ARTICLE INFO

Article Type

Original Research

Authors

Heidarikia   S. (1)
Araban   M. (*2)
Babaei Heydarabadi   A. (2)
Latifi   S.M. (3)






(*2) “Department of Health Education and Promotion, Public Health School”, and “Social Determinant of Health Research Center”, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
(1) Department of Health Education and Promotion, Public Health School, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
(3) Department of Biostatistics and Epidemiology, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran

Correspondence

Article History

Received:  March  12, 2020
Accepted:  June 20, 2020
ePublished:  December 20, 2020

BRIEF TEXT


Child injuries are the most serious problem facing children since the beginning of the 21st century, and are still the major cause of death and complications in children [1].

Road accidents, drownings, burn injuries, falls, and poisonings are the most important causes of death due to child injuries [2]. According to studies, the relative frequency of accidents in children under 5 years old varies between 21 to 68% in different countries of the world [3]. ... [4-10]. Safety is a fundamental human right and is directly related to health; especially for children under 5 years old who need more care. Indeed, environment and behavior are the main factors affecting safety that directly and indirectly affect children's health [11]. According to the World Health Organization, 2300 child deaths per day can be prevented by parent education [12]. Considering that more than 90% of injuries caused by accidents in children are predictable [13], therefore, educating mothers as an important person in the family has a particular importance and its requirements are assessing the knowledge and attitude of the mother in this regard [14]. Since the most health problems are closely related to human behavior, therefore the behavioral theories and patterns can be used to understand the ways of prevent health problems. One of the training models in health education is the Health Belief Model [15]. …[16].

The aim of this study was to determine the effect of educational intervention on safety behavior in the prevention of injuries caused by accidents in children under 5 years old using the Health Belief Model.

This research is a semi experimental study.

This study was conducted through the participation of 220 mothers who referred to health centers in Shush city in 2019.

Of 3 health centers in Shush city, 2 centers were selected as the control and intervention samples using a simple random method. Samples were selected by available sampling in the health centers. The subjects were invited to the study after control the inclusion criteria and obtaining informed consent of the subjects. The sample size in this study was determined 110 people in each group considering a similar study [14] based on the mean of perceived sensitivity with a standard deviation of 14.86, the confidence level of 95%, the study power of 80%, and taking into account the difference of 10 in the mean score of structures between the two groups of intervention and control after the intervention, as well as the possibility of samples drop. The inclusion criteria for the participants were having a child under 5 years old, willingness to cooperate until the end of the research, and minimum literacy. Exclusion criteria were absence from more than one training session, unwillingness to continue participating in research, failure to respond to the questionnaire and home safety checklist.

The data collection tool was a questionnaire taken from the study of Pour-Ajal et al. [17], whose validity and reliability was re-examined by making some changes. The questionnaire was organized into four sections including demographic information, knowledge, dimensions of health belief model, and behavioral questions. The content validity of the questionnaire was assessed by reviewing the opinions of 5 health education experts, the ratio of content validity (CVR=1), and the content validity index (CVI=1). Cronbach's alpha method was used to determine the reliability of the questionnaire. For this purpose, the questionnaires were distributed among the 20 subjects. Data analysis showed the acceptable alpha levels in the awareness (0.77), sensitivity (0.73), perceived intensity (0.71), perceived benefits (0.81), perceived barriers (0.70), self-efficacy (0.77), practice guide (0.73), and behavior (0.75) structures.In order to assess the home safety status, a home safety checklist based on the study of Mohammadinia et al. was used which its face and content validity has been assessed by safety specialists and pediatricians [10]. This checklist included 67 safety issues in the areas of the physical condition of the home, kitchen, and hazardous materials, bathroom, and toys. Questionnaires were completed in a self-reported manner. The mothers were asked to complete a home safety checklist within a week and submit it to the health center. After collecting information in the first stage, the intervention group was divided into 6 groups of 18-20 people to participate in training sessions. The number of sessions were two 90-minute sessions in the form of feedback lectures, screenings, educational clips, and pamphlet distribution, and a 45-minute group discussion session in a group with the 8-10 subjects. Within a month, the intervention group was trained and, no training was provided to the control group. The training content for the intervention group was designed based on the Health Belief Model. In order to evaluate the effect of the educational intervention, the questionnaire and checklist were again provided to the intervention and control group 2 months after the last training session. At this stage, 2 people from the control group and 2 people from the intervention group were excluded due to not attending the training sessions or not completing the second stage questionnaire. Data were analysed by SPSS 22 software using Mann-Whitney, Wilcoxon, T and Chi-square tests. The normality distribution of the data were examined by Kolmogorov-Smirnov test. Significance level for the tests was considered less than 0.05.

