@2024 Afarand., IRAN
ISSN: 2383-2150 Journal of Education and Community Health 2014;1(1):1-10
ISSN: 2383-2150 Journal of Education and Community Health 2014;1(1):1-10
Effect of Educational Program to Encourage Safe Sexual Behaviors Among Addicted Men Refered to Substance Abuse Treatment Centers in Hamadan, Western Iran: Applying the Theory of Planned Behavior
ARTICLE INFO
Article Type
Original ResearchAuthors
Moieni B. (1)Mehdi Hazavehei S.M. (2)
Bashirian S. (1)
Soltanian A. (3)
Mousali A.A. (4*)
Kafami V. (4)
(1) Social Determinants of Health Research Center and Department of Public Health, School of Health, Hamadan University of Medical Sciences, Hamadan, Iran
(2) Health Science Research Center and Department of Public Health, School of Health, Hamadan University of Medical Sciences, Hamadan, Iran
(3) Modeling of Non-communicable Disease Research Center and Department of Biostatistics and Epidemiology, School of Health, Hamadan University of Medical Sciences, Hamadan, Iran
(4*) Department of Public Health, School of Health, Hamadan University of Medical Sciences, Hamadan, Iran
Correspondence
Article History
Received: January 10, 2014Accepted: April 22, 2014
ePublished: June 12, 2014
BRIEF TEXT
Addiction and high-risk sexual behaviors are considered among the most important risky behaviors which expose the individuals and the community to serious infectious diseases such as AIDS and hepatitis [1,2]. ... [3, 4].Lack of information or inaccurate information about sexual issues will naturally increase the dangers of high-risk behaviors and sexually transmitted diseases [5]. ... [6-11].
Given the increasing prevalence of high-risk sexual behaviors in drug addicts, addiction functions as an important factor in the spread of infection to other social groups [12]. Behavioral theories and models can be employed to understand how to prevent health problems [13]. The theory of planned behavior is widely used to predict high- risk sexual behavior and is saidto be effective in predicting these behaviors [14]and on a wide range of other behaviors [15]. … [16-19].
This study aimed to determine the effect of educational programs of encouraging safe sexual behaviors among male addicts who clientele to drug rehabilitation centers in Hamadan.
This is a quasi-experimental research which is done through intervention.
The population is comprised of 104 drug addicts under the cover of governmental drug rehabilitation centers in Hamadan.
Out of 3 governmental drug rehabilitation centers in the city of Hamedan, one center was chosen as the control group and another one as the intervention group randomly. The criteria for being included in the study were: age range of 20 to 45, drug addicts covered by addiction rehabilitation centers and taking part in more than half of the study`s training sessions; the exclusion criteria included: failure to complete the questionnaire.
The data collection tool was a questionnaire containing two parts; the first part of the questionnaire was related to background information and the second part to the Theory of Planned Behavior (TPB) constructs. The questionnaire consisted of 10 questions of attitudes, 10 questions of subjective norms, 8 questions of perceived behavioral control, 2 questions of behavioral intention and 2 questions of behavior. To assess the validity of the questions, opinions of 5 health education specialists were applied and to examine their reliability, Cronbach's alpha coefficient test was used after a preliminary study. Cronbach's alpha coefficient for the attitude construct, subjective norms construct and perceived behavioral control was 0.77, 0.721 and 0.74, respectively.Participants of the intervention group took part in four training sessions and the control group received no instruction. The educational syllabus of the intervention included the consequences of unsafe sexual behaviors using educational slides and videos, manuals to change attitudes, information about the consequences, complications and effects of unsafe sexual behavior as a way to foster emotionally, instructing the skills of detecting high-risk situation, problem-solving skills in changing perceived behavioral control, assertiveness skills, the skill of rejecting dangerous proposals as well as the presence of the staff of the drug rehabilitation centers in changing subjective norms using role-plays techniques and educational clips. Each training session was held for 45 minutes through lecture and question and response methods, and using training aids in these centers. The effect of intervention was assessed on safe sexual behaviors two months after the fourth training session Statistical analysis: Collected data was analyzed through SPSS statistical software (version 16) and with the use of statistical paired t tests, independent t-test, chi-square test, Fisher`s exact test, McNemar test and multivariate logistic regression analysis with random effects for paired binary data.
