1.Use of personal protective equipment during surgical procedures including aerosol-generating procedures in reducing the risk of SARS-CoV-2 viral transmission: A rapid review
Valentin C. Dones III ; Maria Cristina Z. San Jose ; Howell G. Bayona
Acta Medica Philippina 2020;54(Rapid Reviews on COVID19):1-6
Introduction:
COVID-19 infection spreads through respiratory droplets, contact, and airborne transmission. During aerosol-generating procedures (AGPs), the risk of spreading SARS-CoV-2 via aerosols is increased significantly. This rapid review determined the association between using personal protective equipment (PPE) during AGPs, including those during surgery, among confirmed or suspected patients with COVID-19 and the risk of infection among healthcare workers.
Method:
A systematic search of electronic databases MEDLINE, EBSCO, Science Direct, Google Scholar, and Cochrane CENTRAL base was performed last March 21, 2021, using the Boolean combination of keywords for SARS-CoV-2, PPE, and surgery. Two reviewers screened the articles for relevance and extracted the data from the included studies. We critically appraised the included studies using criteria from the Painless Evidence-Based Medicine Evaluation of Articles on Harm. We used RevMan for data pooling, with a 40% heterogeneity cut-off score. GRADEpro guideline development tool determined the quality of evidence of the included studies.
Results:
Five observational studies investigated the effectiveness of PPE use in reducing SARS-CoV-2 transmission among healthcare workers during any AGPs. The use of N95 masks (OR 0.37 [95% CI 0.21, 0.67], 1 study, n=195), surgical gown (OR 0.59 [95% CI 0.46, 0.77] I2= 0%, 2 studies, n= 941) and gloves (OR 0.42 [95% CI 0.43, 0.55] I2=34%, 3 studies, n=978) versus their non-use significantly reduced the odds of SARS-COV-2 transmission among healthcare workers involved in AGP. Albeit inconclusive due to the very low quality of evidence, using face shields or goggles was not associated with a significant reduction in the odds of SARS-CoV-2 transmission (OR 0.70 [95% CI 0.31, 1.59]) than the non-use of face shields or goggles. The certainty of the overall body of evidence on PPE use in reducing SARS-CoV-2 transmission during AGP procedures was rated very low. In addition, confounders in the assessment could have been using individual PPE with the other standard PPE, compliance of healthcare worker on properly wearing it, and observing other preventive measures.
Conclusion
There were lower odds of COVID-19 infection among healthcare workers using appropriate PPE, including N95 respirators, surgical gowns, and gloves during AGPs in suspected or confirmed COVID-19 patients. Several guidelines recommended using enhanced PPE among healthcare workers during surgery despite limited and low-quality evidence. The findings should help in developing recommendations in reducing SARS-CoV-2 transmission in the Philippines. The findings should provide the information needed for healthcare policy decision-making.
Personal Protective Equipment
;
Methods
;
COVID-19
;
SARS-CoV-2
2.The effectiveness of mindfulness-based interventions versus cognitive behavioral therapy on social anxiety of adolescents: A systematic review and meta-analysis
Valentin C. Dones III ; Kristel S. Yamat ; Krystin Elda P. Santos ; Abby Victoria M. Concepcion ; Margarita Anne R. Lacson
Acta Medica Philippina 2024;58(Early Access 2024):1-10
Background and Objective:
Mindfulness-based interventions (MBI), a novel treatment, and cognitive behavioral
therapy (CBT), the standard treatment, are both effective in treating anxiety in adolescents. This study determined the effectiveness of mindfulness-based interventions versus cognitive behavioral therapy in reducing symptoms of anxiety among adolescents experiencing social anxiety through a systematic review and meta-analysis.
Methods:
A systematic approach was used to identify eligible studies. Electronic databases, reference lists of relevant articles, and gray literature were searched. Data was analyzed using RevMan to calculate standard mean differences with 95% confidence intervals and subgroups. Heterogeneity was measured using visual assessment, the I2 statistic, and chi-square test.
