ARTICLE INFO

Article Type

Original Research

Authors

Khajehlandi   K. (1)
Babaei Heydarabadi   A. (*2)
Araban   M. (2)
Haghighizadeh   M.H. (3)






(*2) Socioal Determinants of Health Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
(1) Health Education & Promotion Department, Public Health Faculty, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
(3) Biostatistics Department, Public Health Faculty, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran

Correspondence

Address: No. 370, Laleh Street, Ostadan Alley, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran. Postal Code: 6135713476
Phone: +98 (61) 33116413
Fax: +98 (61) 33738282
babaeinmz2056@gmail.com

Article History

Received:  August  31, 2018
Accepted:  February 20, 2019
ePublished:  March 19, 2019

BRIEF TEXT


One of the most important causes of nutritional problems is the discrepancy between the performance of individuals on the basis of knowledge and the lack of proper nutritional knowledge.

... [1-13]. The transational model (TTM) by Prochaska is one of the health education patterns that can be used individually to change behavior. This model is a useful tool for planning educational interventions and predicts how to change behavior at different stages and over time [14, 15]. The decisional balance construct is defined as the cost and benefits of changing behavior, and it is assumed that the person does not change his behavior unless he thinks that the benefits outweigh the obstacles [16]. The self-efficacy construct also defines the person's confidence in his ability to perform healthy behaviors in any situation [16]. ... [17-21].

The aim of the current study was to investigate effect of targeted educational program based on the transtheoretical model in promoting healthy nutrition behaviors in middle-aged women in Dehdez, Iran.

This research is a semi-experimental study with pre-test post-test design with control group.

This study was conducted on 108 middle-aged women (30-58 years old) referring to the Dehdez health center in 2017.

The inclusion criteria included the willingness to participate in research, lack of pregnancy, reading and writing ability, and no disease requiring a particular diet. Exclusion criteria included unwillingness to continue to participate in research, changing the subjects’ location difficult to access and the absence of more than once in the training sessions. The sample size was calculated 49 subjects for each group, based on Hashemi et al. [22] with a 95% confidence level and the test power of 90%. The number of participants increased to 54 subjects in each group, due to the 10% possibility of falling.

The data collection tool was the nutrition questionnaire developed by Qanad et al. [23], whose validity and reliability were confirmed. The question of the behavior processes of change construct in was raised to determine which individuals were at what stages of the change, and the participants were divided into five stages of behavior change based on their responses. The subjects in the pre-contemplation, contemplationand and preparation for consumption of each food groups were included as the targeted group (108 people) and others (68 people) who were consumed all food groups during the action and maintenance stages were excluded. According to the sample size of 108 people, the participants were randomly divided into two experimental (54 persons) and control (54 people) groups. Before the intervention, the research objectives were explained to the participants. In the first stage, the questionnaire was completed before and after the call of selected women (experimental and control groups). 54 subjects from the experimental group were divided into four groups (two groups of 14 and two groups of 13) to conduct educational intervention. The number of sessions, 3 sessions and the duration of training per session was 60 min. During the one month, the experimental group was trained and the educational program was performed using lectures, brainstorming and group discussion, in accordance with the transtheoretical model constructs by educational media, such as posters, pamphlets and clips. It should be noted that no educational program was performed for the control group by the researcher. Educational program was designed based on the analysis of the questionnaire in the first stage. Each group was subjected to three training sessions, in which healthy nutritional behavior was introduced according to the transtheoretical model. The intervals were also held with the approval of the experimental group at the maximum of one week from the previous session. In the first session, the participants were informed about the importance of healthy eating in human health, the groups of food pyramid, benefits of healthy eating and the consequences of adopting unhealthy nutritional behavior. The second session aimed at promoting attitude and self-efficacy and adopting healthy eating habits and participants were asked to express and compare the barriers and benefits of adopting healthy and unhealthy nutrition behaviors through group discussions. In order to increase the self-efficacy of verbal encouragement and encouragement, the researcher used positive thinking and dividing the considered behavior into smaller activities. The third session aimed at enhancing the participants' behavior and performance, while reviewing the previous sessions, and the experimental group was asked to formulate a program for adopting a healthy nutritional behavior, self-rewarding and using alternative behaviors. All provided educational lessons were submitted in writing to the participants. In the intervals, a reminder of appropriate nutrition was sent to the experimental group by the researcher (assisting relationships). Two months after the end of the training sessions, a questionnaire was provided to the experimental and control groups. Data were analyzed by SPSS-22 software using Independent T-test to compare the two groups in terms of age and because of non-normal distribution of other data, Mann–Whitney U, Wilcoxon and Chi-square tests were used to analyze the data.

The mean age in the experimental and control groups was 36.27±3.55 and 36.03±4.91 years, respectively (30-50 years). There was no significant difference between two groups in terms of demographic variables before and after the study (p>0.05, Table 2). Before the training, there was no significant difference between the mean scores of the transtheoretical model in the experimental and control groups (p>0.05), however, after intervention, the mean scores of perceived benefits and self-efficacy in the experimental group were significantly increased compared with the control group (p<0.05). The mean score of the perceived barriers construct in the experimental group after the intervention was reduced, but this change was not significant in comparison with the control group (p>0.05). Also, after intervention, the mean score of nutritional behavior in the experimental group was significantly higher than the control group (p<0.05; Table 3).

... [24-26]. According to the results, there was a significant difference in the effect of educational intervention on the mean score of the perceived benefits in the experimental group compared with the control group. In the study of Plotnikoff et al. [27], after intervention, the perceived benefits in the experimental group were significantly higher than the control group. Also, in the studies by Fahrenwald et al. [28], Hassani et al. [29] and Hashemi et al. [22], the mean score of the perceived benefits in the experimental group was significantly different from that of the control group, which is consistent with the results of the present study. ... [30-31]. In self-efficacy construct, the mean scores after training intervention in the experimental group showed a significant increase compared with the control group. In the study by Luszczynska et al. [32], after educational intervention, to increase the self-efficacy an increases in the consumption of fruits and vegetables in the experimental group after 6 months of intervention. ... [33-39].

It is suggested to separately study the impact of each of ten processes of change based on transtheoretical model and also to use multiple tools (for example, self-expression and observation) to assess educational interventions.

This study was done using self-reported methodology and some participants might not have given the right information, which is one of the limitations of this study.

Educational program based on the transtheoretical model is effective in promoting healthy nutrition behaviors in the middle-aged women in Dehdez, Iran

The authors are thankful to the Vice-Chancellor of the Jundishapur University of Medical Sciences in Ahvaz, Social Determinants of Health Research Center (study ID: SDH-9613) and all those who contributed to this study.

None declared.

This study was approved by the ethics committee of the deputy of research and technology of Ahwaz University of Medical Sciences (Ethics code: IR.AJUMS.REC.1396.497).

The present study was funded by the Social Determinants of Health Research Center of the Jundishapur University of Ahwaz.

TABLES and CHARTS

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