@2024 Afarand., IRAN

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ISSN: 2383-2150    Journal of Education and Community Health 2015;2(2):56-65

Background
One of the favorable habits which positively affect the nutritional balance, physical growth, academic performance and learning is eating breakfast [1].
Previous Studies
... [2-14]. The findings of other studies suggest that not eating breakfast is associated with decreasing the physical growth and behavioral problems such as diminishing the learning ability, irritability, tantrum and difficulties in cognitive functions [15]. ... [16-23] one of the most effective theories used to predict and explain nutritional behaviors is the Theory of Planned Behavior [24].
Aim(s)
This study has aimed to investigate the effect of educational program based on the theory of planned behavior on increasing the breakfast intake among high school students of Hamadan.
Research type
This is a quasi-experimental interventional study.
Research society, place and time
This study was carried out in 2015 among 140 first-grade high school students.
Sampling method and number
Out of first-grade high schools in district one, four schools for girls and boys (two schools for each) were selected based on simple random sampling and then using random numbers` table, two schools were considered the intervention group (one for boys and one for girls) as were two schools for the control group. The sample size was estimated at least 65 people in each group taking into view the mean values and standard deviation of similar studies [21], the 95% of assurance level and test power of 80 and by calculating the probability of samples` loss 70 people were included in the study in each group. 7 participants of the control group did not complete the questionnaire after the intervention and were excluded from the research. The criteria for entering the study were studying in the first grade of high school, precisely going to school in the morning, and having the parents` letters of agreement. Exclusion criteria were unwillingness to participate in the study and lack of persistent presence in the training sessions.
Used devices&materials
The data collection instrument was a researcher-made questionnaire consisting of two main parts; the first part wasrelated to background information and the second part of the questionnaire was associated withthe questions of the constructs of planned behavior theory. The number of questions and the scoring were as follows: The questionnaire of attitude toward eating healthy breakfast included 12 questions scaling1 to 5 points from strongly agree (the score of 5) to strongly disagree (the score of 1). Persuasive Subjective Norms questionnaire of eating breakfast contained 17 questions scaling 1 to 3 options from I agree (score 3), I have no idea (score 2) and I disagree (score 1). The construct of perceived behavioral control also had 10 questions with the scale of 1 to 3 options from most likely (score 3), less likely (score 2) and never (score 1). The questionnaire of behavioral intention for eating healthy breakfast consisted of 3 questions with the scale of 1 to 5 points so that the options of "completely incorrect", "false", "uncertainty" , "correct" and "completely correct " each was given the rating of 1, 2, 3, 4 and 5, respectively. The questionnaire of eating healthy breakfast behavior included 12 questions regarding the variety of foods available at the morning meal during one week. In this part, the amount of each food`s consumption are asked form students and then converted to food units; if they comply with the standards they are appropriate, otherwise they are undesirably evaluated and classified. The content validity of the questionnaire was measured so that the questionnaire was first prepared based on the theory of planned behavior according to the valid scientific resources. Then it was examined by 6 health education specialists and 2 nutrition experts, and their opinions were applied to the questionnaire. Finally after resolving some problems and ambiguities, its validity was confirmed. To examine the reliability, Cronbach's alpha coefficient was usedafter conducting a pilot study on 30 students. The reliability coefficient was calculated 0.73, 0.93, 0.87, 0.89 and 0.7 for constructs of attitude, subjective norms, perceived behavioral control, behavioral intention and behavior, respectively. For the intervention group a total number of 70 and for the control group 63 peopleparticipated in the study. The first and second sessions were devoted to increasing students` knowledge about food groups and the amount of their consumption in one breakfast meal. The third and fourth sessions highlighted the benefits of eating breakfast to improve students' attitudes. In the fifth session, strategies of increasing self-efficacy were emphasized regarding the correct pattern of eating breakfast and a training reminder session was held one month after the fifth session for the intervention group. In order to strengthen the subjective norms, two training sessions took place for teachers and students` parents about the food groups and the benefits of eating breakfast. Methods used for training included lecture, questions and answers, group discussion, training booklets and brochures containing educational content. For evaluating the effect of educational intervention, the same questionnaire was completed by participants of the intervention and control groups two months after the last training session. Statistical analysis Data was statistically analyzed using SPSS software (version 19) and chi-square test, independent t-test, paired t test and Wilcoxon test. The significance level for all tests was less than 0.05.
Findings by Text
The mean of height and weight of students were 180.21 - 57.31 and 160.46 and 54.37 in the intervention and the control groups, respectively and no significant difference was observed between the two groups in terms of height (P=0.060) and weight (P=0.133) according to the results of the independent t-test. Table 1 shows the frequency distribution of the gender, parents' education level, their occupation and birth rating in the intervention and control groups. The results of chi-square test and Fisher's exact test indicated that there was no significant difference before the intervention between two groups in terms of demographic variables (P>0. 05). Table 2 represents a comparison between the mean and standard deviation of the scores of planned behavior theory constructs in both intervention and control groups before and after the educational interventions. As it is specified in the table`s results, comparing the mean scores of these variables according to test results of independent t test showed that there was no significant difference between intervention and control groups before the intervention (P>0.05). However,a significant difference was observed between the mean scores of attitude (P<0.001), perceived behavioral control (P=0.48) and behavioral intention (P=0.025) in the intervention group before and after the educational intervention (P<0.001) while in the control group before and after the intervention, a significant difference was observed in other constructs except in the behavioral intention construct. According to the Wilcoxon test results from among the average numbers of consuming the foods of morning meal, the mean frequency of eating eggs, sweet Halva ( a pudding in Iran) and milk had significantly increased in the intervention group after the educational intervention (P<0.001). But after the intervention, there was no statistically significant difference between the pre and post scores ofthe intervention group regarding the frequency of consuming other foods for breakfast such as biscuits, fruit, juice, sweet tea, butter, jam, cheese and all kinds of breads (P>0.05).
Main comparison to the similar studies
The results of a study by MohammadiZeidi and Pakpour Haji Agha showed that students' attitudes in the intervention group about eating breakfast and healthy snacks had significantly increased after the educational intervention [25]. ... [26-34].
Suggestions
It seems that if health educators attempt to train based on models and theories of behavior change systematically, eating breakfast among students will increase and it will eventually lead to their health.
Limitations
Non-declared
Conclusions
The results of this study indicated a significant increase in mean scores of attitude, perceived behavioral control and behavioral intention two months after the intervention.
Acknowledgments
Loads of gratitude is regarded to the authorities and the head of education, managers and high school students in Hamadan.
Conflict of interest
Non-declared
Ethical Permissions
The subjects were included willingly with their parents’ consent.
Funding Sources
This study is the result of HSR research project approved by the Research Council of Hamadan University of Medical Sciences which has been supported by the University’s Vice Chancellor for Research and Technology.

TABLES and CHARTS

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