Results:
Randomized controlled trials comparing MBI to CBT for adolescents diagnosed with social anxiety or social phobia disorder were analyzed, with non-randomized studies being excluded. Structured searches in electronic databases, reference lists, and gray literature were conducted by four independent reviewers who initially identified potential articles through title and abstract screening. After a comprehensive review of full-text articles and a consensus-building process, the selection of included articles was finalized. Data was analyzed using RevMan to calculate standard mean differences with 95% confidence intervals and to examine subgroups, with heterogeneity being assessed through visual evaluation, the I² statistic, and chi-square tests. Total number of participants was 255; 101 were male and 158 were women. Mean age was 27.5 years old, and diagnosed with Social Anxiety Disorder, Social Phobia, or DSM-IV-Defined-Anxiety-Disorder. They were divided into two groups: 125 participated in 8- to 12-week MBI sessions lasting 2 hours each, while 130 underwent 2-hour CBT sessions spanning 8, 12, or 14 weeks. There is moderate quality of evidence reporting non-significant difference on MBI vs CBT's effectiveness in alleviating symptoms of social anxiety [mean (95% CI) = -0.04 (-0.58, 0.51)].
Conclusion
Study found that there were no significant differences between Mindfulness-Based Interventions
and Cognitive Behavioral Therapy in reducing social anxiety in adolescents. Mindfulness interventions have
advantages in terms of cost-effectiveness for reducing symptoms of anxiety. Future research should include
larger sample sizes and longer follow-up periods to further assess long-term effects of these interventions.
Adolescent
;
Mindfulness
;
Anxiety
;
Cognitive Behavioral Therapy
;
Occupational Therapy
3.Cross-cultural adaptation of the Oswestry Disability Index: From English to Ilokano version.
Myra R. LAMPITOC ; Valentin C. DONES III
Acta Medica Philippina 2025;59(Early Access 2025):1-8
BACKGROUND AND OBJECTIVE
The Oswestry Disability Index (ODI)–English is a valid and reliable instrument for disability measurement in low back pain (LBP) patients. There is no existing ODI–Ilokano that evaluates LBP patients. This study aimed to cross-culturally adapt the ODI–English into Ilokano.
METHODSThe ODI–English was cross-culturally adapted into Ilokano through a process that included forward translation, synthesis of the translations, back translation, expert committee review, and testing of the pre-final version.
RESULTSForward translation focused on capturing the essence of terms related to pain intensity, personal care, and daily activities, achieving consensus on phrases that accurately mirrored the original English meanings. Subsequent synthesis refined these translations, emphasizing idiomatic and conceptual equivalence over literal interpretations, particularly in nuanced areas like sleep disturbance and social life activities. Backward translation processes aligned Ilokano and English terms, especially for pain intensity and personal care, ensuring consistency across languages. The expert committee review addressed spelling, word choice, and sentence structure, making strategic adjustments for cultural relevance. Pilot testing with participants from Ilocos Norte and Ilocos Sur, Philippines highlighted comprehension challenges with specific terms, leading to adaptations like replacing 'milya' and 'yarda' with metric units and retaining culturally sensitive terms with supplementary English explanations.
CONCLUSIONThis study refined the ODI–English into a culturally adapted Ilokano version, focusing on semantic, idiomatic, and cultural equivalence. Incorporating pilot testing feedback, such as modifying measurement units and addressing sensitive terms, highlighted the thorough adaptation process. The collaborative translation efforts and diverse patient input ensured a culturally resonant ODI version for Ilokano speakers. This adaptation enhances physical therapy practices by improving patient assessments and advocates for adapting patient-reported outcomes to diverse cultures, advancing patient-centered care.
Human ; Low Back Pain ; Cross-cultural Comparison ; Translations ; Surveys And Questionnaires
4.The effectiveness of mindfulness-based interventions versus cognitive behavioral therapy on social anxiety of adolescents: A systematic review and meta-analysis.
Valentin C. DONES III ; Kristel S. YAMAT ; Krystin Elda P. SANTOS ; Abby Victoria M. CONCEPCION ; Margarita Anne R. LACSON
Acta Medica Philippina 2025;59(2):15-24
BACKGROUND AND OBJECTIVE
Mindfulness-based interventions (MBI), a novel treatment, and cognitive behavioral therapy (CBT), the standard treatment, are both effective in treating anxiety in adolescents. This study determined the effectiveness of mindfulness-based interventions versus cognitive behavioral therapy in reducing symptoms of anxiety among adolescents experiencing social anxiety through a systematic review and meta-analysis.
