Background: Adapting existing health programs for synchronous remote implementation has the potential to support vulnerable youth during the COVID 19 pandemic and beyond. Methods: The Stanford Youth Diabetes Coaches Program (SYDCP), a school-based health promotion and coaching skills program, was adapted for remote implementation and offered to adolescents from low-income communities in the US: an urban site in San Jose, CA and rural sites in Lawrence County, MO, and Central Valley, CA. Participants completed online pre- and post- surveys. Analysis included paired T-tests, linear regression, and qualitative coding. Results: Of 156 enrolled students, 100 completed pre- and post-surveys. Of those: 84% female; 40% Hispanic; 37% White; 28% Asian; 3% African American; 30% other race. With T-tests and regression models, the following measures showed statistically significant improvements after program participation: health knowledge, patient activation, health understanding and communication, consumption of fruits and vegetables, psychosocial assets of self-esteem, self-efficacy, problem-solving, and ability to reduce stress. Technology barriers were frequently reported at Lawrence County site. 96% participants reported making a lifestyle change after program participation. Conclusions: Remote implementation of health promotion programs for vulnerable youth in diverse settings has potential to support adoption of healthy behaviors, enhance patient activation levels, and improve psychosocial assets. The burden of chronic disease across the globe is rising daily and disproportionately affects individuals from low-income and ethnic minority populations ,2. The iThe COVID-19 global pandemic highlighted numerous ways in which inequality leaves marginalized groups more vulnerable to disease and poor health outcomes . SpecifiFor youth, the pandemic has resulted in widespread challenges to physical and mental health related to isolation stress, childcare deficits, reduced access to nutritious food, decreased opportunities for physical activity, and decreased insurance coverage . For exaTo best support vulnerable youth during this time, experts recommend facilitating avenues of communication and empowerment through school and community-based programs . When inIn this study, the authors assess the implementation of a school based, health promotion program adapted for synchronous remote learning for adolescent participants from rural and urban underserved communities. The validated health promotion program, called the Stanford Youth Diabetes Coaches Program (SYDCP), has been implemented widely over the past twelve years with community partners as an in-person program in 12 US states and in Canada ,23,24. IAlthough the SYDCP has been shown to provide significant benefit to participants when implemented in person, in this study the authors aim to assess whether remote participation can also benefit and support youth to improve and promote key health related outcomes as described in the methods section. This study aims to understand whether remote participation is associated with benefit for participants by comparing responses between pre and post participation surveys.The Stanford Youth Diabetes Coaches Program (SYDCP) is a validated “train the trainer program” in which health care professionals and trainees teach healthy high school students  from underserved schools to coach family members with chronic health conditions . The curIn March 2020, the SYDCP team rapidly adapted the SYDCP curriculum from an in-person program into a completely remote program that delivered synchronous virtual lessons through an online portal. A SYDCP research team member observed each of the pilot remote classes and took notes on student participation to adjust and improve the SYDCP curriculum accordingly. By September 2020, the curriculum was revised to include features designed to engage students remotely including: setting ground rules for remote participation etiquette; reducing text content of program slides; utilizing the chat feature to have participants respond to quizzes and discussion questions; enabling role plays by asking volunteers to unmute; asking participants to use objects at home to learn subjects like reading nutrition labels; and encouraging instructors to verbally address chat comments and questions in real time.In this study participants were recruited from seven underserved high schools in three geographic sites: San Jose, CA ; Central Valley, CA ; and Lawrence County, MO . Recruitment method varied by site, but the goal was to recruit approximately 30 high school students per implementation group. In San Jose, participation in the SYDCP was offered to all high school students (grades 9–12) through widespread program advertisement facilitated by the high schools. All interested high school participants were invited to join the program. In Lawrence County, MO, SYDCP was part of a school class and participation in SYDCP was mandatory for all students enrolled in that class. In the Central Valley, high school teachers at each high school selected and invited high school students whom they believed would benefit most from participation. The sample selected was a convenience sample, based on participant availability and interest in participating in the SYDCP. Researchers received informed consent or assent from all participants.The program was offered at each site during the pandemic from September 2020 through June 2021 . One sitThe San Jose, CA site remote implementation was part of a long-established partnership between a family medicine residency program and one local underserved high school. The program switched to remote implementation because of the pandemic. Data was gathered from two remote cohorts  that met weekly as an elective after-school program. High school student participants were recruited by a teacher who directs the high school’s medical magnet program, and students were offered hours toward their medical magnet certificate for participation in the program. Family medicine residents taught the sessions as part of their community medicine rotation. The family medicine residents received an introductory email that included logistics for the course, the PowerPoint files for all the classes which include instructor guides, and a short informational video on screen sharing and sound management to support their remote implementation of the program. Attendance and homework were tracked in a spreadsheet to see which students could receive credit for the course, and students accessed the coaching assignments through Google drive.In Central Valley, CA, SYDCP was taught remotely over Zoom as part of a new partnership through the Central Valley Area Health Education Center (CVAHEC). Data was gathered from three remote cohorts (Spring 2021) that met weekly as an elective after-school program for which the high school students would receive a certificate of completion. The CVAHEC, through their established network of health care provider training programs and high school health educators, was able to recruit family medicine residents and medical students to teach high school students. The CVAHEC also utilized their established relationship with the local school district to identify high school partners that meet our target population criteria. For this pilot, CVAHEC staff distributed recruitment materials to the high schools and coordinated the high school students’ enrollment in the program. The residents and medical students were asked to view the instructional video developed for the San Jose cohort. CVAHEC staff hosted the Zoom class sessions; sent weekly email reminders about the classes; and distributed and collected the coaching assignments on Google drive. A member of the SYDCP team observed each class session to assess fidelity to the model.In Lawrence County, MO, the SYDCP was implemented with support from the Missouri Department of Health and Senior Services. Data was gathered from two remote cohorts  that met weekly during school hours as a mandatory activity that counted towards the course grade. Remote implementation of SYDCP was initially planned for at least three rural high schools in Lawrence and Barry Counties, but due to limited availability of health educators and insufficient time to adjust yearly curriculum at other high schools, SYDCP was implemented in one rural high school. The program was taught remotely over Zoom by community health educators. The Fall 2020 session was taught by the local high school health educator. The Spring 2021 session was taught by a health educator from the University of Missouri extension department that works with the local communities. Health educators lived locally and had graduate level professional degrees in health education and public health. Health educators received orientation about the SYDCP curriculum in a one-hour presentation that included information on the curriculum and coaching assignments. During orientation, a nursing doctorate student who had implemented the SYDCP at a rural setting in 2017 shared her experiences and tips for student engagement as well. Health educators routinely communicated with site supervisor (author S.P.) with any questions.The SYDCP aims to reach youth and their families in low-income and/or under-represented and underserved communities. Because of concerns about confidentiality for the youth participants, the research team did not ask youth participants to report on their socio-economic status. Instead, demographics of high schools were researched, and a general understanding of the socio-economic status of youth participants was determined by examining the percentage of students receiving free or reduced lunch at that high school as reported in 2020–2021 . In CentThe following outcome measures were assessed: health knowledge; patient activation; health communication and understanding; health behaviors ; psycho-social assets ; and lifestyle changes that promote health. Outcomes and measures used to evaluate these outcomes are highlighted in Participants were asked to complete online pre-surveys before the first program session and online post-surveys immediately