The results of chi-square test and Fisher's exact test illustrated that there was no significant differences in terms of age, education and marital status between the intervention and control groups (Table 1).A comparison between the scores of TPB constructs revealed no significant differences between the intervention and control groups before the educational intervention (p>0.05). Changes in the mean scores of TPB constructs are presented in Table 2 using independent t test (before and afterward difference) in both intervention and control groups after the educational intervention. The mean score of attitude in the intervention group increased from 33.47 to 36.29, and this increase was statistically significant according to the result of the paired t test (p=0.004) and the mean score of attitude in the control group decreased from 34.13 to 33.71 and this decrease was not statistically significant according to the result of the paired t test (p=0.398). The mean score of subjective norms of encouraging safe sexual behavior in the intervention group rose from 38.68 to 41.13 and this increase was statistically significant according to paired t-test result (p=0.005). The mean score of subjective norms heightened from 37.91 to 38 in the control group and this boost was not statistically significant due to the result of the paired t-test (p=0.866). The mean score of behavioral control of refusing unsafe sexual behavior increased from 30.13 to 32.86 in the intervention group and this was statistically significant according to the paired t test result (p=0.014) whereas the mean score of this structure went up from 29.04 to 29.55 in the control group and this increase was not statistically significant (p=0.384). The comparison of safe sexual behavior intention has been indicated in Table 3 before and after the intervention using chi-square test in both groups of intervention and control. According to the findings, the number of people with the intention of safe sexual behavior increased from 31 to 40 and the result of McNemartest was statistically significant likewise (p=0.001). The behavioral intention diminished from 43 to 40 people in the control group and this difference was not statistically significant (p=0.125). Chi-square test results showed that there was a significant statistical difference between the two groups before the educational intervention. Due to the significant difference before the intervention, to determine significant difference after the intervention, multivariate logistic regression analysis with random effects for paired binary data was used and after the educational intervention a significant difference was observed between the two groups (p=0.009). Figure 1 demonstrates the comparison of conducting safe sexual behavior before and after the intervention in both intervention and control groups. According to the results, the number of people with safe sexual behavior in the intervention group increased from 20 to 34 and McNemar test result was statistically significant in the intervention group (p=0.001). However, the number dropped from 38 to 35 in the control group and this difference was not statistically significant in the control group (p=0.508). Chi-square test result revealed that there was a statistically significant difference between the intervention and control groups before the intervention (p=0.001). Multivariate logistic regression analysis with random effects for paired binary data was deployed. Test results showed a significant difference in sexual behavior between the two groups after the educational intervention (p=0.027).
… [20] The significant change in attitude score with regards to safe sexual behaviors in the intervention group indicates the effectiveness of the educational program among the participants of the intervention group and these results are in line with the findings of similar studies [21-24]. … [25]. Significant increase of subjective norms in the intervention group was, also, consistent with the results of other studies [21, 22, 26-29]. … [30-32]. Results of this study demonstrate the positive effect of educational program on improving individuals, skills in controlling behavior and arein harmony with the results of similar studies [21, 22, 26, 33, 34]. … [35, 36].An increase in the scores of attitude, subjective norms, perceived behavioral control, and behavioral intention were predictable which exhibits the effect of educational program in terms of safe sexual behavior and goes with similar studies (24,26, 37-39). The results indicate the positive effect of theoretical educational intervention on conducting safe sexual behavior among the addicts covered by drug rehabilitation centers in the intervention group after enforcing the educational program which are sufficiently in consistency with the results of similar studies [21, 23, 40-42]. …[43-44].
It is necessary to establish communicative skills to provide information which are suitable to the cultural characteristics of addicts referring to drug treatment and rehabilitation centers.
Lack of cooperation on some of the participants` side due to a few cultural sensitivities is one of the limitations of this study.
Holding educational sessions that encourage safe sexual behaviors by using the theory of planned behavior might be useful for addicted people who are covered by drug rehabilitation centers.
Special regards are addressed to the Vice Chancellor for Research and Technology of Hamedan University of Medical Sciences, personnel of governmental drug rehabilitation centers in Hamadan, and clients referring to these centers.
