pursuing the goal of improved health literacy requires more alliances between health and education sectors to improve literacy levels in the population . it is important for health educators to know about knowledge transfer to meet their needs in transferring their knowledge to public . knowledge transfer , which means the synthesis , exchange and ethically application of knowledge within a complex system of relationship among researchers and users , has become one of the recent priorities in research centers . the word the method of knowledge transfer , apart from its characteristics , requires active interactions between researchers and users . caplan proposes the two- communities theory indicating a gap between researchers and policymakers , whereas these days another gap has been formed between researchers and other users . in addition to illiteracy in developing countries that hampers effective health education , there are multitudes of non - medical specialists who do not have enough information about daily health affairs , and this lack is more remarkable in countries that welcome immigrants . immigrants often have significant language and health literacy difficulties , which are further exacerbated by cultural barriers . alongside with sophisticated methods like computer and internet , using simple methods help us bring to achieve our health goals[68 ] . also , the lack of health literacy needs more attention when it is manifested in caregivers . it is believed that some of the undesirable health outcomes in children are because of inadequate health knowledge among caregivers . in the usa , therefore researchers have considered different methods to come up with this deficiency by having children to cooperate in their health programs . a research group in india endeavored to transfer knowledge on leprosy in cooperation with children and informed their parents through them . jacob et al ( 1994 ) started conducting a similar research that yields promising results . rimal and flora ( 1998 ) express that parental dietary behavior is partially affected by children . the findings from studies in this field have encouraged other experts to apply similar methods to conduct their research projects , allahverdipour and bashirian , onyango - ouma and mwangagain from the influence of children in order to teach different parts of their society[1316 ] . despite the researcher 's trends in using novel methods in this field , none of them have used childish poem as a medium for knowledge transferring . in this study , we try to raise families health knowledge about infectious diseases by a method that uses children as health agents . infectious diseases are still the leading cause of mortality in children less than 60 months in developing countries . juvenile age is accompanied by learning childish poems , which can be sung contnuously at home and potentially become as part of both children 's and parents memories . we decided to transfer health knowledge to families through altering this information to childish poems and teaching children at kindergartens . in this method the outcome of transferring health knowledge through childish poems has been assessed in this study . in this study , we use the method of interventional pre and post series to conduct our research . the proposal of this non - invasive project was approved by the research committee of hamadan medical university in january 2009 . it was also accepted by hamadan welfare organization , which is the responsible organization of kindergartens in hamadan . our methodology is briefly explained as follows . at first , a sub specialist in pediatric infectious diseases provides seven short texts about health and common pediatric infectious diseases prevention . then , a poet transfers these conceptions to childish poems for the first time ( appendix 1&2 ) . in the process of preparing an accurate questionnaire , at first 30 questions with three choices of ,  false  and  do not know  were made , but 24 items of those are confirmed as valid questions by two experts of health education and infectious diseases . to assess the reliability of the questionnaire a pilot study on a 40 participant sample was performed and cronbach 's alpha of the questionnaire was determined as 83 percent . in addition , we defined knowledge mark ( km ) as a parent mark in both the pre - test and/or post - tests . among 35 kindergartens in hamadan , we selected 7 kindergartens by simple random method . the parents ( either father or mother , the one who is responsible to take her / his child ) of all five to six year old children of the selected kindergartens are asked to participate in the survey and a verbal consent is obtained from those who accepted . we excluded the following children from our sample : those whose parents are physicians , nurses , health - care workers , and those children whose parents work at the kindergarten ( exclusion criteria ) . we asked the parents of the sample survey to participate in a pretest by answering to a questionnaire when they are in the kindergartens . also , they were asked to come to the kindergartens personally one more time when it is required ( to answer to the post test ) . then , we asked our kindergarten tutors to teach children seven musical poems about hydatid cyst , antibiotic misuse , botulinum toxin in home - canned foods , dysentery , the importance of sixth tooth , brucellosis and tetanus . in this step , children were not allowed to take home these texts , but they were asked to sing the poems at home and want their parents to re - write the poems on a paper and give them the papers to take to the kindergarten . the teaching stage took between three to four months . during the next stage , parents took a post - test survey with the same 24 questions . parents of 115 kids participated in the pre - test and 103 of them completed the post - test . statistical analysis is done on 103 who completed both tests by paired t - test . the sample data consists of 103 parents who provided solutions to both the pre- and post - test question survey . of the participants 77 were female and 26 male . from the level of education point of view , 19 were below high school diploma , 45 had high school diploma , 8 had associate degree , 27 had ba , 3 had ma , and 1 had phd . the results of the survey show a significant difference between the correct answers in both pre - test and post - test stages ( fig . 1 ) . the frequency of correct answers to the tests 
 table 1 shows the mean of the correct answers in the pre - test stage is 59.22 while the same figure for the post - test step is 81 ( p < 0.001 ) . in addition , we define knowledge mark ( km ) as a parent mark in both the pre - test and/or post - test stages . the mean km shows a significant increase ( 5.01 ) from 13.62 in the pre - test to 18.63 in the post - test ( table 2 ) . mean percent of correct answers to pre - test and post - test categories 
