The impact of emotional and moral intelligence on nurses’ organizational commitment

Abstract

Background

Emotion control, adherence to ethics, and organizational commitment are among the widely addressed topics in response to turbulent and complex organizational environments. The aim of this study was to investigate emotional and moral intelligence and their effect on organizational commitment among nurses working in public hospitals.

Methods

This descriptive-analytical cross-sectional study was conducted on 385 nurses. The data collection tools were standard questionnaires on emotional intelligence, moral intelligence, and organizational commitment. The data were analyzed using t-test, ANOVA, Pearson correlation coefficient, and multiple linear regression with SPSS23 software.

Results

The mean scores indicated moderate levels of emotional and moral intelligence and a low levels of organizational commitment among nurses. There was a significant positive correlation between emotional intelligence and moral intelligence with organizational commitment. Based on the results of multiple linear regression, components of emotional intelligence and moral intelligence, including responsibility, compassion, self-awareness, forgiveness, integrity, relationship management, self-management, and social awareness were identified as predictors of organizational commitment.

Conclusion

Emotional intelligence and moral intelligence were estimated to be at moderate levels, and organizational commitment among the nurses was at a low level. Improving emotional and moral intelligence may enhance nurses’ organizational commitment. Therefore, it is recommended that hospital managers provide training courses and workshops to improve nurses’ emotional and moral intelligence, which can, in turn, promote their organizational commitment.

Introduction

Intelligence refers to an individual’s adaptive behavior, typically involving problem-solving elements and guided by cognitive processes and operations [1]. Intelligence is divided into various types, such as social intelligence, cultural intelligence, emotional intelligence, and moral intelligence [2]. Emotional intelligence is the intelligent use of emotions to help individuals consciously control their emotions and use them as a guide for thinking and behavior [3]. Emotional intelligence is a type of cognitive intelligence that encompasses a set of abilities, social and emotional skills that increase an individual’s chances of success in coping with environmental pressures and conditions [4–6]. This intelligence significantly impacts individuals’ psychological, social, and physical states and is associated with a sense of well-being, improved social status, better communication, and reduced psychological disorders. Conversely, it has an inverse relationship with internal and external life problems [7]. Emotional intelligence enables individuals to prevent difficult situations from becoming uncontrollable, thus making stress management easier [8]. Those who employ emotional intelligence show better adaptability and higher self-confidence and are aware of their capabilities [9].

Moral intelligence, another dimension of intelligence, provides a framework for proper human behavior and is theoretically considered a predictor of behavior [10]. Moral intelligence has four dimensions: integrity, responsibility, compassion, and forgiveness [11]. Integrity refers to the alignment between an individual’s beliefs and actions, responsibility involves accepting actions and their consequences, compassion pertains to caring for others, and forgiveness involves understanding mistakes and forgiving oneself and others [12]. Moral intelligence pertains to the capacity and ability to understand right from wrong, having strong and deep moral beliefs, and exhibiting appropriate behavior [13, 14]. Moral intelligence is crucial because many human behaviors and performances stem from moral principles and values and are influenced by them [14, 15]. Moral intelligence directly relates to the behaviors individuals display and establishes a system of principles and rules that guide humans in doing what is right [16, 17]. Moreover, moral intelligence fosters strong teamwork and productivity, prevents criminal acts, incorporates ethical guidelines into decision-making, and develops a program to assess ethical needs [18].

Emotional and moral intelligence are vital in improving interpersonal relationships, particularly in professions related to the medical and nursing fields, which deal with people and their lives [19]. Nurses with high emotional and moral intelligence can make better, more logical, and ethical decisions focused on their goals despite their emotions and feelings [20]. Additionally, low emotional and moral intelligence affects nurses’ happiness and health, making it difficult for them to manage problems and conflicts [21]. Research shows a connection between emotional intelligence and moral intelligence with nursing performance, indicating that emotional and moral intelligence in nurses is associated with increased job satisfaction, professional achievements, and clinical competence [22, 23].