The mean and standard deviation of the subjects was 28.50. 5.20 years. There was no significant difference between the two groups in terms of maternal age, child age, number of children under 5 years, and number of children under 5 years. There was no significance difference between the subjects in terms of maternal age, child age, and the number of children under 5 years based on the T-test. According to the Chi-square test, there was no statistically significant difference between the two groups in terms of demographic variables (Table 1). Mean and standard deviation of knowledge variables, the Health Belief Model constructs, behavior and home safety status in the two groups of control and intervention are shown in Table 2. According to the results of the Mann-Whitney test showed a significant difference between the mean scores of knowledge, perceived benefits, perceived barriers, practice guide, self-efficacy, behavior, and home safety in the intervention and control groups before the raining intervention. While a statistically significant difference was observed in the structures of perceived sensitivity and perceived intensity. The results of the Mann-Whitney test show that a significant difference was observed in the mean scores of knowledge, behavior, safety, and each of the constructs of the Health Belief Model between the two groups after the implementation of the educational intervention (p<0.001). The results also showed a significant difference between the mean scores of the variables in the intervention group before and after the educational intervention (p<0.001). While in the control group, the mean scores of the perceived sensitivity, perceived barriers, behavior, and home safety variables increased significantly based on the comparison of the mentioned variables scores before and after the training intervention. However, there was a statistically significant difference in terms of the difference in scores of the variables between the two groups before and after the intervention (Table 2).

The level of mothers' awareness in the two groups was less than average before the educational intervention, and there was no significant difference. Khademi et al. [18] in their research concluded that only 26% of mothers have good knowledge. An increase in the mean score of knowledge following training intervention has been observed in other studies, which is consistent with the result of this study [19, 20]. The mean score of perceived sensitivity of mothers increased significantly after the training intervention in the intervention group. In the study of Morungilo et al. [21], training intervention has led to the promotion of mothers' attitudes toward childcare. This finding is consistent with the results of the studies related to the increased perceived sensitivity in mothers after training interventions [16, 22]. No training intervention was performed to increase the mean score of perceived sensitivity in the control group, but the distribution of the questionnaire can be considered as an intervention and has increased the sensitivity of mothers, which has also been mentioned in the study of Arab et al. [23]. The perceived intensity score in the intervention group increased significantly after the training intervention. Rahimi et al. mentioned the costs of treatment due to injury as one of the most serious risks associated with home accidents [7]. The results of the study by Cao et al. [24] showed the perceived intensity as the most effective factor in performing preventive behaviors. The results of this study are similar to the findings of different studies [22, 25]. There was no difference in mothers' perception of the perceived barriers in the intervention and control groups. The most important perceived barriers in mothers were to take care of home affair, and fatigue from constant monitoring and control of the child, which decreased significantly after training in the intervention group. In the qualitative study of Abloit et al. [13], in addition to the mentioned cases, the unpredictability of accidents and developmental changes of the child were reported by mothers. Comparing the findings before and after intervention showed that there was a significant difference in the structure of perceived barriers in the two groups. Various studies have shown the reduction of perceived barriers after training interventions in the study group [14, 26]. In this study, the mothers' perception of the benefits of preventive behaviors was high in both groups, before the training intervention. The attitude of some mothers towards some items was not completely agreeable and increased significantly after training intervention in the intervention group and a statistically significant difference between the two groups was created which is in line with the results of other studies [14, 27]. However, the result is not consistent with the results of Farhadi et al.'s study [28] based on the lack of a statistically significant difference between the mean scores of perceived benefits after the intervention. The mean score of the practice guide in the intervention group increased significantly after the training. In the study of Rosemary et al. [29], the practice guide was determined to be the strongest predictor of safe driving behavior. Garmaroodi et al. [30] concluded that there was no significant difference in the practice guide between the two groups after the training intervention, which may be due to the difference in the study groups and the training method. There was a statistically significant increase in the level of self-efficacy in the intervention group compared to the control group after the training intervention. In the study of Rezapour et al., The structure of self-efficacy was determined as one of the strong predictors of mothers' behavior to perform safety measures [31]. Evaluating the effect of training intervention showed a significant difference between the control and intervention groups, which indicates the effectiveness of training based on the Health Belief Model in mothers as in the other studies [16, 27]. There was a significant difference in the mean scores of home safety between the two groups, and its rate was increased in the intervention group. Some studies indicate that the implementation of home safety programs with the help of families will have a positive effect in preventing accidents as well as improving the knowledge and practice of parents [32, 33]. The results of Jacques et al.'s research also showed that parental behavior and safety at home play a significant role in reducing children's risk [34]. The results of a study by Mohammadnia et al. [10] showed that improving home safety for children requires more planning, training, and intervention.

No cases have been suggested.