after program completion. In addition to basic demographics, the online pre and post surveys included questions to assess the six major outcome measures as described in Health knowledge was assessed with eight previously validated questions from the University of Michigan’s Diabetes Research and Training Center’s Brief Diabetes Knowledge Test  and the ®10) licensed through lnsignia Health 2020 .The three youth assets assessed were self-esteem, self-efficacy, and problem solving. Significant improvements were seen across all three assets: self-esteem , we used the analysis of covariance (ANCOVA) with the change in outcomes of interest as dependent variable, location as independent variable of interest and grade and gender as additional independent variables adjusted for in the multiple linear regression. The authors created multivariate linear regression models to assess changes in health knowledge, patient activation, health communication and understanding, health behaviors and youth psychosocial assets. The authors calculated difference in post and pre-test scores, as the dependent variable and analyzed whether there were differences in outcomes by location when controlling for baseline  score, grade, and gender. Other independent variables were also explored, but since they correlated with the main independent or controlling variables, those results are not shown here. For example, the authors found correlation between ethnicity and location, hence developed two different sets of multivariate linear regression models. When the authors replaced location with ethnicity, ethnicity was not a significant predictor of outcomes when controlling for baseline score, grade, and gender.In five outcomes there was no significant difference by location when predicting outcome improvements, meaning that improvements in outcomes were not statistically different among the three locations when controlling for baseline score, grade, and gender. These outcomes were: change in health knowledge, patient activation, consumption of fruits and vegetables, ability to reduce stress and youth psycho-social asset of self-esteem .th and 10th grade were significantly more likely to improve talking about health and understanding of health compared to older participants in 11th and 12th grades. Regarding physical activity, participants in Lawrence County, MO were significantly more likely to increase physical activity compared to participants in San Jose, CA or Central Valley, CA. Consumption of sugary foods and sugary drinks significantly decreased in San Jose, CA but not in Lawrence County, MO and Central Valley, CA. For psychosocial assets of resilience (self-efficacy and problem solving combined), participants in rural Central Valley were significantly more likely to increase youth assets of resilience compared to participants in San Jose, CA and Lawrence County, MO sites when controlling for baseline scores, grade, and gender . I started with 2 meals a day with this method, at least 4–5 days a week at my designated eating times. I meal prepped so it was less stressful, and it worked very well!Theme 2—Increased physical activity: 48% participants reported exercising more, including utilizing time management skills to make time for exercise. A participant in the Central Valley wrote:One action plan is to exercise more with my aunt. For example, we went to walk every day for about 1 h and did zumba for 30 min after. Also, to eat healthier, we both stopped eating junk food 4 days a week and started drinking 3 water bottles every day.Theme 3—Improved sleep: Nearly 35% participants reported increasing hours of sleep and described adjusting sleep schedules, reducing cell phone use before bedtime, and improving quality of sleep. A participant from San Jose wrote:I realized how much sleep could affect my lifestyle and life span. I am starting to get more sleep and prioritizing my night routine. I tried a sleep mask and going to bed earlier. I now get around 7–8 h of sleep which is a big change from before.Theme 4—Stress reduction: 14% participants reported reducing stress and described incorporating breathing exercises and meditation, as well as practicing yoga. Many participants reported making numerous lifestyle changes because of program participation. A participant in Lawrence County noted:I start eating less snacks in between meals and started being more active by playing more with my dogs.A participant in Central Valley described extensive changes made in the process of working with her grandfather:As a part of this program, I created various action plans for my grandfather and I. For my grandfather, we worked on a walking plan to incorporate more walking and stretching into his schedule because he has to sit for the entire duration of his work on a tractor, he decided on splitting a bit of time during his lunches to stretch and take a light walk around the tractor, then once at home off of work, another walk around the ranch, he made this plan to fit into 6 out of the 7 days. We also made an action plan to incorporate daily breathing techniques that he would incorporate into the beginning of the day before breakfast and at the end of the day right before bed which was reminded with an alarm. For myself, I made an action plan to start running five times a week after a light breakfast at 6 am. I cut down my brownie/cookie intake only having 1–2 after lunch every other day. I also increased the amount of water I drank by replacing soda with water with lemon.Another participant in Central Valley reports making numerous lifestyle changes:Changes I have made are eating healthier, going to bed earlier and putting my phone down at least 10 min before going to sleep, and reducing stress by taking time to breathe. When it comes to healthier eating, I have started to not buy snack foods like chips and I have started reading food labels. With reducing stress, I have made sure to wake up 5 min earlier to take a couple deep breaths before getting ready for the day.Other reported lifestyle changes included reading more, procrastinating less, and getting more involved in their parents’ healthcare.When asked what participants liked about the program, 96% participants agreed or strongly agreed that they learned something new about diabetes and 92% that the program helped them connect with the family member they coached.This study demonstrates that remote implementation of a health promotion program for vulnerable youth is feasible and has the potential to empower at-risk youth from a variety of demographic and geographic backgrounds. After remote implementation, overall, program participants demonstrated statistically significant improvements in health knowledge, patient activation scores, health communication and understanding, health behaviors, and psycho-social assets. Additionally, 96% of participants reported making a lifestyle change to improve their health after program participation.®10 scoring places individuals into one of four activation levels which correlate with patient motivation and readiness for change with patients at Level 1 disengaged and overwhelmed, lacking confidence and skills necessary to manage their own health and patients at Level 4 adopting and maintaining new behaviors and a healthy lifestyle [When comparing results between the three sites, it is notable that participants at each site demonstrated statistically significant improvements in health knowledge and patient activation scores. The improvements in patient activation scores and resultant increases in patient activation levels of study participants are particularly meaningful because higher patient activation is strongly associated with better health outcomes , decreasifestyle . Among sifestyle .The improvements in participants’ understanding of how to improve their health speaks to the practical knowledge and skills learned during the program. Concordantly, as participants gained confidence in their ability to improve their health, they also reported increased family communication about health. Increased family communication about health has been shown to improve health beliefs and behaviors  which isOur results indicate that in most outcomes including health knowledge, patient activation, consumption of fruits and vegetables, ability to reduce stress and youth self-esteem the improvements were statistically significant among the three locations, and there was no statistical difference between locations when controlling for gender and grade. However, in some outcomes, specifically health communication and understanding, and self-efficacy and problem solving, there were some statistically significant differences between locations, and greater improvements were observed in Central Valley, CA. On the other hand, regarding consumption of sugary foods, participants in San Jose, CA were more likely to decrease consumption than participants in Central Valley, CA or Lawrence County, MO.Overall, our study shows that the remote implementation of the SYDCP has benefit for vulnerable adolescents from a variety of settings. Although the participants were all vulnerable youth secondary to the socio-economic status of their families and communities, the three implementation sites varied by geography and demographics. Additionally, program instructors had different educational backgrounds across sites. Findings suggest that the program had benefit to participants in different ways depending on site of implementation which suggests the program can support youth from varied backgrounds and utilizing instructors with different health educational backgrounds. Understanding why significant improvements were seen for certain measures at some but not all sites requires further investigation.Another important finding was how almost all participants reported making lifestyle changes to improve their health because of program participation. Those findings validate the significant improvements seen in the quantitative outcome measures and the qualitative data that provided examples of the specific changes made. One area in which the qualitative data did not correlate with the quantitative outcome measures was improvement in physical