations included artificial intelligence, machine learning, programming languages, healthcare, and medical informatics. After screening, 174 studies that explicitly mentioned programming languages in their abstracts were included for analysis. Results: Public health accounted for 50.6% (n=88/174) of the reviewed studies, followed by medicine at 25.9% (n=45/174) and genomics at 14.4% (n=25/174). Python emerged as the most widely used programming language, appearing in 37.47% (n=65) of the articles, followed by R at 29.6% (n=51) and MATLAB at 17.8% (n=31). Machine learning methods were predominant in genomics and epidemiology. The temporal trend showed an increasing preference for Python, while MATLAB use declined in recent years. Conclusion: The selection of programming languages in healthcare data science is influenced by technical needs, application-specific requirements, and collaboration dynamics. Python’s versatility has made it a dominant choice, while R’s statistical focus and MATLAB’s specialized toolkits remain significant in specific domains. The findings provide a framework for educational strategies, guiding data scientists in making informed decisions about language proficiency. Future research should evaluate the long-term implications of programming language adoption on healthcare analytics.