METHODSA systematic approach was used to identify eligible studies. Electronic databases, reference lists of relevant articles, and gray literature were searched. Data was analyzed using RevMan to calculate standard mean differences with 95% confidence intervals and subgroups. Heterogeneity was measured using visual assessment, the I2 statistic, and chi-square test.
RESULTSRandomized controlled trials comparing MBI to CBT for adolescents diagnosed with social anxiety or social phobia disorder were analyzed, with non-randomized studies being excluded. Structured searches in electronic databases, reference lists, and gray literature were conducted by four independent reviewers who initially identified potential articles through title and abstract screening. After a comprehensive review of full-text articles and a consensus-building process, the selection of included articles was finalized. Data was analyzed using RevMan to calculate standard mean differences with 95% confidence intervals and to examine subgroups, with heterogeneity being assessed through visual evaluation, the I² statistic, and chi-square tests. Total number of participants was 255; 101 were male and 158 were women. Mean age was 27.5 years old, and diagnosed with Social Anxiety Disorder, Social Phobia, or DSM-IV-Defined-Anxiety-Disorder. They were divided into two groups: 125 participated in 8- to 12-week MBI sessions lasting 2 hours each, while 130 underwent 2-hour CBT sessions spanning 8, 12, or 14 weeks. There is moderate quality of evidence reporting non-significant difference on MBI vs CBT's effectiveness in alleviating symptoms of social anxiety [mean (95% CI) = -0.04 (-0.58, 0.51)].
CONCLUSIONStudy found that there were no significant differences between Mindfulness-Based Interventions and Cognitive Behavioral Therapy in reducing social anxiety in adolescents. Mindfulness interventions have advantages in terms of cost-effectiveness for reducing symptoms of anxiety. Future research should include larger sample sizes and longer follow-up periods to further assess long-term effects of these interventions.
Human ; Adolescent ; Mindfulness ; Anxiety ; Cognitive Behavioral Therapy ; Occupational Therapy
5.Development and content validation of a questionnaire on the perception of PPE usage in response to COVID-19 for Filipino physical therapists: A study protocol.
Christopher Cruz ; Valentin Dones III ; Joshua Kyle Bunye ; Milea Margarette Chin ; Marion Dominique Cu ; Leeuwin Lim ; Mary Avegail Rosales ; Lorenzo Miguel Sison ; Shanen Alyanna Vitug
Philippine Journal of Allied Health Sciences 2022;6(1):48-53
BACKGROUND:
The COVID-19 pandemic has led to innumerable challenges in the practice of physical therapy (PT) in both local and global settings.
Healthcare settings often use Personal Protective Equipment (PPE) to prevent contamination. Despite its benefits, compliance is challenged by
issues such as discomfort, availability, accessibility, and individual perception.
OBJECTIVES:
Considering the contrasting roles and nature of
healthcare practitioners' work and the differences in the demands of PPE usage, this study aims to develop a profession-specific questionnaire on
the perceptions of physical therapists on PPE usage in response to the COVID-19 pandemic with good face and content validity.
METHODS:
The study
comprises Phase 1 for questionnaire development and Phase 2 for questionnaire validation. Five experts recruited using purposive sampling
participated in three rounds of the validation process. Each expert evaluated the face and content validity through Google Forms. Consequently, an
expert panel evaluation to reach a consensus on the final items. Google sheets were utilized for analysis.
EXPECTED RESULTS
The final questionnaire
will have 35 items covering the Health Belief Theory domains. All items will receive FVI (overall agreement scores), I-CVI, S-CVI/Ave, and S-CVI/UA
scores that meet the cut-off. The final questionnaire will be useful in evaluating physical therapists' perceptions of using PPE due to COVID-19 and
may also be helpful to organizations, policymakers, and other entities in their decision-making for PPE protocols, guidelines, and implementation.
Future researchers can use this study to conduct a pilot study that assesses other psychometric properties of the tool.
6.The short-term effects of biomechanical taping on upper extremity muscles in unilateral lateral epicondylalgia: A pre-and Post-experimental study protocol
Valentin Dones III ; Christian Rimando ; Andrea Janelle Co ; Clarence Almazan ; Marie Capistrano ; Kimberly-Anne Enriquez ; Jorell Inarda ; Maria Quebral ; John Aldee Rigor ; Angelica Supangan
Philippine Journal of Allied Health Sciences 2022;5(2):50-56
Background:
Lateral epicondylalgia (LE) causes ineffective handgrip due to microtrauma on the elbow's common extensor origin.