activity. Although many participants reported increases in physical activity in their open-ended survey responses, analysis did not yield statistically significant improvements in the quantitative outcome measures related to physical activity. One explanation for this discrepancy may be that the quantitative physical activity questions were too limited in their wording and answer choices and were not able to capture the changes that participants made.Technology challenges were more common in rural locations . This discrepancy was not surprising as there continues to be a significant gap in home broad band access between rural residents and urban residents . Our parAlthough there are numerous documented successful web-based health promotion programs for youth, in review of the literature, no studies were found that explore the efficacy of validated health promotion programs for youth adapted from in-person to synchronous remote implementation. A few studies explore the process and feasibility of adapting programs for remote implementation. For example, one recent study examined the feasibility and acceptability of adapting a sexual health program for virtual implementation for Native American teens . SimilarIn another study in which a different teen sexual health program targeting Latino youth, El Camino, was adapted for a virtual setting, the authors focused on lessons learned during remote implementation . AlthougAnother example of adapting an in-person health program for vulnerable youth during the COVID-19 pandemic is the suicide prevention program, PC CARES which targets Alaska Native youth . Wells eAt the outset of the COVID-19 pandemic, SYDCP community partners requested an option to provide the program remotely. The SYDCP research team immediately adapted the SYDCP program for remote implementation and offered the remote program to three community partners in different settings around the United States to engage youth in health promotion despite the school cancellation that resulted from the pandemic.Because this study arose from the unexpected and needed adaptation of the SYDCP during the pandemic, we had to work within the realities of the situation to plan the study and assess the efficacy of the program. Because the remote adaptation of the program was implemented quickly in response to community need, there was not enough time to perform a randomized controlled study or even a quasi-experimental design.As a result, this study is limited in numerous ways. First, selection bias exists because students either elected to participate or were recruited by teachers to participate. For that reason, our results are not generalizable to all vulnerable youth. Second, because 36% of our study enrollees did not complete post-surveys, our data may be skewed towards participants who are more motivated or who benefited more from the program or who had better access to Zoom technology. Results may not be generalizable to male youth due to limited post-survey completions by male students. Third, although the study demonstrated that the program can be taught successfully by instructors with different medical backgrounds, it is likely that the instructor difference led to some variability in how the program was administered. Fourth, post participation evaluation only occurred immediately after the eight-week program and therefore could not assess duration of program benefits. Fifth, our research team did not assess program impact for the family members being coached and can thus only draw conclusions about program impact for the adolescent participants. Lastly, as explained above, this study did not include a control group which makes it difficult to determine whether our results are a direct consequence of program participation or whether other variables affected the outcome measures.Future studies will include control groups; aim to better engage and measure program effectiveness for vulnerable male youth; and assess whether program benefit is sustained beyond program participation.Programs are needed to support and empower vulnerable youth to mitigate the rise in chronic illness and disproportionate burden of disease in low-income and racial and ethnic minority populations. This study demonstrates that even in circumstances when in-person programmatic activities are not possible, remote synchronous participation in school-based health promotion and health coaching programs such as SYDCP has potential to support vulnerable youth from a variety of geographic settings and demographic backgrounds to improve health knowledge, patient activation scores and levels, health communication and understanding, health behaviors, and psycho-social assets. Program participation may also encourage adoption of lifestyle changes to improve health. Thus, it is possible that youth health programs developed for in-person implementation can be adapted successfully for remote participation and yield significant benefit for participants.


A regional Australian Primary Health Network (PHN) has been subsidising administrative staff from local general practices to undertake the Medical Practice Assisting (MPA) course as part of its MPA Program. The MPA Program aimed to upskill administrative staff to undertake clinical tasks and fill in for busy or absent Practice Nurses (PNs), freeing up PNs to increase revenue-generating activity, avoiding casual replacement staff wages, and increasing patient throughput. An impact assessment was undertaken to evaluate the impact and estimate the economic costs of the MPA program to the PHN, general practices, and students to inform future uptake of the intervention.The Framework to Assess the Impact of Translational Health Research (FAIT) was utilised. Originally designed to assess the impact of health research, this was its first application to a health services project. FAIT combines three validated methods of impact assessment—Payback, economic analysis and narratives underpinned by a program logic model. Quantified metrics describe the impacts of the program within various “domains of benefit”, the economic model costs the intervention and monetises potential consequences, and the narrative tells the story of the MPA Program and the difference it has made. Data were collected via online surveys from general practitioners (GPs), PNs, practice managers; MPA graduates and PHN staff were interviewed by phone and on Zoom.FAIT was effective in evidencing the impacts and economic viability of the MPA Program. GPs and PNs reported greater work satisfaction, PNs reported less stress and reduced workloads and MPA graduates reported higher job satisfaction and greater confidence performing a range of clinical skills. MPA Program economic costs for general practices during candidature, and 12 month post-graduation was estimated at $69,756. With effective re-integration planning, this investment was recoverable within 12 months through increased revenue for practices. Graduates paid appropriately for their new skills also recouped their investment within 24 months.Utilisation of MPA graduates varied substantially between practices and COVID-19 impacted on their utilisation. More strategic reintegration of the MPA graduate back into the practice to most effectively utilise their new skillset could optimise potential benefits realised by participating practices.The online version contains supplementary material available at 10.1186/s12960-022-00781-6. In Australia, primary health care (PHC) covers health care unrelated to a hospital visit including health promotion, prevention, early intervention, treatment of some acute conditions, and management of chronic conditions. Through a fee-for service arrangement administered by the Australian Federal government, primary health care services are delivered by community health centres, Aboriginal community-managed medical services and allied health clinics, but the bulk of PHC is provided by general practices, the setting of focus in this study. These practices have a mix of staffing including general practitioners (GPs), practice nurses (PNs), practice managers (PMs), allied health professionals and administrative staff/receptionists.Workforce issues in general practice, mainly the recruitment and retention of GPs and PNs, have been concerning across many parts of Australia –5 and otA range of policy, legislative and industry initiatives have been utilised to address these workforce issues such as the Stronger Rural Health Strategy and the National Strategic Framework for Rural and Remote Health , 11, 12.In Australia, primary health networks (PHNs) were established by the Federal Government to increase efficiency and effectiveness of medical services and improve coordination of care to ensure patients receive the right care, in the right place, at the right time . In 2018The MPA Program originated in 2003 at GP Partners, a division of general practice in Queensland . HoweverIn 2020, the Embedded Economist program funded by New South Wales Regional Health Partners and the Australian Medical Research Future Fund was implemented at HNECC PHN. The program enabled PHN staff to work with health economists and impact specialists from the Hunter Medical Research Institute to undertake an impact evaluation of the MPA Program, as it was being applied by the PHN. It was anticipated that the results would inform ongoing PHN investment in the MPA program and inform general practices and their staff considering this intervention in the future, not just in Australia, but in other developed nations facing similar workforce issues.The primary aims of the impact evaluation were to assess the impact of the MPA Program on participating general practices and their staff, capture the economic cost of the MPA Program to the PHN, practices and students, and determine whether the monetisable consequencesThe setting for the impact assessment was the HNECC PHN and general practices across the Hunter, New England, and Central Coast regions in the Australian state of New South Wales who had participated in the MPA Program in 2018 and 2019. The HNECC regions cover an area of approximately 130 000 square kilometres and are home to 1.2 