@2024 Afarand., IRAN

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ISSN: 2383-2150    Journal of Education and Community Health 2020;7(3):169-175

Background
Hepatitis B virus (HBV) is one of the most important health problems and causes of death worldwide [1, 2].
Previous Studies
…[3-6]. The strategy of presenting health training programs is necessary to fight against hepatitis B infection, intending to increase public awareness of all members of society, and prevent its spread and occurrence [7]. …[8]. Health liaisons are the link between health workers with the public, and training of a health liaison is the education of several people. Since hepatitis B virus is a behavioral health problem, it should be investigated through training using behavioral health models. The Health Belief Model was used as the main framework in this research. This model was founded in the 1950s by Hochban and Rosen Stock in the United States. This model, which is based on the five main constructs of perceived sensitivity and severity, perceived benefits and barriers, and perceived self-efficacy, focuses on preventive behaviors [9]. This model emphasizes how evaluating the benefits and barriers to preventive behavior leads to such behavior. According to this model, in order to promote the right behaviors, people must first feel threatened by the problem (perceived sensitivity), then understand the depth of risk and its severity (perceived severity), and finally, they take the preventive behavior if the benefits are positively evaluated [10]. The effectiveness of this model in adopting health behaviors has been tested and confirmed in previous studies [11].
Aim(s)
The aim of this study was to determine the effect of training based on the Health Belief Model on preventive behaviors of hepatitis B infection in health liaisons.
Research type
This study is a quasi-experimental research.
Research society, place and time
This study was conducted among the liaisons of comprehensive urban health centers in Malayer city located in Hamadan province in 2015.
Sampling method and number
The sample size was determined 58 people in each group according to the same study [12] and considering the standard deviation of 3.29, the confidence level of 95% and the minimum difference of 2 between the intervention and control groups (as the effect size of the study), but taking into account the 10% statistical drop probability, 64 people in each group were determined as the sample of the study. The total number of subjects was 128 people. The subjects were randomly selected from 8 clinics of Malayer city. The liaisons of the Comprehensive Urban Health centers of Malayer city participated in the study with informed consent. Exclusion criteria were absent from more than one training session and relocation of the health liaison. The subjects were randomly assigned to experimental and control groups (n=64 in each group).
Used devices&materials
Data were collected through a reliable and valid researcher-made questionnaire, which was prepared based on the Health Belief Model and according to reliable sources and books [13]. This questionnaire included demographic characteristics and the structural part of the Health Belief Model. The validity of this questionnaire was assessed by the Content Validity Method. The minimum content validity ratio (CVR) was 0.62 based on the Lawshe Table and the number of the experts who evaluated the questions (10 people including an infectious disease specialist, 8 health training specialists, and a nurse). Therefore, the questions with the calculated content validity ratio of less than 0.62 were deleted. The content validity index (CVI) was also assessed. Finally, after resolving some problems and ambiguities, the validity of the questionnaire was confirmed, quantitatively. In order to a qualitative evaluation of the content validity, the experts were asked to review the questionnaires based on the criteria of grammar, use of appropriate words, placement of items in their proper place and proper scoring, and finally, their opinions were summarized and applied in a questionnaire [14]. The reliability of the questionnaire was measured through Cronbach's alpha test by 30 health liaisons who were similar to the study population in the aspect of demographic characteristics. Cronbach's alpha value in perceived sensitivity structure, perceived intensity, perceived benefits, perceived barriers, perceived self-efficacy, and performance were 0.68, 0.73, 0.74, 0.85, 0.78, and 0.72, respectively.After stating the research aims for the participants, a pre-test was performed. Then, the proper content was prepared and compiled for the training intervention based on the results of the cross-sectional study of the training program [14]. Finally, the intervention was performed in 4 training sessions for 40 minutes, in the experimental group based on the Health Belief Model (Table 1). No training intervention was performed in the control group. Finally, after three months, the same questionnaire was distributed and collected again in both experimental (n=56) and control (n=60) groups.Necessary permits were obtained from the relevant authorities as well as an ethics code were obtained from Hamadan University of Medical Sciences. This study was also registered in the clinical trial registration database under the number of IRCT2014082118885N1. It should be noted that all participants in the study signed a written consent form. After the end of the project, the control group was trained about hepatitis B infection and its preventative ways, and their questions were answered in this regard. Data were entered into SPSS 20 software and analyzed using Chi-square, Paired T, independent T-tests, and one-way analysis of covariance.