Objectives:
This study will determine the differences in the Extensor Digitorum Communis' (EDC) fascia slide, percentage maximum voluntary contraction (%MVC), static maximum handgrip strength (SMHGT), muscle activation onset time (MAOT) in LE and non-LE elbows, with and without Biomechanical Tape (BMT). The study will determine differences in Visual Analogue Scales (VAS) and Patient Rated Tennis Elbow Evaluation (PRTEE) scores of patients with and without BMT.
Methods:
Nineteen participants' elbows with unilateral LE with and without BMT will be evaluated using musculoskeletal ultrasound (MSK) and electromyography (EMG) on Days 1, 3, and 5. A Physiotherapist-Sonographer, a Physiotherapist-EMG user, and a Research Assistant using Jamar hydraulic dynamometer will evaluate the participants. The participants will perform Mill's test during MSK and SMHGT using the dynamometer during EMG. A Chi-squared test will evaluate the relationship between BMT and fascia slide. Two-way repeated-measures ANOVA will compare the fascia slide, %MVC, SMHGT, and MAOT between elbows with and without BMT. It will be blocked according to elbow status (i.e., LE, no LE). Dunnett post hoc test will determine the groups whose results differed significantly. Differences in PRTEE scores at Days 1 and 5 will be determined. A p-value <0.05 indicates a significant difference in scores.
Expected Results
We expect decreased fascial slide measurements on EDC, VAS, PRTEE scores, and increased %MVC, MAOT, and SMHGT on taped elbows. Results will determine the underpinning mechanism behind the short-term effects of BMT.
Electromyography
7.Effects and safety of facemask use on healthy adults during exercise: a systematic review and meta-analysis protocol.
Valentin Dones III ; Mark Angel Serra ; Maria Cristina San Jose ; Francine Abigail San Jose ; Angelo Paulo Palima ; Jovi Anne Macaraeg ; Lou Jericho Alejandrino ; Alexandra Mae Baybay ; Carlos Daniel Aniciete ; Kerrie Lyn Matheson ; Lance Aldrich Embile
Philippine Journal of Allied Health Sciences 2023;6(2):19-24
BACKGROUND:
Facemasks are used to minimize SARS-CoV-2 spread during the COVID-19 pandemic. However, facemask use during exercise is
associated with possible adverse effects.
OBJECTIVES:
To compare the effects of facemask use vs. non-facemask use on subjective responses, COVID-
19 incidence, and physiologic changes in healthy adults during exercise.
METHODS:
The systematic review (PROSPERO registration number:
CRD42022296247) will follow the PRISMA-P guidelines and use electronic databases Science Direct, PubMed, Google Scholar, Herdin, and
EbscoHost. This will cover randomized parallel groups or randomized crossover studies investigating tolerability, physiologic effects, and the
impact on SARS-COV2 incidence of commercially-available cloth, surgical, or FFR/N95 facemasks compared to no-facemask conditions during
exercise among healthy adults, including studies published from the earliest date to January 31, 2022. Outcomes of interest will be facemask
tolerability in 10 domains of comfort and objective cardiopulmonary, gas exchange, and metabolic responses. Mean differences (MD) or
standardized mean differences (SMD) with a 95% confidence interval (CI) will be calculated overall and for subgroups using RevMan software
(version 5.4.1). Pooled and subgroup estimates will be calculated using random-effects meta-analysis. The chi-squared test, I2 statistics, and visual
analysis will assess heterogeneity. The GRADEpro will determine the certainty of the level of evidence.
EXPECTED RESULTS
An evidence-based
recommendation using GRADE on the changes attributed to facemask use during exercise will be available. This will be useful for organizations
when developing appropriate guidelines for exercising while mitigating the risk of SARS-CoV-2 transmission. Future researchers may use this study
when redesigning comfortable facemasks without compromising filtration capability.
8.Biomechanical taping and standard physical therapy were effective in the management of acute ankle inversion sprain: A pre- and post- intervention study.