Non-declared
This study has been registered in the Iran’s International Center of clinical trials under the Code of IRCT2013071313979N1.
This study is part of a thesis for Master`s degree (with the registration number of 4013), which has been conducted by the financial support of the Research Department of Hamedan University of Medical Sciences (Health Science Center).
TABLES and CHARTS
Show attach fileCITIATION LINKS
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[16]Armitage CJ. Can the Theory of Planned Behavior Predict the Maintenance of Physical Activity? Health Psychol.2005; 24(3):235-45.
[17]Godin G, Gagné C, Maziade J, Moreault L, Beaulieu D, Morel S. Breast Cancer: the intention to have a mammography and a clinical breast examination-application of the theory of planned behavior. Psychol Health.2001; 16(4):423-41.
[18]Tolma EL, Reininger BM, Evans A, Ureda J. Examining the theory of planned behavior and the construct of self-efficacy to predict mammography intention. Health Educ Behav. 2006; 33(2):233-51.
[19]Mohr DC, Lukas CVD, Meterko M. Predicting healthcare employees' participation in an office redesign program: Atti-tudes, norms and behavioral control. Implement Sci.2008; 3(1):47.
[20]Turchik JA, Gidycz CA. Prediction of Sexual Risk Behaviors in College Students Using the Theory of Planned Behavior: A Prospective Analysis. J Soc Clin Psychol.2012; 31(1):1-27.
[21]Pakpour HajiAgha A, Mohammadi Zeidi I, Mohammadi Zeidi B. [The Impact of Health Education Based on Theory of Planned Behavior on the Prevention of AIDS among Adolescents]. Iran Journal of Nursing.2012; 25(78):1-13. )Persian(
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[24]Ghaffari M, Jamali RS, Rakhshandeh S, Eslami AA. [Effect of educational program on HIV/AIDS-related knowledge, attitude, and behavioral intentions of male high school’s students in Bavanat (Fars province): An interventional research]. Journal of Health in the Field.2013; 1(1):6-12. )Persian(
[25]Tussing L, Chapman-Novakofski K. Osteoporo-sis prevention education: behavior theories and calcium intake. J Am Diet Assoc.2005; 105(1):92-7.
[26]Karimy M, Abedi AR, Amin-Shokravi F, Tavafian SS. Preventing HIV Transmission among the Opiate-Dependent Population in Zarandieh: Evaluation of the HBM-Based Educational Programs. Health Education & Health Promotion.2013; 1(1):21-31.
[27]Coyle K, Basen-Engquist K, Kirby D, Parcel G, Banspach S, Harrist R, and et al. Short-term impact of safer choices: a multicomponent, school-based HIV, other STD, and pregnancy prevention programe. J Sch Health.1999; 69(5):181-8.
[28]Klepp K, Ndeki SS, Lleshabari MT, Hnnana PJ, and Lyimo BA. AIDS education in Tanzania: Promoting risk reduction among primary school children. Am J Public Health.1997; 87(12):1931-6.
[29]Kyrychenko P, Kohler C, Sathiakumar N. Evaluation of a school-based HIV/AIDS educationalintervention in Ukraine. J Adolesc Health.2006; 39(6):900-7.
[30]Hazavehei S, Sharifirad G, Kargar M. [The Comparison of Educational Intervention Effect Using BASNEF and Classic Models on Improving Assertion Skill Level]. J Res Health Sci.2008; 8(1):1-11. )Persian(
[31]Bashirian S, Hidarnia AR, Allahverdipour H, Hajizadeh E. Application of the theory of planned behavior to predict drug abuse related behaviors among adolescents. J Res Health Sci.2012; 12(1):54-60.
[32]Barati M, Allahverdipour H, Moinei B, Farhadinasab A, Mahjub H, Jalilin F. [Assertiveness skills training efficiency on college students’ persuasive subjective norms against substance abuse]. Scientific Journal of Hamadan University of Medical Sciences.2011; 18(3):40-49. )Persian(
[33]Aghamolai T, Eftekhar H, Kazem M. [Health belief model application for changing diabetic patients behavior]. Payesh.2005; 4(4):263-9. )Persian(
[34]Caron F, Godin G, Otis J, Lambert L. [Evaluation of a theoretically based AIDS/STD peereducation program on postponing sexual intercourse and on condom use among adolescents attendinghigh school]. Health Educ Res.2004; 19(2):185-197.
