This descriptive-analytical study was carried out during September to December, 2016 including all undergraduate midwifery students from the first to eighth semester of Nursing and Midwifery Faculty of Ilam University of Medical Sciences, Iran. After coordinating with college officials, the researchers asked participants to complete the questionnaires. The questionnaire was completed by students in Training place (hospital, health center and classrooms).

Inclusion criteria were studying midwifery in Ilam University of Medical Sciences and willingness to participate in the study. Patients of Drug addiction, history of medical illness, history of referral to a psychiatrist or psychologist, drug use or hospitalization due to mental illness in recent years, and severe tension during the past six months such as the death of the closest relatives were excluded.

The data gathering tool used was a three-part questionnaire including demographic characteristics (age, total grade, semester, participation in communication skills, workshops, etc.,), optimism questionnaire, and communication skills questionnaire. A life-orientation questionnaire was used to assess optimism, which is characterized by personal desires in the future. This version was designed by Scheier MF et al., and its reliability was confirmed by Cronbach’s alpha of 0.7 [8]. The validity and reliability of this test has been analysed by Hassanshahi MM [9]. We also tested the reliability of the tool by Cronbach’s alpha. The reliability of the tool was tested with the participation of 10 midwifery students. Cronbach alpha coefficient for optimism questionnaire was 0.75. Life-orientation questionnaire consists of Optimism and Pessimism scales, with 10 items (three items assess optimism, three assess pessimism, and four of them are fillers). The respondents indicated the extent to which they agreed with each item on a 5-point Likert scale (0 for completely disagree, 1 for disagree, 2 for no opinion, 3 for agree, and 4 for completely agree). Questions 3, 7, and 9 had a reverse score. Questions 2, 5, 6, and 8 can be ignored. The overall score was from 0 to 24 with six questions in life-orientation questionnaire and scores closer to 24 show higher optimism.

Queendom communication skills test-revised questionnaire (2004) was designed to measure communication skills [10]; the validity and reliability of this test has been analysed by Hosseinchari M and Fadakar M [11]. Subcategory communication skills that are considered on this scale include the listening skill, the skill to receive and send messages, insight into communication, emotional control, and assertion communication. The questionnaire had 34 items with a Likert scale of 1 to 5: never (1 point), rarely (2 points), sometimes (3 points), often (4 points), and always (5 points). The total score of each person was from 34 to 170. The low score indicates weakness in communication skills. The reliability of the tool was tested with the participation of 10 midwifery students. Cronbach alpha coefficient for communication skills questionnaire was 0.83.

In order to observe ethical considerations, the researcher, provided a full explanation on the purpose of research and confidentiality of the information. Also, entrusted the students’ satisfaction and trust to complete the questionnaire and to sign the consent form. An anonymous questionnaire was used for confidentiality of information and each questionnaire was assigned a separate code. This study is a research project with the number 90936 approved by Ilam University of Medical Sciences.

Data were analysed by descriptive statistical methods (frequency distribution, percentage, and mean) and analytical statistics (Pearson’s correlation coefficient, Spearman’s correlation coefficient and ANOVA) using SPSS version 16 (SPSS Inc, Chicago, IL, USA). p<0.05 was considered as Statistically significant. Kolmogrov-Spirnov test showed that distribution of quantitative variables followed the normal distribution. Therefore, parametric tests were used.

Out of the total 126 midwifery students in the research period, 115 students completed the questionnaire. The mean age, total grade and number of exercise sessions per week of the participants was 23.4±5.5 years, 15.90±1.31 and 1.53±1.43, respectively. Most students were single (71.3%), semester 6 (25.2%). Students (42.6%) had a history of participation in communication skills workshops. Also, 60% of the people were aware of the degree before they chose the course.

The mean score of communication skill was 108.9±10.9, with the lowest being 84 and the highest was 132. The mean score of 11optimism was 13.9±3.5, with the lowest being 5 and the highest was 21. Pearson’s correlation coefficient showed that there was a direct correlation between communication skill and optimism scores (r=0.477, p<0.001).

Pearson’s correlation coefficient showed that the communication scores had a direct relation with age (r= 0.238, p=0.01), but there was no significant relationship with other variables. Spearman’s correlation coefficient showed that optimism score had a reverse relation with the level of awareness of the field of study (r= -0.336, p<0.001), but there was no significant relationship with other variables [Table/Fig-1].

Independent sample t-test showed that the mean score of communication skills in married people was significantly higher than in single ones (p = 0.02), but there was no significant relationship with history of participation in communication skills workshops (p=0.18). Independent sample t-test showed that the mean score of optimism was not relation with marital status (p=0.98) and history of participation in communication skills workshops (p=0.38) [Table/Fig-2].