Valentin Dones III ; Lyle Patrick Tangcuangco ; Mark Angel Serra ; Angeleah Abad ; Zacharie Fuentes ; Phyll Josh Labad ; Jannie Mauren Liboon ; Judy April Emmanuelle Miano ; Gian Karlo Reyes ; Marc Ryan Gerald Sabatin ; Maria Bianca Vergel de Dios
Philippine Journal of Allied Health Sciences 2020;3(2):9-17
BACKGROUND:
Ankle inversion sprain is a common musculoskeletal injury due to an inward foot twist. It results in pain, swelling, limited movement,
instability, and tenderness of the injured ankle. Standard physical therapy (PT) for acute ankle inversion sprain involves cryotherapy, range of
motion, balance, and strengthening exercises. Biomechanical Taping (BMT) is an adjunct to PT.
OBJECTIVES:
To identify the short-term effects of
BMT and PT on pain and function of individuals with acute ankle inversion sprains.
METHODS:
Two licensed physiotherapists screened the
participants. Eligible participants were treated 3x/week with BMT and PT, with a day of home exercises in between treatments. Participants
answered the Visual Analogue Scale (VAS) and Foot and Ankle Ability Measure (FAAM). Friedman Test was used to determine differences in prepost measurements of VAS and FAAM.
RESULTS:
17 participants (10 males: 7 females) with unilateral acute ankle inversion sprains were included
in the study with a mean (95% CI) age of 21 (20-22) years. BMT and PT (a) decreased VAS mean rank scores at Treatments 3 and 5 (p<0.05); (b)
improved FAAM-ADL mean rank scores in Treatments 1 and 3 (p<0.05); (c) improved FAAM-Sports mean rank scores in all Treatments (p<0.05);
and (d) improved in VAS, FAAM ADL and Sports scores between Treatment 1, Treatment 2 and Treatment 3 (p<0.00001).
CONCLUSION
BMT may
be an effective adjunct to PT in improving pain and function of participants with acute ankle inversion sprains. The increased stability created by
BMT may underpin the improved pain and function of participants.
Ankle Injuries
;
Fascia
;
Lateral Ligament, Ankle
;
Pain
9.The effectiveness of telerehabilitation in hypertension management of adults in communities: protocol for a systematic review.
Christian Rey Rimando ; Valentin Dones III ; Archelle Jane Callejo-Tiuseco ; Abigail Anne Velasquez ; Maureen Dacuya ; Kirsten Ermengild Ignacio ; Stephanie Elisha Marie Pasol ; Ella Teresa Cavite ; Liam Sebastian Dy ; Patrick Angelo Tayag ; Ronan II Ibuna ; Maria Florissa Valerio ; Gino Valderama ; Carl Froilan Leochico
Philippine Journal of Allied Health Sciences 2023;6(2):25-31
BACKGROUND:
The emergence of Telerehabilitation in managing hypertension showed positive outcomes as an alternative approach to deliver
healthcare services. With the ongoing COVID-19 pandemic which necessitates less physical contact, the study aims to determine the effectiveness
of Telerehabilitation versus the usual care in hypertension management among adults in communities, especially in rural settings.
METHODS:
A
comprehensive electronic search was conducted in the following databases: ProQuest, EBSCOhost, AHA Journals, PubMed, Google Scholar, Scopus,
HERDIN, Web of Science, JSTOR, and ScienceDirect in March 2022 and was updated in August 2022. Inclusion criteria are randomized controlled
trial studies that involve participants aged ≥ 18 years old with hypertension or baseline blood pressure of >140/90 mmHg and the use of
technologies and digital services to address hypertension versus non-Telerehabilitation approaches in rural communities or through community-
based rehabilitation. Exclusion criteria are non-randomized controlled trials, qualitative studies, unfinished and article type records. The revised
Cochrane Collaboration Risk of Bias tool will be used to evaluate the content for risk of bias, quality, and internal validity. An electronic data
collection form and Raxter will be utilized to extract and to organize the following: demographics, objectives, design, settings, interventions,
outcome measures, and significant findings. Review Manager (RevMan) version 5.4 will be used to perform quantitative synthesis of the pooled
data if homogeneity is observed in the outcomes.
EXPECTED RESULTS
The study will determine the effectiveness of Telerehabilitation in managing
hypertension and aiding in its implementation in response to the global trend of urbanization in rural areas.
Telerehabilitation
10.Psychometric properties of self-report questionnaires in evaluating blended learning in health science university students: A systematic review.