Furthermore, nursing as a profession requires proper performance, and organizational commitment is one of its core principles [24]. Organizational commitment is an attitude reflecting employees’ interest, attachment, loyalty to the organization, and their willingness to stay [25]. Some scholars consider organizational commitment to have two interrelated but distinct components: attitudinal commitment and behavioral commitment [26]. Attitudinal commitment reflects individuals’ loyalty to the organization, emphasizing their adaptation and participation in it [27]. Behavioral commitment indicates the process of individuals’ bonding with the organization [27]. Given the challenging nature of nursing, high organizational commitment is crucial to prevent job turnover [28]. The challenges of nursing include constant and direct contact with patients’ pain and suffering, staff shortages [29], numerous tasks, heavy workloads [30], nursing complexity, and rotating shifts [31]. Concerns about nurse turnover have become a challenge for healthcare system managers in recent years [32]. Organizational commitment and decent work, in addition to preventing job turnover, motivates, vigour at work, adopting moral ideologies, and increases employees’ enthusiasm for performing their duties, improves communication with patients and their families [33–36], reduces absenteeism and tardiness, enhances performance, achieves personal goals, fosters vitality, accomplishes higher organizational goals [37], and ultimately improves patient safety and nursing care quality [38]. Organizational commitment is influenced by various factors. Some studies have examined the relationship between individual variables such as personality traits or emotional intelligence and moral intelligence with organizational commitment [39, 40]. It is acknowledged that many behaviors and actions stem from moral and emotional intelligence [39], and neglecting these in organizations and their weakness can cause many problems and negatively impact individuals’ organizational commitment [40].

According to some scholars, both moral intelligence and emotional intelligence may influence organizational commitment by identifying with the organization, encouraging participation in organizational activities, and valuing and sharing in organizational life [36, 37]. Furthermore, moral intelligence and emotional intelligence can assist employees in establishing effective communication and, by distinguishing between thought and feeling as well as enhancing learning behavior and perseverance, positively impact their organizational commitment [18, 41].

A review of the limited prior studies indicates that most have focused on examining the correlation between either emotional intelligence or moral intelligence with organizational commitment. Therefore, one of the existing knowledge gaps, which necessitates further studies, is to simultaneously examine these two types of intelligence, and secondly, investigate their concurrent effect and predictive role in forecasting organizational commitment—an aspect that previous studies have not sufficiently addressed. Given the importance of the three aforementioned variables emotional intelligence, moral intelligence, and organizational commitment in improving performance and the quality of nursing services, and the limited studies on these three variables and the simultaneous effect of emotional and moral intelligence on nurses’ organizational commitment, this study aimed to determine the status of emotional and moral intelligence and their relationship and impact on organizational commitment among nurses working in hospitals affiliated with Jiroft University of Medical Sciences in southern Iran in 2024.

The findings of this research, while expanding knowledge on the variables under study in the nursing field, also increase the awareness of managers and health system policymakers regarding the simultaneous effect of emotional intelligence and moral intelligence on organizational commitment among the nursing community. Moreover, considering the main objective of this study, the findings can provide a basis for planning to enhance nurses’ organizational commitment.

Methods

Design and setting

This descriptive-analytical cross-sectional study was conducted in 2024 on nurses working in hospitals affiliated with Jiroft University of Medical Sciences (including six hospitals) in southern Iran from March to May 2024.

Participants

The study population consisted of nurses working in these hospitals, and the sample size was estimated to be 385 using the following formula [42] with a 5% error level. Then, by dividing 385 by the total number of nurses and multiplying the obtained number by the number of nurses in each hospital, the required sample size for each hospital was determined.

In the above formula: z = 1.96 d = 0.05.

Moreover, in each hospital, nurses were randomly selected based on the number of working nurses in each department using stratified sampling proportional to size and according to their personnel numbers and random number tables. The inclusion criteria were a minimum of one year of work experience in the hospital, employment in clinical departments, and willingness to participate in the study. Exclusion criteria included employment in administrative departments (unrelated to nursing), no recent adverse events (e.g., death of a loved one, divorce) within a month before the study, and unwillingness to participate in the study.

Instruments

The data collection tool was a four-part questionnaire. The first part of the questionnaire included demographic information such as age, gender, marital status, type of employment, and work experience. The second part was the standard Bradberry-Greaves’ (2006) Emotional Intelligence Questionnaire with 28 questions and four components: self-awareness (questions 1 to 6), self-management (questions 7 to 15), social awareness (questions 16 to 20), and relationship management (questions 21 to 28). The questionnaire was scored on a 6-point Likert scale ranging from never (score 1), rarely (score 2), sometimes (score 3), usually (score 4), almost always (score 5), to always (score 6). Based on the score range (28 to 168), a mean score of 28 to 63 was classified as low emotional intelligence, 64 to 98 as moderate emotional intelligence, 99 to 133 as good emotional intelligence, and 134 to 168 as excellent emotional intelligence [43]. The validity and reliability of this section (with a Cronbach’s alpha of 0.83) have been confirmed in previous studies [44, 45]. In addition to the confirmation of the validity of this questionnaire in previous studies [44, 45], in the present study, the face validity was approved by 10 members of the faculty in the field of healthcare management in Iran. Moreover, content validity with CVR = 0.73 and CVI = 0.86 and convergent validity with AVE = 0.79 were confirmed.