  analyzed by paired t - test sd : standard deviation mean of knowledge mark in pre - test and post test analysed by paired t - test the difference of km promotion among females and males was not significant ( 21.6120.17 in males and 20.331.61 in females , p=0.8 ) . the km was increased to 19.9325.06 among parents who at most had high school diploma and 23.4720.84 among parents with upper educational levels ( p=0.5 ) . health has been the concern of poets such as fiona sampson for years , however , these poems never had educational purposes . the results of this study confirm our hypothesis about the role of children in raising family 's knowledge on health . the results show that neither gender nor the grade of knowledge degree ( below and upper high school diploma or below and upper ba ) affect answers . therefore , people with different educational status have received the information similarly implying that this method can be extended to general cases in a straightforward manner . 1 shows that the percentage of correct answers has increased in 23 out of 24 questions . the percent - age of correct answer to post - test has decreased only in one item ( item 11 ) which compares the risk of brucellosis transmission via unpasteurized milk and yogurt . although the term yogurt has not been mentioned directly in the related poem , but there is a hint about boiling mechanism and we expect that the audience discover the answer by logical thinking about the necessitation of boiling milk for preparing yogurt . the decrease in answering is 2 percent which is not significant ; however , it shows that it would be better to mention the conceptions directly in these types of poems in order to avoid any misconceptions . moreover , the percentage of correct answers to the questions of selected topics in pre - test and post - test has been compared ( table 1 ) and shows that parents have done better in post - test about all topics except one . the difference of correct answers to the questions about brucellosis does not show a significant increase in post - test . this finding is probably due to higher basic knowledge about brucellosis among parents . in other words , parents have had acceptable information about brucellosis even without our educational program , so we observe lower contrast between pre - test and post - test about brucellosis . it should be taken into consideration that brucellosis is an endemic disease in hamadan and people have been educated in different ways about this disease in recent years . although the lowest contrast between pre - test and post - test correct answers belongs to a question about botulism , the overall assessment shows that parent 's knowledge about this topic has been promoted significantly ( p<0.001 , table 1 ) . the significant difference between the pre - test and post - test km , based on the results of table 2 , is the sign of successful knowledge transfer through childish poems . the researcher 's method is impressively successful ; however , the fact that he mentions that some mothers can not distinguish the semantic difference between information and advice , needs serious attention . in addition , since daughters may misunderstand the information , it would be probable to transfer the misconceived information to their mothers and this fact threats the successfulness of study in applying . while , in our study ; firstly , childish poems do not imply sententious , secondly , if the poem is sung wrong , the disturbance in rhythm will be appeared , so the information which is transferred through poems is not at risk of alteration . in evans research , parents get familiar with educated topics with the help of their children in homework assignments designed for asthma management , and are taught about asthma indirectly . the advantage of our study in comparison with evans is that in evans method knowledge transfer brings to bear via homework assignment , while in our study there is no obligation for doing home works , and parents are educated while enjoying their child 's singing . on account of the fact that making communication with younger children is not as difficult as with adolescents for parents , we are sure that knowledge transfers within a family through a continuous and friendly communication will work . christensen expressed the importance of children 's role in promoting the family health status . in his article , he emphasized on the activities that children can perform to enhance their health and promote their family health situation via the health efforts for themselves . we showed that children , additionally to what christensen mentioned , are able to affect their family 's health status directly . they can improve their family 's health as little teachers in health . it should be taken into consideration that the limitations of this study was the impact of other media on participant 's knowledge , which was not preventable . one of the acceptable results of this survey was publishing the poems as a book for children which was republished and welcomed by public . this study 's results suggest that health knowledge transfer to families through childish poems is an applicable method that has many advantages . by applying this joyful , cost - effective and easy - to - use method however , it should be taken into consideration that this method is applicable for families with trainable children , for teaching in larger scales more general ways should be added to this method . moreover , the simplicity of poems and expressing the topics in a less elaborative form are the key factors that affect the successfulness of this way .
objectivethe purpose of this study is to propose an innovative method of knowledge transfer that aims to improve health literacy about pediatric infectious diseases prevention in families . 
 children have an appreciable role in this scheme.methodsthis study is a before and after trial that has been conducted in hamedan in 2009 . after changing seven infectious disease topics into childish poems , we selected five kindergartens randomly and taught these poetries to the children . teaching process held after a pretest containing 24 questions that examined 103 of parents about mentioned topics . 
 the same post - test was given after 4 months of teaching process.findingsthe mean of correct answers to the pretest was 59.22% comparable with 81.00% for post - test ( p<0.00 ) . 
 gender and knowledge degree could not change the results significantly . 
 assuming one 's correct answers to the questions as his / her knowledge mark , the mean of this variable increased to 5.32 by this method.conclusionthis cost - effective and joyful method had successful results in promoting health knowledge . 
 children are able to play an active role in family 's health situation . 
 learning within family atmosphere without any obligations makes our scheme a solution for paving the knowledge transferring way .