Findings by Text
There was no statistically significant difference between the experimental and control groups in terms of quantitative and qualitative demographic characteristics (p>0.05; Table 2).Before the intervention in the experiment, there was no significant difference between the experimental and control groups in terms of the Health Belief Model constructs (p>0.05). The mean scores of the model structures showed a significant difference (p<0.05) in the experimental group after the intervention, compared to before the intervention; in the control group, a significant difference was observed in terms of awareness, self-efficacy and perceived sensitivity compared to before the intervention (p<0.05). Also, the mean performance score of the experimental group liaisons was significantly increased compared to the control group, after the intervention (p<0.001; Table 3).Also, by controlling the effect of the pretest, there was a significant difference between the two groups in terms of awareness, perceived sensitivity, perceived intensity, perceived benefits, internal practice guide, self-efficacy, performance and perceived barriers (p<0.01; Table 4) three months after the intervention.The majority of subjects in the experimental group (66.1%) referred to the laboratory to check the hepatitis B antigen in case of exposure to a risk factor; 23.3% of the control group had this performance during the last three months.
Main comparison to the similar studies
The results of this study are consistent with the studies of Jadgal et al. [15] in terms of performance. …[16, 17]. Also, the results of this study are consistent with other studies in terms of awareness about hepatitis B infection, and training the health liaisons can improve their awareness [18]. The results of this study are consistent with the the study's results of Khodaveisy et al. [19] and Didarloo et al. [20] in terms of perceived sensitivity. Also the perceived risk of health managers regarding hepatitis B infection was very high in a similar study by Zolghadr et al. [21]. The findings of this study are consistent with the research's results of Amiri Siavashani et al. [22] and Hashemi et al. [23] in terms of perceived benefits. No contradictory results with the results of this study were found in other researches through examining the literature in this field. The results of Karimi et al.'s study on the effect of training on contraceptive behaviors against unwanted pregnancy did not have a significant effect on reducing barriers based on the Health Belief Model [24] and this results contradict the findings of the present study. Significance of the variables of barriers after the training intervention was also not observed in the study of Hazavaei et al. [25]. The results of the jahani et al.'s study showed that training intervention has increased self-efficacy in women under training [26], which is consistent with the findings of this study.
Suggestions
The authors emphasize repeating the present study in other target groups, including investigating the effect of the results of liaisons training to the people of a neighborhood covered by each health liaison; they also emphasize educating their spouses.
Limitations
There was a statistical drop in the study because training feedback was measured after three months. Other limitations of this study was data collection through self-reporting.
Conclusions
Training based on the Health Belief Model can affect sensitivity, perceived severity, benefits and barriers, perceived self-efficacy, and even the performance of health liaisons, and increase the adoption of hepatitis B-preventive behaviors in health liaisons.
Acknowledgments
We would like to thank all the liaisons and people who helped us in this research.
Conflict of interest
No conflict has been reported by the authors.
Ethical Permissions
This research has been registered in Iran Trial Registration Center with the number of IRCT2014082118885N1 and the ethics code of 163593559 has been obtained from Hamadan University of Medical Sciences.
Funding Sources
This study is the result of the master's thesis approved by the Deputy of Research and Information Technology of Arak University of Medical Sciences with the project number of 1215 and has been done with the financing of the mentioned university.

TABLES and CHARTS

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