The third part of the questionnaire was the standard Lennick And Kiel’s (2005) Moral Intelligence Questionnaire with 40 questions and four components: integrity (questions 1 to 10), responsibility (questions 11 to 20), compassion (questions 21 to 30), and forgiveness (questions 31 to 40). This questionnaire was classified and graded on a Likert scale (never score 1, rarely score 2, sometimes score 3, most of the time score 4, always score 5). In this questionnaire, each respondent scored between a minimum of 40 and a maximum of 200, which was then divided by 2 to get the final moral intelligence score between 20 and 100. A score of 90 to 100 was considered excellent, 80 to 89 very good, 70 to 79 moderate, and 69 or less poor [46]. The validity and reliability of this section (with a Cronbach’s alpha of 0.89) have been confirmed in the study by Sadeghi and colleagues [46]. In addition to the confirmation of the validity of this questionnaire in previous studies [46], in this study, face validity was approved by the aforementioned experts. Moreover, content validity with CVR = 0.75 and CVI = 0.87 and convergent validity with AVE = 0.78 were confirmed.

The fourth part of the questionnaire was the standard Allen and Meyer’s (1990) Organizational Commitment Questionnaire with 24 questions and three components: affective commitment (8 questions), continuance commitment (8 questions), and normative commitment (8 questions). The questionnaire was scored on a 5-point Likert scale ranging from strongly agree (score 5), agree (score 4), neutral (score 3), disagree (score 2), to strongly disagree (score 1). Based on the score range of 24 to 120, a mean score of 24 to 48 was classified as low organizational commitment, 49 to 72 as moderate, 73 to 96 as good, and 97 to 120 as excellent organizational commitment [47]. The validity and reliability of this section (with a Cronbach’s alpha of 0.83) have been confirmed in the study by Hosseini and colleagues [48]. In addition to the confirmation of the validity of this questionnaire in previous studies [48], in this study, face validity was approved by the experts mentioned in the second part of the questionnaire. Moreover, content validity with CVR = 0.77 and CVI = 0.83 and convergent validity with AVE = 0.75 were confirmed.

Procedures and statistical analysis

For data collection, two researchers (ARY & HA) visited the hospitals under study on different days of the week during morning, afternoon, and night shifts to distribute and collect the questionnaires. To observe ethical considerations, nurses’ participation in the study and filling out the questionnaires were entirely voluntary and only done if the individual was willing. After explaining the study’s objectives to the participants, their responses were assured confidentiality, verbal consent was obtained, and then the questionnaires were distributed among the nurses and collected on the same day.

To reduce potential biases such as self-reporting, Likert scales were used in the second to fourth parts of the questionnaire. Additionally, double-barrelled, leading, and absolute questions were avoided.

The collected data were then entered into SPSS version 23 software for analysis. Pearson correlation coefficient was used to examine the correlation between emotional intelligence, moral intelligence, and organizational commitment, as well as the correlation of these three variables with nurses’ age and work experience. T-test was used to examine the mean score differences of the three main variables of the study by gender and marital status. ANOVA was used to examine the mean score differences of emotional intelligence, moral intelligence, and organizational commitment among nurses based on employment type. Finally, multiple linear regression was used to examine the simultaneous effects of different dimensions of emotional and moral intelligence on nurses’ organizational commitment.

Results

The average age of the participating nurses was 30.41 ± 8.15 years, with most of them (62.60%) being under 30 years old. The average work experience was 5.87 ± 4.29 years, with most of them (77.14%) having less than 10 years of experience. 66.49% were female, and the rest were male. Most respondents were on contractual (63.89%) and married (68.57%) (Table 1).

Table 1.