One of the limitations of this study was self-report in filling the questionnaire. The use of this method may cause mothers to report behaviors under the influence of excessive social utility bias, which do not reflect the actual behavior of mothers. Of course, self-reported data collection is the most common method in social science and related sciences research [35]. Other limitations include the lack of study in the village in which the results cannot be generalized to mothers in rural areas.

Training intervention based on the Health Belief Model has a positive effect on changing attitudes and improving mothers' behavior towards children's injuries.

The cooperation of the esteemed staff of the Shush Health Centers and the mothers participating in this research is appreciated.

This research is retrieved from the master's thesis in the field of health education, with the approved plan number of SDH-9722.

This study was approved by the Research Ethics Committee of the Vice Chancellor for Research and Technology of Ahvaz Jundishapur University of Medical Sciences with the IR.AJUMS.REC.1397.944 ID.

No financial support has been received.

TABLES and CHARTS

Show attach file


CITIATION LINKS

[1]Dorney K, Dodington JM, Rees CA, Farrell CA, Hanson HR, Lyons TW, et al. Preventing injuries must be a priority to prevent disease in the twenty-first century. Pediatr Res. 2020;87(2):282-92.
[2]Ebadi Fardazar F, Solhi M, Mansori K, Mansouri Hanis S, Hashemi SS. Assessment the effect of educational intervention on preventive behaviors of home accidents in mothers with children less than 5- year based on protection motivation theory (PMT). Int J Pediatr. 2016;4(7):2051-9.
[3]Kahriman IL, Karadeniz H. Effects of a safety-awareness-promoting program targeting mothers of children aged 0-6 years to prevent pediatric injuries in the home environment: Implications for nurses. J Trauma Nurs. 2018;25(5):327-35.
[4]Centers for disease control and prevention. Leading causes of death. [Internet]. Atlanta: CDC; 2018 [Cited 2018 8 8]. Available from: https://www.cdc.gov/nchs/fastats/leading-causes-of-death.htm.
[5]Roshanfekr P. Situation analysis of children, youth, adolescent and women in Iran [Report]. New York: UNICEF; 2015.
[6]Fathi Shekhi M, Shamsi M, Khorsandi M, Heaidari M. Predictors accident structures in mothers with children under 5 years old in city of Khorramabad based on health belief model. J Saf Promot Inj Prev. 2015;3(3):199-206. [Persian]
[7]Rahimi T, Faryabi R, Javadi A, Shojaei S. Attitudes of women from Jiroft city about prevention of home injuries in children under 5 years using protection motivation theory in 2015. J Rafsanjan Univ Med Sci. 2017;16(1):17-30. [Persian]
[8]Zahedinia F, Akaberian S, Mirzaei K, Azodi P, Dowlatkhah H, Jahanpour F. Household accidents awareness of preventive behaviors in mothers of children one to five years referred to health centers in Bushehr. Nurs J Vulnerable. 2017;3(9):81-90. [Persian]
[9]Mobasheri F, Azizi H, Rastbaf F. The epidemiological pattern of injuries among children under 15 years of age in Fasa in 2013. J Fasa Univ Med Sci. 2016;6(1):69-78. [Persian]
[10]Mohammadinia L, Khorasani-Zavareh D, Gharibzadeh S, Roshanferk P, Malekafzali H. Social determinants of health and home safety for under-five children in a neighbor's Tehran, Iran. Int J Prev Med. 2018;9:109.
[11]Mohammadinia L, Malekafzali H, Khorasani-Zavareh D, Roshanferk P. Family-based tool to assess home safety for children. Hakim Health Syst Res. 2017;20(2):73-84. [Persian]
[12]World health organization. 10 facts on injuries to children [Internet]. Geneva: WHO; 2012 [Cited 2019 1 6]. Available from: https://www.who.int/features/factfiles/injuries/facts/en/index8.html.
[13]Ablewhite J, McDaid L, Hawkins A, Peel I, Goodenough T, Deave T, et al. Approaches used by parents to keep their children safe at home: A qualitative study to explore the perspectives of parents with children aged under five years. BMC Public Health. 2015;15:983.
[14]Fathi M, Shamsi M, Khorsandi M. Effect of theory-based education on the promotion of preventive behaviors of accidents and injuries among mothers with under-5-years-old children. Iran J Health Educ Health Promot. 2016;4(3):184-93. [Persian]
[15]Moeini B, Rezapur-Shahkolai F, Faradmal J, Soheylizad M. Effect of an educational program based on the health belief model to reduce cell phone usage during driving in taxi drivers. J Educ Community Health. 2014;1(2):56-66. [Persian]