million residents, a quarter of whom live in rural, regional, and remote locations. The combined area has a total of 410 general practices and nine Aboriginal Medical Services; 65 of them participated in the MPA Program in 2018 and 2019 .FAIT was developed specifically to improve research translation and to optimise and assess the impact from research investments . FAIT haA detailed program logic model (PLM) was developed to map the pathway between the need for the MPA Program and the eventual impact of the intervention see Fig. . Within Next, a modification of the Payback Framework, first developed by Buxton and Hanney , was appA cost-consequence analysis (CCA) was used to compare costs of the MPA program to its potential consequences for general practices and for MPA students. A CCA does not limit itself to standard metrics like cost–benefit ratios. Rather it lays out the costs and consequences for decision makers to make their own subjective judgements on program cost-efficacy and whether the investment choice represents value for money.All resources used for the MPA program were reported in monetary terms (economic costs). This included actual cash costs and the ‘opportunity costs’ of directing resources to the MPA program rather than another activity. A bottom-up approach was used to capture all resources from the perspectives of HNECC PHN, participating practices and MPA students. All resources were identified, valued, and aggregated separately as detailed in Additional file Consequences were focussed on realised and potential benefits for general practices and MPA graduates. These would also indirectly benefit the PHN whose main aim and function is to improve the delivery and quality of primary care, including general practice, within its jurisdiction. The consequences included were limited to those that were monetisable. Consequences not readily monetisable  are presented in their natural units and discussed within the Payback metrics Table .The main monetisable consequences were efficiencies gained through utilisation of MPA graduates in their upskilled role for half a day, every day; and opportunities for the practice to gain from increases in billable services. The administrative duties performed by the MPA graduate prior to the completion of their course  would be picked up by the Practice Manager or a casual administration assistant. Financial and administrative data to inform on actual level of billable services was unavailable, so modelling was informed by survey data and supplemented with expert input from PHN staff.Monetizable consequences for graduates were their potential higher remuneration following course completion. Additional wages were projected over a full year and based on survey responses and an aspirational goal of MPAs being paid $3.00 extra per hour . Sensitivity analyses was used to provide the range of potential returns to both general practices and MPA graduates.The narrative was built from the program logic model and impacts and responses from study participants, all of whom provided consent for their qualitative responses to be included in the analysis. Comments were grouped by key themes and captured the various perspectives around impact. The results for the application of FAIT to the MPA Program are summarised and presented in a scorecard format by each method.Data collection methods for each component of FAIT are summarised here:Payback: Online surveys and interviews with participants and administrative records from the HNECC PHN.Economics: Online surveys and interviews with participants, administrative records from the HNECC PHN, and secondary data and expert input provided by the MPA Coordinator and Primary Care Improvement Officer from the PHN.Narrative: Online surveys and interviews with participants.Participants represented five groups of general practice staff: (1) practice managers; (2) current MPA students; (3) PN’s; (4) GP’s and (5) MPA graduates. Eligible general practices were those that were listed as having at least one MPA student enrolled between January 2018 and December 2019. Eligible practice managers, PNs and GPs were those who were working at those practices and eligible MPA students were those who were currently enrolled in the MPA Program, at the time of the survey. Eligible MPA graduates were those who had graduated by June 2020. All eligible practices were invited to participate. Of the 62 eligible practices, 36 had one current MPA student (58%) and 26 (42%) had a returned graduate. Of these 26 practices, 4 had their MPA graduate leave their practice by the time of the survey, leaving only 22 eligible MPA graduates. To supplement general practice staff views, the MPA Coordinator and Primary Care Improvement Officer from the PHN, and the Program Manager for Health Programs at UNE Partnerships were consulted due to their experience with the program and capacity to provide contextual clarity.Online surveys were programmed and deployed using REDCap (Research Electronic Data Capture) a secure web application for building and managing online surveys and databases . Five suA total of 57 general practice staff completed surveys  conduct extra revenue earning tasks as qualified by the course; or (b) replace practice nurses on lower-level tasks, freeing the nurses for higher revenue services such as creating GP management plans. Scenario analysis found potential annual gross extra revenue of $136 474 to $152 672 or a mid-point of $144 673 per practice  documenting the pathway between the MPA Program and its impact on practices, their staff, MPA students and graduates; (ii) identifying metrics that could evidence impact from the MPA Program; and (iii) raising awareness within the PHN team as to other benefits of the MPA Program that had not been previously considered such as a reduction in stress for PNs or certain measures of increased productivity such as additional patients seen in the practice per day. The economic analysis gave transparency to the economic cost involved in the delivery of the MPA Program from the perspective of the PHN, participating practices and MPA students. It was also able to project the monetary value of some of the potential consequences of the investment. The narrative articulated the pathway from the need for the MPA Program  to the impact; and expressed benefits of the MPA Program that could not be expressed in quantitative terms such as “improved relationships between MPA graduates and their colleagues and patients” and “confidence to undertake further tertiary studies- primarily in health care”.The impact assessment found the MPA Program to be a feasible, economically viable strategy for rural general practices in Australia to address workforce shortages and retention issues. When appropriately managed, the program increased potential for revenue generation and improved patient care, and increased job satisfaction for MPA graduates, PNs and GPs, an outcome linked to improved workforce retention , 9, 29. Qualitative findings suggested other benefits including reduced workload, reduced stress, and reduced pressure on PNs in the practice. The MPA graduates also benefited through their enhanced market value (through their upskilling and increased confidence) and increased job satisfaction associated with undertaking more meaningful tasks. In addition to existing strategies like recruiting more overseas trained doctors, and training more local doctors , 30, theThe impact assessment also revealed a large variation in the utilisation and remuneration of MPAs, resulting in a variance in the anticipated benefits for participating practices. This suggests that greater consistency in the utilisation and remuneration of MPA graduates and more supported collaborative integration planning involving all practice staff and the PHN, could optimise the benefits of the program. In addition to being adequately renumerated for their additional skills, MPA graduates also suggested that greater recognition of the role, a dedicated award, and greater direction on how to manage this role within the practice team would improve the overall MPA experience. Support from the PHN through providing relevant good practice models and exempler case studies of succesful MPA graduate reintegration and utilisation would be of benefit. Additionally, the impact assessment highlighted the importance of embedding impact planning and evaluation processes upfront to minimise data collection burden and costs and optimise impact. Additional file The comprehensive collection of evidence and its analysis, as per the FAIT methods, was a key strength of the study. The co-development of the PLM allowed the project team to fully consider all components and perspectives of the MPA Program and develop appropriate metrics to measure its impact. The Payback metrics enabled a comprehensive assessment of the full range of possible impacts of the MPA Program. The CCA gave transparency to the investment from all three perspectives  informing future implementation and scale-up of the initiative. The narrative brought to light the benefits of the MPA course from the perspective of the MPA graduates and their voices were given prominence.The collaborative research approach provided capacity and capability benefits to PHN staff. PHN staff improved their confidence and skills in measuring and reporting impact in a multi-dimensional way. PHN staff also co-produced the research and have benefitted from the networking and learning opportunities with HMRI staff.COVID-19 is likely to have impacted on interview response rates, thereby limiting the representativeness of the results. New mandated infection control measures and increased demand for consultations meant that general practices and AMSs were under additional pressure between November 2020 and February 2021, the period when the survey was open. While remedial measures were taken to increase response rates , they remained below an ideal level. It is also likely that practices who responded to the survey represented practices that had a more positive MPA experience than non-responding practices. This could have biased the results in favour of greater positive impact from