Distribution of nurses studied (n = 385)

Variables	Category	Frequency	Percent
Age (year)	< 30	241	62.60
	30–40	137	35.58
	> 40	7	1.82
Total	------	385	100
Work experience (year)	< 10	297	77.14
	10–20	81	21.04
	> 20	7	1.82
Total	------	385	100
Gender	Male	129	33.51
	Female	256	66.49
Total	------	385	100
Marital status	Single	121	31.43
	Married	264	68.57
Total	------	385	100
Type of employment	Official	46	11.95
	Temporary-to permanent	14	3.64
	Under -a-contract	37	9.61
	Contractual	246	63.89
	Corporative	42	10.91
Total	------	385	100

The mean scores of emotional intelligence, moral intelligence, and organizational commitment among the nurses were 88.54 ± 8.31 out of 168, 75.67 ± 8.24 out of 100, and 43.13 ± 6.82 out of 120, respectively, indicating moderate levels of emotional and moral intelligence and a low level of organizational commitment among nurses (Table 2).

Table 2.

Mean and standard deviation of emotional intelligence, moral intelligence, organizational commitment, and their dimensions among the studied nurses

Emotional Intelligence	Dimension	Range	Mean	SD
	Self-awareness	6–36	18.22	4.26
	Self-management	9–54	26.14	4.32
	Social awareness	5–30	19.56	3.55
	Relationship management	8–48	24.62	3.74
	Total	28–168	88.54	8.31
Moral Intelligence	Integrity	5–25	22.43	5.04
	Responsibility	5–25	17.59	4.47
	Compassion	5–25	18.27	2.69
	Forgiveness	5–25	17.38	4.11
	Total	20–100	75.67	8.24
Organizational Commitment	Affective Commitment	8–40	14.59	3.82
	Continuance Commitment	8–40	13.65	1.35
	Normative Commitment	8–40	14.89	2.49
	Total	24–120	43.13	6.82

The findings showed a significant positive correlation between emotional intelligence and moral intelligence with nurses’ organizational commitment (p < 0.001). This implies that as emotional intelligence and moral intelligence increase, organizational commitment may also increase (Fig. 1).

Fig. 1.

Correlation between emotional and moral intelligence with organizational commitment among the studied nurses

The results of multiple linear regression analysis to determine the simultaneous effect of different dimensions of moral and emotional intelligence on nurses’ organizational commitment showed that the significant variables in the model determined using the Enter method were, in order of importance: “responsibility, compassion, self-awareness, forgiveness, integrity, relationship management, self-management, and social awareness.” The β coefficients for the influencing variables, indicating their priority of impact on organizational commitment, are presented in Table 3. The analysis also showed that the adjusted R² of the processed model was 0.72, meaning that 72% of the changes in nurses’ organizational commitment score could be explained by the variables in the model. The linear equation explaining the nurses’ organizational commitment score based on the variables in the model was obtained as follows:

Table 3.

Factors influencing nurses’ organizational commitment using multiple linear regression model

Variables			Unstandardized coefficients		Standardized coefficient β	P-value
			B	Std. Error
Dimensions of Moral and Emotional Intelligence	---	Constant	2.447	0.879	---	0.02
	X1	Responsibility	0.801	0.165	0.754	< 0.001
	X2	Compassion	0.679	0.161	0.656	< 0.001
	X3	Self-awareness	0.664	0.154	0.643	< 0.001
	X4	Forgiveness	0.656	0.186	0.629	< 0.001
	X5	Integrity	0.631	0.175	0.599	< 0.001
	X6	Relationship Management	0.613	0.172	0.571	0.001
	X7	Self-management	0.602	0.167	0.554	0.001
	X8	Social Awareness	0.572	0.143	0.513	0.002

Y: Nurses’ organizational commitment.

X_{1,2,3,4,5,6,7,8}: Variables affecting nurses’ organizational commitment (Table 3).

Based on the study’s findings, the mean score of emotional intelligence significantly differed based on variables such as age (p = 0.005), gender (p = 0.03), marital status (p = 0.04), and work experience (p = 0.01). The mean score of emotional intelligence among nurses increased with age and work experience. Additionally, emotional intelligence was higher among female (89.17 ± 8.28 out of 168) and married nurses (89.02 ± 8.62 out of 168) compared to others. Similarly, the mean score of moral intelligence significantly differed based on age (p = 0.03) and work experience (p = 0.04), with moral intelligence increasing with age and work experience. Finally, the mean score of organizational commitment among nurses significantly differed based on age (p = 0.003), employment type (p = 0.02), and work experience (p = 0.006), with organizational commitment increasing with age and work experience. Additionally, organizational commitment was higher among nurses with official employment (44.68 ± 6.19 out of 100) compared to others (Table 4).

Table 4.

