@2024 Afarand., IRAN

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ISSN: 2383-2150    Journal of Education and Community Health 2014;1(2):56-66

Background
Damages caused by traffic accidents are one of the biggest forgotten problems of public health that its effective control and its prevention requires coordinated and comprehensive efforts [1].
Previous Studies
...[2-5] during recent years, usage of cell phone has been increasingly increased in Iran;however,low studies have been done about the determination of the amount usage of cell phone while drivingin Iran [6]. … [7-22]. One of the famous educational models in health education is Health Belief Model [23].This model is based on the principle that people show appropriate reaction to the health messages, and the prevention of disease when they feel that they are in danger(perceived sensitivity) ; their minatory risk is so serious (perceived severity); changing behavior has a considerable number of benefits for them (perceived benefits); and they are able to elevate available barriers in accomplishment of health behavior (perceived barriers). It is in these conditions that intervention and educational programs possibly are occurred effectively. …[24].
Aim(s)
This study aimed at determining the effect of educational program based on Health Belief Model on the reduction of cell-phone usage in Tuyserkan taxi drivers.
Research type
This research is a quasi- experimental intervention study.
Research society, place and time
This study was done among 110 Tuyserkan taxi drivers in spring of 2014.
Sampling method and number
Sample size was estimated as 70 for control and intervention groups. Since the number of calculated sample size was more than 5% of population (N=212), the number of needed sample was calculated by using the correction method for limited population and Kukran formula. By replacing these amounts in above formula, number of samples for each group of intervention and control was obtained 53.Due to the possibility of attrition the number of samples; the number of drivers was considered 55 in each of two groups of the intervention and the control. The people of intervention group were chosen from three taxi routes randomly. Accordingly, the people of control group were chosen from three other taxi routes randomly. Criteria of entrance in study were being younger than 35,full-time employment as a taxi-driver, and having file in taxi organization. Exclusion criteria of study were dissatisfaction with attending in study and the continued absence in training sessions.
Used devices&materials
Data collection instrument was a researcher-made questionnaire composed of two parts. The first part of questionnaire was about background information, and the second part of the questionnaire was about questions of knowledge,behavior and the constructs of the Health Belief Model. The number of questions and the scoring of questionnaire was as following; knowledge section had six questions in forms of three multiple choices that the correct choice had 2 scores, null choice had one score and wrong choice did not have any score. Behavior section had seven questions with Likert rating scale of 1 to 5 point that the range of score for each question was between zero and four. The choice of “always” had zero point; the choice of “usually” had one point; the choice of sometimes had two points; and the choices of “seldom” and “never” had three and four points respectively. In this section, reverse scoring was done for three questions. Perceived susceptibility and severity constructs each had five questions with one to five Likert rating scale.The range of scores for each question was varied between one and five.The option of “totally agree” was give five points; the option of “agree” was given four points; the option of “no idea” was given three points; and options of “disagree” and “totally disagree” were given two and one points respectively. Two constructs of perceived barriers and perceived benefits each had six questions with one to five Likert rating scale. The range of points for each question, and scoring was calculated the same as perceived susceptibility and perceived severity. The construct of cues to action had five questions with three options that the option of “yes’ had two points; the option of “to some extent” had one point, and the option of “no” had no point. The construct of “perceived self-efficacy” had four questions with one to five Likert Scale rating. Five points were given to “very high”. Four points were given to “high”; three points were given “to some extend”; and two and one points were given to “low” and “very low’ respectively. For assessing the validity of the questionnaire, content validity was determined by consulting with six health education experts and two traffic experts, and their opinion were implemented that finality the validity was confirmed. For assessing the reliability, after a pilot study on 30 taxi drivers; Cronbach’s alpha coefficient was used. The reliability for the questions of knowledge and behavior were 0.89 and 0.87 respectively. The calculated reliabilities for the constructs of Health Belief model were 0.71 for perceived susceptibility, 0.93 for perceived severity, 0.91 for perceived barriers, 0.93 for perceived benefits, 0.81 for cues to action, and 0.9 for perceived self-efficacy. Appropriate educational content was designed based on Health Belief Model according to the results obtained from the guide study in which the predictive constructs of the behavior (i.e., not using self-phone