the MPA program.COVID-19 also impacted MPA students in the 2019 and 2020 cohorts increasing their workload and their course time, thus reducing the number of participating practices with returning MPA graduates. COVID-19 also limited MPA graduates’ abilities to fully utilise their skills given the high volume of phone consults during this period. The timing of this impact assessment did not provide sufficient lag to realise longer term benefits of the MPA Program such as reduction in workforce shortages.Potential monetisable consequences used in the modelling were not exhaustive. According to survey results and expert input, MPAs can also increase gross revenue through paid quality improvement activities (e.g. undertaking Practice Incentive Program (PIP) quality improvement measures including height and weight measurements for all patients) which attract a government payment  that manThe absence of Aboriginal and/or Torres Strait Islander MPA students, MPA graduates, or staff from Aboriginal Medical Services gives no visibility to the impact of the MPA Program on their operations and means that their perspectives are missing from this study. This limits the applicability of these findings to Australia’s First Nation peoples and the services controlled by their communities. Low numbers of Aboriginal MPA students in the course is thought to be partially due to a preference for attaining the Aboriginal Health Worker qualification rather than the MPA qualification and is an area worthy of further review and discussion. The absence of direct feedback from patients, consumers and caregivers is a further limitation that was unable to be addressed within the resources and timing of this study. Future evaluations of the MPA Program should consider the inclusion of patient perspectives and views to provide a more holistic evaluation.The HNECC PHN initiative and resultant outcomes and impacts associated with regional general practice administrative staff undertaking the MPA Program have been significantly beneficial to a number of participating practices Critically, the impact assessement of the MPA program indicates there is room for improving utilisation of MPA graduates in the workplace and that the program has broader long term potential to mitigate the impacts of regional workforce shortages and low retention, improve primary practice efficiences and gross revenue and further grow and upskill the regional health workforce.Additional file 1: The Framework to Assess the Impact of Translational Health Research. Description: A detailed description of the FAIT method.Additional file 2: Unit Costs by Perspective. Description: Detailed unit costing of the MPA program resources from HNECC PHN, participating General Practices and MPA students.Additional file 3: Supplementary Methods: Assumptions associated with estimating program costs and detailed survey and interview data. Description: Overview of assumptions and methods for establishing program costs and a detailed description of the survey and interview process.Additional file 4: Consequence and Revenue Modelling. Description: Detailed description of the methods for consequence modelling and revenue scenarios for general practices with a returning MPA graduate.Additional file 5: Recommendations for optimising the benefits and impacts from the HNECC PHN Medical Practise Assisting Program. Description: Outline of key recommendations for optimising the benefits and impacts from the HNECC PHN Medical Practise Assisting Program as demonstrated through the FAIT Impact assessment.


Drastic increases in the rates of maternal depression and anxiety have been reported since the COVID-19 pandemic began. Most programs aim to improve maternal mental health or parenting skills separately, despite it being more effective to target both concurrently. The Building Emotional Awareness and Mental health (BEAM) program was developed to address this gap. BEAM is a mobile health program aiming to mitigate the impacts of pandemic stress on family well-being. Since many family agencies lack infrastructure and personnel to adequately treat maternal mental health concerns, a partnership will occur with Family Dynamics  to address this unmet need. The study’s objective is to examine the feasibility of the BEAM program when delivered with a community partner to inform a larger randomized controlled trial (RCT).A pilot RCT will be conducted with mothers who have depression and/or anxiety with a child 6–18 months old living in Manitoba, Canada. Mothers will be randomized to the 10 weeks of the BEAM program or a standard of care . Back-end App data  will be used to examine feasibility, engagement, and accessibility of the BEAM program; cost-effectiveness will also be examined. Implementation elements  will be piloted to estimate the effect size and variance for future sample size calculations.In partnership with a local family agency, BEAM holds the potential to promote maternal-child health via a cost-effective and an easily accessible program designed to scale. Results will provide insight into the feasibility of the BEAM program and will inform future RCTs.NCT05398107) on May 31st, 2022.This trial was retrospectively registered with ClinicalTrial.gov (The online version contains supplementary material available at 10.1186/s40814-023-01260-y. Note: The numbers in curly brackets in this protocol refer to SPIRIT checklist item numbers. The order of the items has been modified to group similar itemsFebruary 2023, Version 2Leslie E. Roos, Department of Psychology, University of Manitoba, 190 Dysart Road, Winnipeg, MB, R3B 0S8. Email: leslie.roos@umanitoba.ca.The funding source had no role in the design of this study and will not have any role during its execution, analysis, interpretation of data, or decision to submit results for publication.Principle Investigators and Co-Investigators: Study planning; Organization of Parent Advisory Board (PAB); Design and conduct of trial; Preparation of protocol and revisions; Application to ethics review board; Recruitment; BEAM Administration; Reporting of adverse events; Responsible for master file; Budget administration; Data verification; Conduct and interpret analyses; Publication of study reportsCommunity Partner, Family Dynamics: Design of study; Recruitment; BEAM Administration; Interpretation of findingsParent Advisory Board (PAB): Design of trial; BEAM Administration; Interpretation of findingsMaternal depression and anxiety have dramatically increased during the COVID-19 pandemic . Key risExisting therapies are insufficient to address family mental health needs. Programs designed to improve parent mental health and parenting skills separately have small effects with minimal improvements in the past 20 years . AlthougThe Building Emotional Awareness and Mental health (BEAM) program is a mHealth program designed to mitigate the impacts of stress on family mental health and the program’s feasibility is ready to be tested in partnership with an established community agency. The BEAM program was co-designed with a patient advisory board  based oFamily agencies typically lack the infrastructure and personnel capacities to adequately treat maternal mental health concerns , with thN = 65) found clinically significant change in 66.7% of mothers with persistent depression (anxiety symptoms were not assessed) [Our pilot, non-superiority trial of the BEAM program among mothers of toddlers (ssessed) . Qualitassessed) , 26, ourssessed) –30.To examine the feasibility of the BEAM program when delivered by a community agency. Feasibility indicators include recruitment rate, retention rate, and perceived usefulness of BEAM, for example.To assess preliminary implementation elements of the BEAM program to estimate effect size and variance for future sample size calculations (treatment effect) and compare the BEAM program to SOC  in primaA two-armed, parallel-design RCT will occur where participants receive the 10-week app-based BEAM program  or MoodMission . Mothers will be randomized to the BEAM or MoodMission program with a 1:1 allocation as per a computer-generated randomization schedule stratified by participant availability for weekly group telehealth sessions. Self-reported repeated measures data will be collected online via Research Electronic Data Capture (REDCap)  from motThis trial is registered with ClinicalTrials.gov (NCT05398107) and will follow Standard Protocol Items: Recommendations for Intervention Trials (SPIRIT) guidelines , 33. AllParticipants will reside in Manitoba, Canada. Manitoba is in the center of Canada and has a population of 1.3 million. Recent results from a predominantly Manitoban sample of mothers with children 0–18 months old suggested significantly elevated rates of depression and/or anxiety since the onset of the COVID-19 pandemic [Participants will be recruited using online social media advertisements , posters in Manitoba, Canada, and poster-sharing via Family Dynamics listserv. Informed consent will be collected electronically from all mothers on three occasions, before (a) the eligibility screener, (b) the MINI , and (c)Participants must (a) identify as a mother , (b) have a child between 6 and 18 months old at recruitment, (c) be 18 years old or above, (d) reside in Manitoba, Canada, with access to a cellular network, (e) score > 9 on the Patient Health Questionnaire-9 Item (PHQ-9)  and/or tSee Table Mothers will complete an online questionnaire to determine eligibility. This questionnaire will include an author-compiled sociodemographic and suicidality/self-harm questionnaire as well as the PHQ-9  and GAD-If deemed eligible on the eligibility screener, mothers will be invited to complete a psychodiagnostics mental health assessment   with traAll mothers deemed eligible to participate will be invited to complete a series of questionnaires via RedCap to assess baseline data of interest before allocation. See Table The BEAM and MoodMission App-based programs will be offered via mobile device . Participants will be provided with a mobile device, if required.The BEAM program was designed to promote intergenerational well-being through the treatment of maternal mental illness