Relationship between emotional intelligence, moral intelligence, and organizational commitment with demographic variables among the studied nurses

Variables	Category	Emotional intelligence		Moral intelligence		Organizational commitment
		Mean±SD (Out of 168)	P-Value	Mean±SD (Out of 100)	P-Value	Mean±SD (Out of 120)	P- Value
Age (year)	<30	87.53 ± 8.63		74.48 ± 8.17		42.05 ± 6.19	0.003
	30-40	88.54 ± 8.16	0.005	75.86 ± 8.35	0.03	42.89 ± 6.32
	>40	89.64 ± 8.25		76.67 ± 8.27		44.47 ± 6.24
Gender	Male	87.91 ± 8.26	0.03	74.66 ± 8.41	0.11	42.38 ± 6.51	0.35
	Female	89.17 ± 8.28		76.68 ± 8.67		43.88 ± 6.43
Marital status	Single	88.06 ± 8.55	0.04	74.46 ± 8.49	0.43	42.79 ± 6.62	0.23
	Married	89.02 ± 8.62		76.88 ± 8.14		43.47 ± 6.83
Type of employment	Official	89.86 ± 8.52	0.21	77.68 ± 8.24	0.17	44.68 ± 6.19	0.02
	Temporary-to permanent	88.67 ± 8.48		76.18 ± 8.36		43.33 ± 6.76
	Under -a-contract	87.74 ± 8.63		75.09 ± 8.22		43.27 ± 6.66
	Contractual	87.62 ± 8.66		74.29 ± 8.33		42.11 ± 6.54
	Corporative	88.78 ± 8.49		75.12 ± 8.74		42.26 ± 6.27
Work experience (year)	<10	87.43 ± 8.32		74.95 ± 8.54		42.06 ± 6.34	0.006
	10-20	88.60 ± 8.19	0.01	75.64 ± 8.37	0.04	42.48 ± 6.93
	>20	89.58 ± 8.46		76.42 ± 8.21		44.85 ± 6.76

Discussion

The results showed that the emotional intelligence of the studied nurses was at a moderate level. This aligns with studies by Gooya et al. (2012) [49], Kheirmand et al. (2016) [50], Madadkhani et al. (2014) [51], and Soltan Abadi and Beikmoradi (2020) [52]. Contrarily, Masoudi and Alavi (2021) [43] found that nurses’ emotional intelligence was at a good level, while Ghaderi and Shamsi (2013) [53] reported it as above average. Cheraghi et al. (2023) [54] indicated moderate to high levels, and Rahmanian et al. (2022) [55] and Niazi et al. (2015) [56] found high levels. These differences might be attributed to cultural factors. Emotional intelligence is considered crucial for quality nursing care, individual performance, and clinical decision-making, ultimately enhancing job performance [43].

The findings also showed that nurses’ moral intelligence was at a moderate level, consistent with studies by Saied et al. (2017) [57], Nehrir et al. (2015) [58], and Arshiha et al. (2016) [59]. Moral intelligence can be developed through education and influences ethical behavior and beliefs. Thus, enhancing nurses’ ethical capabilities through training is essential. In contrast, studies by Kheirandish et al. (2022) [60], Sadeghi et al. (2016) [61], and Kalantari et al. (2020) reported good levels of moral intelligence, while Dehghani et al. (2022) [62] found it very good among ICU nurses, and Amini et al. (2015) [63] found it above average. These differences underscore the impact of the work environment on moral intelligence.

The study also found that the mean score of nurses’ organizational commitment was low, aligning with studies by Buckley & Halbesleben (2004) [64] and Baby & Damodaran (2022) [65]. Studies by Rahmanzade et al. (2014) [66], Nabizadeh Gharghozar (2013) [67], Abbaszadeh et al. (2013) [68], and Parizad et al. (2013) [69] showed moderate levels. In contrast, studies by Azizi-Qadikolaee et al. (2019) [70] and Sadeghi et al. (2023) [71] reported high levels, and Safavi et al. (2016) [72] and Kebriaei et al. (2016) [73] found above-average levels. Differences in organizational characteristics and assessment tools seem to influence these results. Low organizational commitment, leading to job turnover, necessitates attention to fostering commitment in nurses.