while driving) based on Health Belied Model were perceived barriers, perceived susceptibility, and perceived self-efficacy respectively, and according to the results of diagnostic pretest. The educational content was conducted during the three 90-minute sessions. First session was allocated for increasing the information, perceptive susceptibility and severity of learners to the risks of using cell phone while driving, as well as its consequences and outcome, and the second session was allocated for highlighting the benefits of not using cell phone while driving or removing barriers to not use of cell phone while driving. Third sessions was allocated to the strategies for increasing self-efficacy to prevent using cell phone while driving , and a reminder training session was held one month after third sessions for the intervention group and the control group did not receive any training. The methods used for trainingincluded:lecture, film screening, question and answer, group discussion, booklet, and sending SMS containing educational materials in especial times apart from the drivers’ shift. Training sessions were held in the conference hall of health center in Tuyserkan that had suitable educational facilities. Moreover, a training session was held for employees of traffic police, authorities of taxi organization, supervisors and observes of taxi lines, and key people, such as drivers with working experiences in driving as cues to action. The same questionnaire was completed by participants in order to evaluate the effect of training two month after the last training session. Statistical analysis: Data was analyzed using SPSS software version 19,as well as chi-square test, independent T-test, paired T-test, and McNemar test.
Findings by Text
The mean age of participants in study was 30.56±2.42 years (30.42±2.63years for intervention group and 30.71±2.2 for the control group). The result of chi-square test showed that there was no significant difference in terms of background factors between intervention group and control group (Table 1).The situation and changes of the mean for knowledge, the factors of Health Belief Model, and the behavior (good behavior of not using of cell phone while driving) in the two groups before and after educational intervention has been provided in table 2. As it is clear from the results of this table,in comparison of the mean of these variables scores according to the results of the independent T-test, there was no significant difference between intervention group and control group before educational intervention (p>0.05). However, after the intervention, significant difference was observed between the mean score of all desired variables in the intervention group before and after the intervention (p<0.001). This is while in the control group no significant difference was observed in all the variables before and after educational intervention apart from the factor of cues to action in which the difference was significant (p<0.001). According to the findings, all the behaviors of using cell phone while driving had been reduced in intervention group after educational intervention and the result of MacNemar test showed the significance of this reduction (p<0.001). In the control group, however, all these behaviors had been increased and the result of MacNemar test was not significant for speaking with cell phone (p=0.687), and reading and writing SMS (p=0.25).
Main comparison to the similar studies
… [25-34]. The results of this research was similar to many studies [27, 30] in terms of applying Health Belief Model and effectiveness of intervention on increasing the perceived severity of the people. However, it is not in line with the results of Tussing et al. study [35].... [36].The results of this research are in line with other studies [26, 30] in terms of the increase in the score of perceived benefits after the intervention in the intervention group. However, it is not consistent with the results of some other studies [37].
Suggestions
In other studies, educational interventions should be followed in long-term and direct observation should be used for measuring the behavior.
Limitations
Of the limitations of this study, the short period of perseverance of performing the educational intervention and the difficultly of measuring the behavior because of using the method of self-report can be mentioned.
Conclusions
Usage of Health Belief Model based on organized program can be effective on training of the taxi drivers and changing in model constructs can prevent the behavior of using cell phone while driving.
Acknowledgments
Researchers appreciate the Deputy of Research and Technology, Hamedan University of Medical Sciences, officials and employees oftraffic police, organization of the public transportation, and dear taxi drivers of Tuyserkan who had sincere cooperation in conducting this research.
Conflict of interest
Non-declared
Ethical Permissions
Adequate explanation was given to the qualified participants about the purpose of research and confidentiality of information that obtained from participants in study. Moreover, it was emphasized that they were able to exit of study when they were not willing to continue to participate in the study.
Funding Sources
This study is part of the master dissertation (with registration number 4979) of the fourth author that has been done by the financial support of the Deputy of Research and Technology, Hamedan University of Medical Sciences.

TABLES and CHARTS

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