[16]Navabi M, Khorsandi M, Rouzbahani N, Ranjbaran M. The effect of education on preventive behaviors of failure to thrive in mothers with children aged one to five years: Applied health belief model. J Arak Univ Med Sci. 2017;20(1):59-68. [Persian]
[17]Poorolajal J, Cheraghi P, Hazavehei SMM, Rezapur-Shahkolai F. Factors associated with mothers' beliefs and practices concerning injury prevention in under five-year children, based on health belief model. J Res Health Sci. 2012;13(1):63-8.
[18]Khademi G, Nazeri N, Hamedi A, Abdollahpour N, Sezavar M, Gholami H. Knowledge and attitudes of educated parents about carrying children in private cars. J Saf Promot Inj Prev. 2016;3(3):141-6. [Persian]
[19]Afshari M, Moghimbeigi A, Mahdi-Hazavehei SM, Rezapur-Shahkolai F. Effect of a model-based educational program for mothers, on home-related injury prevention among under-five-year children in rural Twiserkan, Iran. Turk J Pediatr. 2017;59(6):648-56.
[20]Silva ECS, Fernandes MN, Sa MCN, De Souza LM, De Arahjo Gordon AS, De Jesus Costa ACP, et al. The effect of educational intervention regarding the knowledge of mothers on prevention of accidents in childhood. Open Nurs J. 2016;10:113-21.
[21]Morrongiello BA, Hou S, Bell M, Walton K, Filion AJ, Haines J. Supervising for home safety program: A randomized controlled trial (RCT) testing community-based group delivery. J Pediatr Psychol. 2017;42(7):768-78.
[22]Tariku B, Whiting SJ, Mulualem D, Singh P. Application of the health belief model to teach complementary feeding messages in Ethiopia. Ecol Food Nutr. 2015;54(5):572-82.
[23]Araban M, Tavafian SS, Zarandi SM, Hidarnia AR, Burri A, Montazeri A. A behavioral strategy to minimize air pollution exposure in pregnant women: A randomized controlled trial. Environ Health Prev Med. 2017;22:26.
[24]Cao ZJ, Chen Y, Wang SM. Health belief model based evaluation of school health education programme for injury prevention among high school students in the community context. BMC Public Health. 2014;14:26.
[25]Sharifikia I, Rohani C, Estebsari F, Matbouei M, Salmani F, Hossein-Nejad A. Health belief model-based intervention on women's knowledge and perceived beliefs about warning signs of cancer. Asia Pac J Oncol Nurs. 2019;6(4):431-9.
[26]Shabibi P, Abedzadeh Zavareh MS, Sayehmiri K, Qorbani M, Safari O, Rastegarimehr B, et al. effect of educational intervention based on the health belief model on promoting self-care behaviors of type-2 diabetes patients. Electron Physician. 2017;9(12):5960-8.
[27]Mokhtari Nouri J, Jalali M, Parandeh A, Javadi M. The effectiveness of education based on health belief model on promoting preventive behaviors of mothers from girls' early puberty. J Nurs Educ. 2019;8(2):37-43. [Persian]
[28]Farhadi Z, Roshanaei G, Bashirian S, Rezapur Shahkolai F. The effect of an educational program on school injury prevention in junior high school students of famenin based on the health belief model. J Educ Community Health. 2014;1(3):1-11. [Persian]
[29]Razmara A, Aghamolaei T, Madani A, Hosseini Z, Zare S. Prediction of safe driving Behaviours based on health belief model: The case of taxi drivers in Bandar Abbas, Iran. BMC Public Health. 2018;18(1):380.
[30]Garmaroudi G, Sarlak B, Sadeghi R, Rahimi Foroushani A. The effect of an intervention based on the health belief model on preventive behaviors of domestic violence in female high school students in Tehran. J Knowl Health. 2016;11(1):69-74. [Persian]
[31]Rezapur Shahkolai F, Bandehelahi K, Karimi Shahanjarini A, Farhadian M. The factors related to mothers' beliefs and behaviors concerning the prevention of poisoning among children under the age of five, using the health belief model. Turk J Pediatr. 2019;61(5):749-56.
[32]Habermehl N, Diekroger E, Lazebnik R, Kim G. Injury prevention education in the waiting room of an underserved pediatric primary care clinic. Clin Pediatr. 2019;58(1):73-8.
[33]Stewart TC, Clark A, Gilliland J, Miller MR, Edwards J, Haidar T, et al. Home safe home: Evaluation of a childhood home safety program. J Trauma Acute Care Surg. 2016;81(3):533-40.
[34]Jaques ML, Weaver TL, Willoughby L. The association between pediatric injury risks and parenting behaviours. Child Care Health Dev. 2018;44(2):297-303.
[35]Bazaz M, Shahry P, Latifi SM, Araban M. Cervical cancer literacy in women of reproductive age and its related factors. J Cancer Educ. 2019;34(1):82-9.