A significant positive correlation was found between emotional intelligence, moral intelligence, and nurses’ organizational commitment. This implies that as emotional intelligence and moral intelligence increase, organizational commitment may also increase. This aligns with studies by Boyokzadeh et al. (2017) [74], Bazvand et al. (2014) [75], Shams Mourkani et al. (2012) [76], Davoudi et al. (2020) [77], Aghabozorgi et al. (2014) [78], Kumari (2018) [79], Alam (2020) [80], Widayanti and Palupiningdyah (2019) [81], and Geun and Park (2019) [82]. It seems that emotional intelligence enhances organizational commitment by improving interpersonal communication and teamwork. Higher emotional intelligence may lead to greater commitment, even without external control. Moreover, it is likely that individuals with high emotional intelligence, when facing problems in the organization, do not blame the organization for their feelings of frustration and, consequently, do not consider it a reason for leaving the organization. As a result, these individuals will be more committed to their organization compared to others.

Regarding moral intelligence, studies by Farrokhi and Asadi (2018) [83] and Dehghani et al. (2015) [84] found a positive relationship between moral intelligence and organizational commitment. It is possible that adherence to ethical principles and developing moral intelligence increases service quality, commitment, and accountability, stabilizing the organization.

It is worth noting that nurses’ emotional and moral intelligence can also be influenced by cultural factors. Values, attitudes, beliefs, opinions, and customs may influence nurses’ emotional and moral intelligence and clinical performance, and thus, the results of this study in different cultural contexts may yield different outcomes [85, 86].

Multiple linear regression analysis identified dimensions of emotional and moral intelligence, including responsibility, compassion, self-awareness, forgiveness, integrity, relationship management, self-management, and social awareness, as predictors of organizational commitment. Studies by Kim et al. (2018) [87], Vedadi et al. (2009) [88], Aghili and Danaei (2016) [89], Mohammadimehr et al. (2017) [90], and Ghiyasvandian et al. (2017) [91] support these findings. Communication satisfaction and stress management also positively impact organizational commitment, suggesting that training in communication skills can enhance commitment and reduce turnover.

Conclusion

The results of this study indicated that effective and beneficial actions have not been taken in the hospitals under study to familiarize, train, and enhance nurses’ emotional and moral intelligence. The low level of nurses’ organizational commitment is a critical and alarming sign, requiring hospital managers to investigate and identify the reasons for the low organizational commitment of nurses and employ necessary strategies to address and mitigate it. Low organizational commitment among nurses, the most important human resource related to patient care, can have dangerous and irreversible consequences.

Additionally, a significant positive correlation was observed between emotional and moral intelligence and organizational commitment. Also, the components of these two intelligences, in order of importance, included responsibility, compassion, self-awareness, forgiveness, integrity, relationship management, self-management, and social awareness, which were identified as predictors of organizational commitment. Therefore, it is recommended that with the support of hospital management and medical units, increasing the nursing staff’s understanding of moral and emotional intelligence, especially the priority components of responsibility, compassion, and self-awareness, through designing and implementing special training programs for nurses, organizing specialized seminars and workshops with the presence of experts and scholars in this field, one can promote the development of moral and emotional intelligence among nurses and ultimately their organizational commitment.

Limitations and suggestions for future research

One of the limitations of this study is the quantitative methodology, data collection through questionnaires, and self-reporting which can affect the findings’ limitations and weak generalizability. Conducting qualitative, longitudinal, and mixed research’s related to the study’s topic can partially address this limitation, as it may reveal new dimensions of hidden and unexpressed findings.

Theoretical contributions and practical applications

The findings of this study, in addition to contributing to the expansion of knowledge about the variables under investigation in the nursing field, help hospital managers and policymakers utilize the study’s findings as evidence and documentation to influence and improve nurses’ organizational commitment.

Author contributions

GM was designed the study and prepared the initial draft. HA and ARY are contributed in data collection and data analysis. SHB and JB have supervised the whole study and finalized the article. All authors have read and approved the manuscript.

Funding

This work was supported by Jirof University of Medical Sciences, Jiroft, Iran with grant numbr: 853.

Data availability

All the data is presented as a part of tables or figures. Additional data can be requested from the corresponding author.

Declarations

Ethics approval and consent to participate

This study is approved by Jiroft University of Medical Sciences Ethics Committee with the ID number of IR.JMU.REC.1402.032. All the methods were carried out in accordance with relevant guidelines and regulations. Meanwhile, the informed consent was obtained from all the study participants. Also, the Helsinki Declaration has been followed for involving human subjects in the study.

Consent for publication

Not applicable.

Clinical trial number

Not applicable.

Competing interests

The authors declare no competing interests.