and preventing child mental health concerns, by integrating parenting and self-compassion skills with UP modules , 18. TheThe BEAM program is a 10-week guided mental health and parenting program where participants move through modules with a cohort of other mothers experiencing depression and/or anxiety. Each week includes 10–30 min of psychoeducational video content, weekly mood tracking, a 1-hour weekly group telehealth session with content review and facilitated discussions in breakout rooms, access to an online forum to cultivate peer support, and assignments to practice key skills. The BEAM program content has been developed in collaboration with our PAB and the Family Dynamics team.BEAM clinical coaches will consist of mental health therapists , parent coaches from Family Dynamics, and a peer coach. Parent coaches are mental health staff  from Family Dynamics. Peer coaches are mothers who recently completed a program targeting their own mental health needs and who have agreed to help promote maternal mental wellness . ClinicaThe BEAM program will include psychoeducational materials consisting of separate weekly videos on mental health and parenting skills. These videos will be approximately 5 to 15 min long each . Mental health videos will provide easily digestible information on emotion regulation strategies adapted from the UP, an evidence-based transdiagnostic treatment for depressive and anxiety disorders , 18, andBrief weekly questionnaires on depression  , anxietyWeekly group telehealth sessions will provide mothers with the opportunity to discuss program material with coaches and peers, ask questions, and gain a sense of community. There will be three telehealth groups with different schedules to accommodate as many mothers as possible.An online community forum will provide mothers with the opportunity to reflect on learned skills from the BEAM weekly modules and access social support by connecting with other mothers in the program. This will be a confidential, closed forum overseen by peer and parent coaches. The forum will consist of open-ended discussions between participants, peer advice, and sharing of anecdotes/non-identifying photos of their wellness journey. Mothers will be able to ask parent and peer coaches mental health- and parenting-related questions.The SOC arm will receive MoodMission, an App-based program effective in the treatment of moderate depression and anxiety in adults and increasing their well-being –30. MoodMothers will be given 2 weeks to complete the post-intervention questionnaires via RedCap after the BEAM and MoodMission programs are complete Clinical coaches will receive an alert from REDCap  if suiciOnce a mother is randomized, all efforts will be made to follow the participant for the study duration. A recent iteration of BEAM for mothers of children 18–36 months old had an 83.7% retention rate (16.3% lost to follow-up) . First, Pre-specified success criteria are identified in Table Back-end App data, collected via Google Analytics and Firebase, will be used to assess recommended mHealth engagement variables , 47: (a)α = 0.88) [α = 0.92) [Data on maternal depression (PHQ-9) and anxiety (GAD-7) will be used to estimate effect size for a future large-scale RCT and to assess preliminary mean change in variables of interest across assessment timepoints. The PHQ-9 includes  nine ite = 0.88) . Anxiety = 0.92) . Items oAdditional questionnaires will assess maternal mental health  maternal demographics , (b) child demographics , and (c) household demographics .Other variables known to impact adult mental health and child development will be collected including the Adverse Childhood Experiences (ACEs) Questionnaire, the author-compiled Recent Stressful Experiences Questionnaire  , and theParticipants will be permitted to receive concomitant care during study involvement. Concomitant care  will be measured during the post-intervention and follow-up surveys .N = 80). With an estimated BEAM sample size of 40 mothers, we aim to achieve questionnaire completion and retention rates of 80% to within a 95% confidence interval of ± 12.4% as well as a treatment adherence rate of 50% to within a 95% confidence interval of ± 15.5%.As this is a pilot and feasibility study, a sample size calculation is not appropriate. However, our target sample size of 30 participants per group is consistent with prior recommendations and will provide data to sufficiently establish BEAM feasibility , 63. Acchttp://www.randomlists.com/team-generator) stratified by participant availability for weekly group telehealth sessions. To conceal allocation sequence, randomization will occur once 10 mothers have been deemed eligible.Mothers will be randomized to the BEAM or MoodMission program with a 1:1 allocation. Randomization will occur in blocks of 10 using a computer-generated randomization schedule . The enrollment of mothers to the proposed study and their allocation to BEAM versus SOC will be completed by two separate research assistants. The research assistant designating treatment condition will have no interaction with participants . Trial participants, clinical coaches, parent coaches, and peer coaches will not be blinded to treatment condition given the behavioral nature of the treatment provided. Data analysts also will not be blinded to treatment condition.An outline of all questionnaires to be used is presented in Table Participants will enter questionnaire responses in REDCap  which isAll analyses will be conducted using IBM Statistical Package for the Social Sciences (SPSS). Descriptive statistics will be computed for the total sample and between the two groups  for demographics and outcome measures at pre-intervention.Descriptive statistics from back-end App data, telehealth group attendance, and questionnaires  will be used to examine program feasibility, engagement, and acceptability.α of 0.05 will determine statistical significance. Aggregate variables will be computed, by converting each measure to a standardized z-score then taking the average. Results will be reported as means and 95% confidence intervals for all comparisons. Bonferroni corrections are considered very conservative [Data on maternal depression (PHQ-9)  and anxiervative , and it ervative .A separate subgroup analysis will be conducted with mothers who report at-risk substance use. This analysis will assess outcomes among mothers with at-risk substance use in the BEAM program and MoodMission. Between- and within-group differences will be examined among mothers with at-risk substance use .Amendments to this protocol will be submitted to the University of Manitoba’s REB who will review and approve amendments prior to implementation. Participants will re-consent to amendments, if required. Amendments will also be submitted as updates on ClinicalTrials.gov.The BEAM program will be provided on a secure platform. Participant confidentiality will be protected throughout the study in accordance with the University of Manitoba’s REB guidelines, with exceptions to confidentiality including suspected cases of child maltreatment  and imminent harm to self or others. Only specific individuals will have access to data who are trained in the University of Manitoba’s ethics and data safety protocols, have completed PHIA training, and have taken an oath of confidentiality.All data, including identifying information, will be password protected and stored on REDCap . All datPrecautions will be taken to manage confidentiality on the online community forums which will include a Data Management Protocol, participant agreed upon Terms of Use . Coaches will have the ability to remove posts which violate the terms of use and participants will be emailed should any concerns arise. Security measures also include monitoring of the forums by the study team and the ability for other participants to anonymously flag posts for review.During the weekly telehealth group sessions, participant anonymity cannot be guaranteed. Telehealth sessions will be hosted on a secure Zoom Healthcare account which is password-protected. At the first group session, the clinical coaches will outline limitations of confidentiality and anonymity. Participant attendance and client records will be tracked through the Titanium platform, hosted by the University of Manitoba Psychological Service Centre, which is PHIA-compliant.The authors of this RCT declare no conflicts of interest.All data will be housed in a secure database accessible by the study investigators.If it is determined that a mother requires further services, they will be referred to a clinician or clinic, and provided with a list of mental health resources.Research findings will be disseminated to academic and public audiences. Several publications describing the feasibility of the BEAM program will be published in peer-reviewed journals following Consolidated Standard of Reporting Trials (CONSORT) guidelines and the CONSORT extension for pilot and feasibility trials , 69. ManIndividuals will be considered eligible for authorship if they contributed to the design, conduct, analysis, or interpretation of the data. Professional writers will not be used for manuscript preparation.De-identified data may be made available on public data platforms such as the Open Science Framework or if made a requirement by the granting agency, journal, or community partner. Statistical code used to conduct analyses for published manuscripts may also be included on public data platforms, allowing other researchers to assess the studies’ scientific rigor.BEAM is an app-based maternal mental health program which is easily accessible and was designed to scale. The program targets peer connection, psychoeducation, and intervention by mental health professionals and has the potential to mitigate the negative impacts of maternal mental health concerns and stress on family well-being during the COVID-19 pandemic and beyond. The proposed RCT will build upon our prior research on the BEAM program  through Recruitment began in January 2022 and finished in March 2022. The date of first enrollment was February 14th, 2022. The intervention launched in April 2022 .Additional file 1.