Valentin C. DONES III ; Maria Teresita B. DALUSONG ; Donald G. MANLAPAZ ; Juan Alfonso S. ROJAS ; Ma. Bianca Beatriz P. BALLESTEROS ; Ron Kevin S. FLORES ; Kaela Celine C. HO ; Jose Angelo D. MONREAL ; Audrey Marie A. NARCELLES ; Jose Joaquin R. REYES ; Lianna Andrea B. SANGATANAN
Acta Medica Philippina 2025;59(Early Access 2025):1-14
BACKGROUND
Due to the COVID-19 outbreak, schools had to switch online. The sudden transition to blended teaching and learning (BTL) poses challenges for students and teachers, especially for health science programs that require hands-on practical experience. The validity, reliability, and responsiveness of these self-report questionnaires (SRQs) should be established to ensure the accuracy of the results as intended by the SRQ.
OBJECTIVESThis study critically appraised, compared, and summarized the psychometric properties of SRQ evaluating BTL among health science university students. This review determined the SRQ’s reliability, internal consistency, various forms of validity (content, criterion, construct), and responsiveness.
METHODSFollowing a 10-step procedure based on COSMIN guidelines, we conducted a systematic review of SRQs used by health science university students to evaluate blended teaching and learning. Studies were eligible if they reported psychometric properties of SRQs related to blended learning among university health science students; exclusions included studies focusing on perceptions, attitudes, self-efficacy, and satisfaction, as well as articles such as biographies, editorials, and conference materials. Searches covered multiple electronic databases until April 26, 2023, including PubMed, EMBASE, Web of Science, MEDLINE (OVID), PsycInfo, CINAHL, EBSCOHOST, ERIC, Scopus, Science Direct, Google Scholar, JSTOR, Acta Medica Philippina, Philippine Journal of Health Research and Development, and HERDIN, managed through Zotero. Two independent reviewers performed database searches, title and abstract screening, and full-text evaluations, with a third reviewer resolving any disputes. The COSMIN Risk of Bias Checklist was employed to evaluate included studies on the development and various measurement properties of SRQs. The reviewers assessed SRQ standards, including validity, reliability, internal consistency, measurement error, responsiveness, interpretability, and feasibility. Data extraction and result tabulation were independently completed, with content comparison by two health education experts. This evaluation categorized the SRQs into three quality and validity levels.
RESULTSThe study examined five articles; four were rated as 'doubtful' and one as 'inadequate' in the overall development of SRQ. All four 'doubtful' studies demonstrated questionable content validity when university students were asked about the questionnaire's relevance, comprehensiveness, and comprehensibility. Only half of these studies achieved an 'adequate' rating for content validity based on expert opinions on relevance and comprehensiveness. All but one study scored from 'very good' to 'adequate' in structural validity. Three out of the four studies scored a very good rating for internal consistency, while one was deemed 'inadequate' in internal consistency, cross-cultural validity, and reliability. Three out of four studies scored 'very good' on construct validity, but all overlooked criterion validity and responsiveness. Conducted in various locations, including Australia, Romania, Turkey, and Taiwan, these studies highlighted both common characteristics and limitations in questionnaire development according to the COSMIN guidelines. Four studies were deemed reliable and valid for BTL constructs (Category A); Wu et al. requires further validation (Category B). Study limitations included heterogeneity in populations, settings, and questionnaire versions, potential subjective bias in SRQ content comparison, and the evolving nature of SRQs in blended learning contexts.
CONCLUSIONThe systematic review reports the development and evaluation of SRQs for BTL while identifying gaps in their applicability to health science programs. The Blended Learning Scale (BLS) of Lazar et al. and the Blended Learning Questionnaire (BLQ) of Ballouk et al. showed an ‘adequate' rating for content validity. BLS revealed very good structural validity, internal consistency, and adequate content validation. Although the BLQ lacked Confirmatory Factor Analysis, it yielded valuable constructs for evaluating health sciences students' experiences in BTL. Both tools require improvements on recall period, completion time, interpretability, and feasibility. The review underscores the necessity for cont inuous assessment and enhancement of such instruments in BTL, advocating a rigorous scale development process. Furthermore, it encourages the customization of teaching and learning evaluation tools to suit specific institutional contexts while promoting further validation of these questionnaires across different populations in future research.
Human ; Psychometrics ; Checklist ; Self Report ; Universities ; Health Education