[35]Sohrabi F, Hadian M, Daemi HR, Asgharnezhad Farid AA. [The effectiveness of healthy behavior training program in changing attitude of students towards substance abuse]. Journal of Behavioral Sciences.2008; 2(3):209-20. )Persian(
[36] Ratleff-craina J, Donald KM, Dalton J. Knowledge, beliefs, peer norms, and past behaviors as correlates of risky sexual behaviors among college students. Psychol Health.1999; 14(4):625-41.
[37]Cai Y, Hong H, Shi R, Ye X, Xu G, Li S, et al. Long-term follow-up study on peer-led school-basedHIV/AIDS prevention among youths in Shanghai. Int J STD AIDS.2008; 19(12):848-50.
[38]Huang H, Ye X, Cai Y, Shen L, Xu G, Shi R, et al. Study on peer-led school-based HIV/AIDS prevention among youths in a medium-sized city in China. Int J STD AIDS.2008; 19(5):342-6.
[39]Ye XX, Huang H, Li SH, XU G, Cai Y, Chen T, et al. HIV/AIDS education effects on behavior among senior high school students in a medium– sized city in china. Int J STD AIDS.2009; 20(8):549-52.
[40]Charuluxananan S, Migasena R, Somboonviboon W, Chinachot T, Kunthollaxami A.Effect of national seminar on AIDS andanesthesia upon knowledge attitude and practice concerning HIV among Thai anesthesiapersonnel. J Med Assoc Thai.2000; 83(2):174-81.
[41]Butts JB, Hartman S. Project BART: Effectiveness of behavioral intervention to reduce HIV risk in adolescents. MCN Am J Matern Child Nurs.2002; 27(3):163-9.
[42]Ashrafizadeh S, Nikkhoy A, Vaziri Esfarjani S. [Knowledge, attitude and practice of high school young students toward HIV disease]. XVIIth IEA World Congress of Epidemiology, 2005; pp:144. )Persian(
[43]Barati M, Allahverdipour H, Moinei B, Farhadnasab A, Mahjub H. [Evaluation of Theory of Planned Behavior-Based Education in Prevention of MDMA (ecstasy) use among University Students]. Medical Journal of Tabriz University of Medical Sciences.2011; 33(3):20-9. )Persian(
[44] Jadgal KH, Zareban I, Rakhshani F, Shahrakipour M, Sepehrvand B. The effect of health education according to the theory of planned behavior on malaria preventive behavior in rural men of Chabahar. J Research Health.2012; 2(2):237-46.
[2]World Health Organization. Young people’s health in context: selected key findings from the health behavior in school-aged Children study. Copenhagen, Edinburgh, 2004.
[3]Yans HA. [Females Sexual life]. Translated by: Nikkhoo MR. 2nded. Tehran: Sobhan publisher; 2001; 78-95. )Persian(
[4]Warnock JJ. Female hypoactive sexual desire disorder: epidemiology, diagnosis and treatment. CNS Drugs.2002; 16(11):745-53.
[5]Asadi-Lari M, Sayyari AA, Akbari ME, Gray D. Public health improvement in Iran-lessons from the last 20 years. Public Health.2004; 118(6):395-402.
[6]Maleki M, Javidi Z, Mashayekhi V, Tayebi-meibodi N, Nahidi Y, Esmaeili H, et al. [HIV and syphilis serologic survey on clinical vart annal genital patients]. Medical Journal of Mashhad University of Medical Sciences.2004; 51(100):87-94. )Persian(
[7]Stopparads M. Family health guide. New York: DK (A Dorling Kindersley book); 2002:116.
[8]Burt RD, Thiede H, Barash ET, Sabin K. Recent condom use by arrested injection drug users in King County, Washington, USA. Int J Drug Policy.2006; 17(3):222-9.