Sexual dysfunctions are one of the health problems after natural disasters that are usually less attention. The purpose of this study was to evaluate the effect of the earthquake on men's sexual functions 1 year after the earthquake.This study was a descriptive‐analytical cross‐section study that took place a year after the Kermanshah earthquake. The population studied was all men living in the Kermanshah earthquake. Demographic, socioeconomic, psychological, health situations, facilities availability, and environmental situations after the earthquake and International Index of Erectile Function (IIEF) were randomly distributed among men affected by the earthquake. Participants returned the questionnaires through the mail. Based on the IIEF cut‐point score, men were divided into two groups: those with sexual dysfunction (Group A) and without sexual dysfunction (Group B).p < 0.001). There was a statistically significant difference between the age (p < 0.001), child numbers (p < 0.017), current live location (p < 0.001), social support after the earthquake (p = 0.033), underlying disease (p < 0.001), availability of sanitary toilets (p < 0.001) and bathrooms (p = 0.002), and total IIEF scores between the two groups (p < 0.001).In this study, 225 married men participated. The prevalence of sexual dysfunction in earthquake‐affected men was 44.9%. The mean total IIEF scores in the A and B groups were 43.47 ± 7.82 and 62.11 ± 6.39, respectively. There was a significant difference between the total and all subcategories IIEF scores in the two groups (Approximately half of the earthquake‐affected men had sexual dysfunctions. The men's age, child numbers, current live location, social support, underlying disease, and availability of sanitary toilets and bathrooms were influential in the severity of men's sexual dysfunctions after the earthquake. Therefore, crisis managers, policymakers, psychiatrists, and psychologists should pay enough attention to men's sexual dysfunction after earthquakes. Usually, after severe emotional shocks such as stress, anxiety, and depression, sexual relations are not as good as before.Paying inadequate attention to the sexual health status of individuals affected by earthquakes may cause a phenomenon called “rape.” Bartels,22.1This descriptive‐analytical cross‐sectional study collected information about the sexual health of the earthquake‐affected men in the year ending November 13, 2018. The study population was all men living in Sar‐e‐Pol‐e‐Zahab and Kermanshah cities when the Kermanshah earthquake occurred and had the inclusion criteria.1.Reside in the earthquake area from the time of the earthquake until the completion of the questionnaire.2.The participant has expressed willingness to participate in the research and completed the informed consent form.3.Be alert and fully able to answer the questionnaire's questions.4.There should be no pain or acute problems when completing the questionnaire.5.The participants be married and should not have any restrictions on the sexual activity before and after the earthquake.6.No history of previously known physical and mental illnesses.Inclusion criteria:1.Unwillingness to continue participating in the study.2.Failure to complete and send the questionnaire.Exclusion criteria:2.2The sample size was estimated based on a preliminary study conducted on 20 earthquake‐affected men with a mean and standard deviation International Index of Erectile Function score of 52.80 ± 13.53.*power software with a confidence interval of 95%, a test power of 99%, and an effect size of 0.150. The minimal sample size was obtained as 212 patients per group.The sample size was computed using the G2.3Data collection tools were demographic, socioeconomic, psychological, health situations, facilities availability, and environmental situations after the earthquake questionnaire and International Erectile Performance Index‐15 (IIEF‐15). After receiving informed consent, the participant completed the patients' demographic information and IIEF‐15 questionnaire. This information includes age, level of education, number of children, duration of the marriage, type of job, socioeconomic status, psychological status, health situation, facilities availability, and environmental situations after the earthquake.The IIEF‐15 questionnaire was used to determine the past year's quality of the sexual function in the participants. This present study utilized the 15‐question format of this questionnaire. This questionnaire is a brief, reliable, validated, multidimensional, self‐administered investigation that has helped assess erectile dysfunction. IIEF‐15 evaluates the presentation of male sexual dysfunction. The minimum score of this questionnaire was 5, which was interpreted as a lack of sexual quality functions and the maximum score was 75, demonstrating the highest amount of sexual quality functions  and without sexual dysfunction (Group B) based on the cut‐point score of 53 on the IIEF questionnaire. Then, the relationship between demographic, socioeconomic, psychological, health situations, facilities availability, and environmental situations after the earthquake variables in people with and without sexual dysfunction were analyzed.2.5t‐test demonstrated the relationship between the participant's age, BMI, number of children, ILEF scores, and IIEF subcategories in the A and B groups. The Mann–Whitney U‐test showed the relationship between the demographic, socio‐economical, psychological, health situation, facility availability, and environmental situations in the A and B groups. The ANOVA test showed the correlation between the socioeconomical, psychological, health situation, facility availability, and environmental situations and the mean of IIEF scores within the A and B groups. The level of statistical significance was set at p < 0.05 for all statistical analyses.All analyses were performed using SPSS‐16 software (SPSS Inc). The Kolmogorov–Smirnov test showed that the data distribution was normal. The data were analyzed using descriptive statistics, including frequency, mean, and standard deviation. The Independent sample 2.6The Ethics Committee of Semnan University of Medical Sciences approved this study protocol . We coordinated with the Kermanshah University of Medical Sciences before sampling. The study objectives and procedure were also explained to the participants, and informed consent was obtained.3Three hundred questionnaires were distributed among those with the inclusion criteria, and 263 questionnaires were returned. Thirty‐eight questionnaires were excluded from the study due to incompleteness, and data from 225 questionnaires were analyzed. At first, the participants in the study were divided into two groups, with (A group) and without sexual dysfunction groups (B group), based on the total score cut‐point of IIEF. 101 (44.9%) participants were in the group with sexual dysfunction, and 124 (55.1%) were in the group without sexual dysfunction.In the with sexual dysfunction group, the participants' mean age, BMI, and child number were 44.73 ± 8.79, 27.29 ± 4.34, and 3.02 ± 1.36, respectively. In the without sexual dysfunction group, the participants' mean age, BMI, and child number were 38.25 ± 8.29, 26.25 ± 3.13, and 2.63 ± 1.10, respectively  participants at the sampling time (1 year after the earthquake) lived in permanent housing, and the rest resided in Connex containers and tents. Also, 96 (42.7%) participants were government employees, and others worked in other occupations. 