According to the results of the study, the mean of the students’ optimism scores was 13.9±3.5, with the lowest of 5 and the highest was 21. In the study of Ozdemir M et al., the average score of optimism in nursing and midwifery students was 18.5±4.54 [12], which is close to the average score in the present study. They reported moderate levels of optimism among students which is consistent with the findings of the present study. Taati F et al., evaluated the role of optimism on the relationship between stressful academic experiences and the response to these experiences in students; the average score of optimism in women was 3.75±19.19 [13] which was consistent with the average score of optimism among midwifery students.

In the present study, the mean score of communication skills among midwifery students was 108.9±10.9. In a study conducted by Ozdemir M et al., among midwifery and nursing students in Turkey, the results showed that the overall mean score of communication skills was 165.15±15.39, which was reported at the average level [12]. In a descriptive-analytical study conducted by Salimi M et al., the average score of interpersonal communication skills was 99.22±9.91 [14]. In a similar study by Mahmoudi GH et al., the communication skills of midwifery students were reported at a moderate level and higher than nursing students [15]. Although some studies have used different questionnaires, the results of these studies are consistent with the average score of communication skills reported in the present study.

In the present study, Pearson’s correlation coefficient showed that there was a direct correlation between communication skill and optimism scores (r=0.477, p<0.001). In the study of Ozdemir M et al., there was a correlation between the level of communication skills and the mean score of optimism, too [12]. This finding suggested that students who were optimists can have higher communication skills.

In the present study, the findings showed that optimism score was significantly correlated with the level of knowledge of the field (p<0.001). Independent t-test also showed that life orientation score was not significantly correlated with other variables (p=0.18). It can be concluded that students who are well-informed about the field of study and the issues are capable of self-control and proper management when faced with the challenges in their studies. Thus, a person does not exhibit pessimism and disappointment towards the future. Students may also face problems such as separation from the family, inability to adapt to living in a dormitory, meeting their expectations of life, and not being compatible with the environment at the time of entering the university [16]. Such a negative feeling and a stressful life can lead to a variety of psychological problems, a decline in academic success, and emotional feelings, such as disappointment for the future [17]. Steptoe A et al., observed that optimism is related to healthy behaviours such as fast walking and regular physical activity, while in the present study, the amount of optimism does not have a meaningful relationship with the number of exercise per week [18].

In the present study, the findings showed that there was a direct relationship between communication skills and age (p=0.01). Independent t-test also showed that the mean score of communication skills in married people was significantly higher than single ones (p=0.02), but had no relationship with history of participation in communication skills workshops (p>0.05). In the study of Mirhaghjoo N et al., there was a significant difference between marital status, communication skills, training history, and mean score of communication skills, such that married people and people with a history of communicative skills training had a higher mean of communication skills scores. The increase in age in this study also had a significant relationship with the amount of communication skills [19]. These findings, in terms of age (p=0.01) and marital relationship (p=0.02), had a significant relationship in the present study. This finding may be due to the fact that married people have higher communication abilities, because they are more mature in their individual relationships seeking to acquire more roles. The findings of Rezaiean M et al., showed that with aging, the amount of communication skills increased significantly [20], which is consistent with the result of the present study, such that the score of communication skills is in direct relation with age, but in the findings of a study by Barati M et al., communication skills decreased with aging [21].

In the present study, the relationship between communication skills and the term of semester of midwifery students has not been meaningful. Also, Fellowes D et al., showed that experience does not increase the amount of communication skills [22]. But Barati M et al., found that there was a positive and significant relationship between communication skills of medical students and their term of semester [21].

Salimi M et al., found out that there was no relationship between the total average and history of participation in communication skills workshops with communication skills [14], which is in line with the present study. However, in a study by Makoul G in nursing students, there was a significant difference between trained and untrained students about communication [23], this was not consistent with the present study and the study by Salimi M et al., [14]; One of the reasons that can be noted for this discrepancy with the findings of other studies is the difference in measurement tools, the difference in the student’s academic discipline, the difference in the quality of education provided, and the willingness of students to learn non-syllabus materials, experiencing them, and ultimately, the use and application of these experiences. Mirhaghjoo M et al., reported the mean score of communication skills of people with a history of communication skills training to be significantly higher than those without communication skills training [19]. However, in the present study there was no significant relationship between passing interpersonal communication skills workshop and communication skills level among the students (p=0.18). It seems that the reason for this difference is due to different educational environments and differences in the quality of teaching. Since the appropriate communication skills and positive orientation in life are considered as a basic and special need for students and as they shape their lifestyle, it is necessary to emphasize on the importance of learning and applying these skills during study in the university and promote these skills through workshops held by experts in these fields.

The limitation of the present study was the use of self-report questionnaire. Therefore, a possibility of bias in completing the questionnaires could be there, which was outside the control of the researcher.

In this study, the communication skills of midwifery students were measured as moderate. Therefore, a comprehensive training is needed to improve these skills in order to increase the quality of care and education in clinical settings and universities. Also, optimism towards life was relatively adequate in most midwifery students. Considering the lack of studies in this field and the newness of this issue in medical sciences, further research is suggested in order to design programs to improve the proper orientation towards life in different groups of students.