[9]Afshar Amin F, Aarabi M, Hagi S, Kasraei F. AIDS and STDs (For adolescents). 2nd edition, Tehran: Iranban Publisher, 2003;1-6. )Persian(
[10]Razzaghi OM. Rahimi Movagher A, Mohammad K, Hosseini M. [Qualitative study of high-risk sexual behaviors among injecting drug users in Tehran]. Journal of Health and Medical Research Institute.2003; 2(2):1-10. )Persian(
[11]Mousali AM, Moeini B, Kafami V, Bashirian S, Barati M.Predicting factors of safe sexual behaviors intention among ad-dicted men covered by addiction treatment centers in Hamadan city: Applying Theory of Planned Behavior (TPB).4th National Congress on High Risk Behaviors, November 2013, Zahedan University of Medical Sciences (abstract book; available at: WWW.zaums.ac.ir/uploads/2014)
[12]Farhoodi B. HIV/AIDS And injection Drug Users Tehran; Nashreh Seda Publication, 2003.
[13]Glanz K, Rimer BK, Viswanath K. Health Behavior and Health Education: Theory, Research and Practice. 4th ed. San Francisco: Jossey-Bass publisher, 2008, PP: 67-92.
[14]Albarracín D, Durantini MR, Earl A. Empirical and Theoretical Conclusions of an Analysis of Outcomes of HIV-Prevention Interventions. Curr Dir Psychol Sci.2006; 15(2):73-78.
[15]Ajzen I. The theory of planned behavior. Organizational Behavior and Human Decision Processes.1991; 50(2):179-211.
[16]Armitage CJ. Can the Theory of Planned Behavior Predict the Maintenance of Physical Activity? Health Psychol.2005; 24(3):235-45.
[17]Godin G, Gagné C, Maziade J, Moreault L, Beaulieu D, Morel S. Breast Cancer: the intention to have a mammography and a clinical breast examination-application of the theory of planned behavior. Psychol Health.2001; 16(4):423-41.
[18]Tolma EL, Reininger BM, Evans A, Ureda J. Examining the theory of planned behavior and the construct of self-efficacy to predict mammography intention. Health Educ Behav. 2006; 33(2):233-51.
[19]Mohr DC, Lukas CVD, Meterko M. Predicting healthcare employees' participation in an office redesign program: Atti-tudes, norms and behavioral control. Implement Sci.2008; 3(1):47.
[20]Turchik JA, Gidycz CA. Prediction of Sexual Risk Behaviors in College Students Using the Theory of Planned Behavior: A Prospective Analysis. J Soc Clin Psychol.2012; 31(1):1-27.
[21]Pakpour HajiAgha A, Mohammadi Zeidi I, Mohammadi Zeidi B. [The Impact of Health Education Based on Theory of Planned Behavior on the Prevention of AIDS among Adolescents]. Iran Journal of Nursing.2012; 25(78):1-13. )Persian(
[22]Ebrahimipour H, Jlmbadany Z, Peyman N, Ismaili H, Vafaie Najjar A. [Effect of sex education, based on the theory of planned behavior, on the sexual function of the woman attending Mashhad health centers]. Journal of Birjand University of Medical Sciences.2013; 20(1):58-67. )Persian(
[23]Zareban I, Heidarnia AR, Rakhshani F, Jabbari H, Abdollahi Mohammad A GH. [Efficacy of AIDS prevention training program on knowledge, attitude and practice of Chabahar sailors, Iran]. Zahedan Journal of Research in Medical Sciences.2006; 8(1):29-36. )Persian(
[24]Ghaffari M, Jamali RS, Rakhshandeh S, Eslami AA. [Effect of educational program on HIV/AIDS-related knowledge, attitude, and behavioral intentions of male high school’s students in Bavanat (Fars province): An interventional research]. Journal of Health in the Field.2013; 1(1):6-12. )Persian(
[25]Tussing L, Chapman-Novakofski K. Osteoporo-sis prevention education: behavior theories and calcium intake. J Am Diet Assoc.2005; 105(1):92-7.
[26]Karimy M, Abedi AR, Amin-Shokravi F, Tavafian SS. Preventing HIV Transmission among the Opiate-Dependent Population in Zarandieh: Evaluation of the HBM-Based Educational Programs. Health Education & Health Promotion.2013; 1(1):21-31.
[27]Coyle K, Basen-Engquist K, Kirby D, Parcel G, Banspach S, Harrist R, and et al. Short-term impact of safer choices: a multicomponent, school-based HIV, other STD, and pregnancy prevention programe. J Sch Health.1999; 69(5):181-8.