105 (46.7%) participants also had a university education (Table .9% partiU‐test showed a significant association between age (p < 0.001), child number (p = 0.017), and current live location (p < 0.001) among the A and B groups. However, there was no significant difference between the BMI, educational status, and types of jobs after the earthquake among the A and B groups (p > 0.05) (Table Mann–Whitney 5) Table .The Pearson's correlation coefficient test showed a negative correlation between age, MMI, and the number of children with IIEF scores. In this way, with increasing age, BMI, and the number of children, the IIEF score decreased. These findings mean that with increasing age, BMI, and the number of children, the severity of sexual disorders in earthquake victims increased.t‐test showed a significant difference between Erectile function, Orgasmic function, Sexual desire, Intercourse satisfaction, and Overall satisfaction subscales in groups A and B (p < 0.001). The mean total IIEF scores in the A and B groups were 43.47 ± 7.82 and 62.11 ± 6.39, respectively. There was a significant difference between total IIEF scores in the two groups (p = 0.000)  had reduced function. In the with sexual dysfunction group, sexual dysfunction prevalence in the IIEF tools subcategories for Erectile function, Orgasmic function, Sexual desire, Intercourse satisfaction, and Overall satisfaction was 48.4%, 72.6%, 91.1%, 83.1%, and 76.6%, respectively. Independent samples U‐test showed a significant association between social support after the earthquake and underlying disease among the A and B groups (p < 0.001). However, there was no significant difference between the economic losses from the earthquake, use of psychological counseling after the earthquake, enough sleep, physical injuries caused by earthquakes, and acceptable use of appropriate foods and suitable fruits after the earthquake among the A and B groups (p > 0.05)  participants in the A group and 54%) participants in the B group did not receive any social support. In the A group, 11 (10.9%) participants were not affected by the economic problems caused by the earthquake, and 26 (25.7%) participants were highly affected by the economic problems caused by the earthquake. After the earthquake, 97 (96%) participants in the A group and 121 (97.6%) participants in the B group did not receive psychological consultations. In the A group, 106 (85.5%) participants did not experience any physical injury during the earthquake. 40 (39.6%) participants in the A group and 20 (16.1%) participants in the B group had underlying diseases. In the A group, 12 (11.9%) and in the B group, 15 (12.1%) participants had enough sleep, but the rest of the participants in both groups experienced some sleep disturbance after the earthquake. 55 (54.5%) participants in the A group and 96 (77.4%) in the B group had access to appropriate food more often or always. The A group, 26 (25.7%), and the B group, 31 (25%), always had access to appropriate and sufficient fruits and vegetables. Mann–Whitney % particip < 0.001). In the B group, there was a statistically significant difference between the mean IIEF scores and underlying illness and enough sleep after the earthquake (p < 0.001)  Table .In the A group, 66 65.3%) participants were satisfied with access to electricity, 53 (52.5%) satisfied with access to sanitary water, 34 (33.7%) satisfied with access to a hygienic toilet, 42 (41.6%) satisfied with access to the sanitary bathroom and 25 (24.8%) satisfied with access to environmental cleanliness . In the A group, there was no statistically significant relationship between the scores of IIEF and facilities availability and environmental situations variables (p > 0.05). In the B group, there was a statistically significant difference between the mean IIEF scores and the availability of electric power and sanitary water (p < 0.05)  participants were satisfied with access to electricity, 60 (48.4%) satisfied with access to sanitary water, 73 58.9%) satisfied with access to a hygienic toilet, 76 (61.3%) satisfied with access to the sanitary bathroom and 33 (26.6%) satisfied with access to environmental cleanliness. The Mann–Whitney 8.9% sati4p < 0.05). The earthquake‐affected men experienced more severe sexual dysfunction. Researchers have not found any study on sexual dysfunction in men after earthquakes. However, some studies are conducted on the prevalence of sexual dysfunctions in Iran using IIEF. For example, Pasha et al.This study evaluated the effect of the earthquake on the sexuality function of men affected by the earthquake. The prevalence of sexual dysfunction in earthquake‐affected men was 44.9%. The mean total IIEF scores in the A and B groups were 43.47 ± 7.82 and 62.11 ± 6.39, respectively. There was a significant difference between the total and all subcategories IIEF scores in the two groups  had more severe sexual dysfunction. In line with the current study's findings, Bahar et al.There was no significant association between having an adequate sleep in earthquake‐affected men and the severity of sexual dysfunction in both groups. Since most participants had a good or relatively good sleep, this finding was not significant in the present study. Consistent with the current study's findings, Pastuszak et al.There was no significant association between adequate food intake and consumption of sufficient fruits and sexual dysfunction in both groups. Mykoniatis et al.There was a significant association between the availability of life facilities such as sanitary toilets and bathrooms between the groups with and without sexual dysfunctions. The authors did not find a study on the association between life facilities of earthquake victims and sexual disorders. However, it seems that the higher the living facilities of earthquake‐affected victims, the higher their physician and mental health would be, and they will have more desire for sexual activities.In this study, a self‐report questionnaire was used to investigate sexual dysfunctions, and the researchers were not present when the participants completed the questionnaire. Some participants may not have answered some questions correctly, so this study is limited in this respect.5The prevalence of sexual dysfunction in men increased after the earthquake. Approximately half of the earthquake‐affected men had sexual dysfunctions. The men's age, child numbers, current live location, social support, underlying disease, and availability of sanitary toilets and bathrooms were influential in the severity of men's sexual dysfunctions after the earthquake. Therefore, crisis managers, policymakers, psychiatrists, and psychologists should pay enough attention to men's sexual dysfunction after earthquakes. This study was one of the first studies conducted on the status of sexual disorders in men after the earthquake. Therefore, it is suggested to conduct more studies in this field in other settings and populations. Also, it is suggested to conduct studies with the same design and examine the sexual disorders of earthquake victims 2–3 years after the earthquake because these disorders may improve or become more severe over time.Abbasali Ebrahimian: Conceptualization; formal analysis; methodology; project administration; resources; supervision; validation; writing – original draft; writing – review & editing. Hossein Babaei: Conceptualization; investigation; methodology; writing – original draft; writing – review & editing. All authors have read and approved the final version of the manuscript.The authors declare no conflict of interest.The lead author Hossein Babaei affirms that this manuscript is an honest, accurate, and transparent account of the study being reported; that no important aspects of the study have been omitted; and that any discrepancies from the study as planned  have been explained.