[28]Klepp K, Ndeki SS, Lleshabari MT, Hnnana PJ, and Lyimo BA. AIDS education in Tanzania: Promoting risk reduction among primary school children. Am J Public Health.1997; 87(12):1931-6.
[29]Kyrychenko P, Kohler C, Sathiakumar N. Evaluation of a school-based HIV/AIDS educationalintervention in Ukraine. J Adolesc Health.2006; 39(6):900-7.
[30]Hazavehei S, Sharifirad G, Kargar M. [The Comparison of Educational Intervention Effect Using BASNEF and Classic Models on Improving Assertion Skill Level]. J Res Health Sci.2008; 8(1):1-11. )Persian(
[31]Bashirian S, Hidarnia AR, Allahverdipour H, Hajizadeh E. Application of the theory of planned behavior to predict drug abuse related behaviors among adolescents. J Res Health Sci.2012; 12(1):54-60.
[32]Barati M, Allahverdipour H, Moinei B, Farhadinasab A, Mahjub H, Jalilin F. [Assertiveness skills training efficiency on college students’ persuasive subjective norms against substance abuse]. Scientific Journal of Hamadan University of Medical Sciences.2011; 18(3):40-49. )Persian(
[33]Aghamolai T, Eftekhar H, Kazem M. [Health belief model application for changing diabetic patients behavior]. Payesh.2005; 4(4):263-9. )Persian(
[34]Caron F, Godin G, Otis J, Lambert L. [Evaluation of a theoretically based AIDS/STD peereducation program on postponing sexual intercourse and on condom use among adolescents attendinghigh school]. Health Educ Res.2004; 19(2):185-197.
[35]Sohrabi F, Hadian M, Daemi HR, Asgharnezhad Farid AA. [The effectiveness of healthy behavior training program in changing attitude of students towards substance abuse]. Journal of Behavioral Sciences.2008; 2(3):209-20. )Persian(
[36] Ratleff-craina J, Donald KM, Dalton J. Knowledge, beliefs, peer norms, and past behaviors as correlates of risky sexual behaviors among college students. Psychol Health.1999; 14(4):625-41.
[37]Cai Y, Hong H, Shi R, Ye X, Xu G, Li S, et al. Long-term follow-up study on peer-led school-basedHIV/AIDS prevention among youths in Shanghai. Int J STD AIDS.2008; 19(12):848-50.
[38]Huang H, Ye X, Cai Y, Shen L, Xu G, Shi R, et al. Study on peer-led school-based HIV/AIDS prevention among youths in a medium-sized city in China. Int J STD AIDS.2008; 19(5):342-6.
[39]Ye XX, Huang H, Li SH, XU G, Cai Y, Chen T, et al. HIV/AIDS education effects on behavior among senior high school students in a medium– sized city in china. Int J STD AIDS.2009; 20(8):549-52.
[40]Charuluxananan S, Migasena R, Somboonviboon W, Chinachot T, Kunthollaxami A.Effect of national seminar on AIDS andanesthesia upon knowledge attitude and practice concerning HIV among Thai anesthesiapersonnel. J Med Assoc Thai.2000; 83(2):174-81.
[41]Butts JB, Hartman S. Project BART: Effectiveness of behavioral intervention to reduce HIV risk in adolescents. MCN Am J Matern Child Nurs.2002; 27(3):163-9.
[42]Ashrafizadeh S, Nikkhoy A, Vaziri Esfarjani S. [Knowledge, attitude and practice of high school young students toward HIV disease]. XVIIth IEA World Congress of Epidemiology, 2005; pp:144. )Persian(
[43]Barati M, Allahverdipour H, Moinei B, Farhadnasab A, Mahjub H. [Evaluation of Theory of Planned Behavior-Based Education in Prevention of MDMA (ecstasy) use among University Students]. Medical Journal of Tabriz University of Medical Sciences.2011; 33(3):20-9. )Persian(
[44] Jadgal KH, Zareban I, Rakhshani F, Shahrakipour M, Sepehrvand B. The effect of health education according to the theory of planned behavior on malaria preventive behavior in rural men of Chabahar. J Research Health.2012; 2(2):237-46.