@2024 Afarand., IRAN

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ISSN: 2383-2150    Journal of Education and Community Health 2014;1(3):1-11

Background
Damages caused by accidents are major health problems all over the world and one of the major causes of death among people under 45 years old [1-2].
Previous Studies
… [3-13]. Health Belief Model is a psychology model that provides a framework for study of possible effective psychological factors on decision. This model on one hand causes the perception of a health threat according to perceived susceptibility and severity components, and on the other hand expresses the reason to adopt or not to adopt the health or preventive behavior by people according to behavior stimulants (perceived benefits, perceived barriers, self-efficacy and cues to action) [14].
Aim(s)
This study is conducted with the aim of determining the influence of education program on school accidents damages among first grade high school students of Famenin city based on Health Belief Model.
Research type
This study is an intervention experimental study.
Research society, place and time
144 students of the first grade of Feminine high school participated in this study. This study was conducted on students of seventh and ninth grades. The study was conducted from March 3, 2014 until May 10, 2014.
Sampling method and number
Sample size was calculated 144 including 72 subjects for intervention group and 72 subjects as control group by considering the statistical power of 80%, 5% type I error and applying a 15% attrition. Sampling method was random classification and samples number was appropriate with the size of each class.
Used devices&materials
The tool for collecting information was researcher-made questionnaire that contained three sections. First section included 11 questions of participants' demographic properties; second section included nine multiple choice knowledge questions and 17 two-option performance questions with a minimum score of zero and maximum score of 17. Third section covered the questions of Health Belief Model constructs as the six-option Likert scale and it included: 5 questions for perceived susceptibility with a minimum score of 5 and maximum score of 30, 5 questions for perceived severity with a minimum score of 5 and maximum score of 30, 4 questions for perceived benefits with minimum score of 4 and maximum score of 24, 7 questions for perceived barriers with a minimum score of 7 and maximum score of 42, 7 questions for cues to action with a minimum score of 7 and maximum score of 42 and 6 questions for self-efficacy with minimum score of 6 and maximum score of 36.The viewpoints of four experts of health education, health promotion and prevention of accidents were used for evaluation of questionnaire content validity. Also, ten students, who had participated in primary study for questionnaire reliability evaluation, were asked regarding the difficulty level and their perception of questions in order to study the questionnaire outward validity and then necessary amendments were applied in questionnaire. Questionnaire reliability was evaluated after collecting relevant information from 30 students by internal consistency method, and Cronbach's Alpha coefficient method for variables of knowledge, behavior and constructs. Questions’ reliability coefficient was 0.71 for knowledge, 0.71 for perceived susceptibility, 0.71 for perceived severity, 0.7 for perceived benefits, 0.72 for perceived barriers, 0.81 for cues to action, 0.83 for self- efficacy and 0.7 for behavior. … [15-16]. Educational booklet was prepared and distributed according to the collected results of basic study [17] and pre-test study. Methods combinations of speech, question-answer and group discussion were used in each training session. Overall, Five training sessions were held. Before instruction, a justification session was held for principal, associate principal and health coach of selected schools with the title of familiarity and group justification regarding the importance of preventing damages caused by school accidents and teaching it to students. Pre-test questionnaires were distributed among students and were completed and collected by students according to self-report method. Then, three 45-minute sessions were held for the students of the intervention group. First session's target was learners familiarity with definitions of damages caused by accidents, effective factors of occurring accidents, and the time and location of occurring accidents among students. In second session, learners were familiarized with the importance of preventing damages, injuries and widespread harms among students and in the third session, students were familiarized with behaviors and preventive actions of considered damages caused by school accidents. A training reminder session was held one month after the third session and two months after training, post-test questionnaires were distributed between both the intervention and control groups and were completed and collected again according to self-report method. In addition, a training session was held for parents of intervention group students with the aim of familiarizing the importance of damages prevention and how to prevent the damages caused by school accidents. After collecting post-test questionnaires, one training session was held for the students of control group by representing the educational booklet. Statistical analysis: Data analysis was carried out by SPSS-16 software. Inferential statistics contained Independent and Dependent t-test and Chi Square test were used for data analysis. Tests’ significant level was considered less than 5%.
Findings by Text
There was not a significant statistical difference between two groups of control and intervention in terms of variables of age, gender, grade, family size, birth rank, mother's education, father's education, mother's occupation and injury history (Table 1). According to findings, 40.3% of participants in control group and 51.4% of participants in intervention group were 13 years old; 51.4% of students in control group and 47.2% of students in intervention group had 4-member households; birth rank 1 had the most plentiful in control and intervention group (39.8% and 40.3% respectively); 58.3% of control group students' mothers and 70.8% of intervention group students' mothers had secondary and primary school degrees (58.3%). Most of father's education of control group participants (59.7%) and intervention group participants (57%) was related to primary and secondary school; majority of control group mothers (90.3%) and intervention group mothers (91.7%) were housewife. Majority of control group fathers' job (59.7%) and intervention group fathers' job (34.7%) was related to self-employed job. Before instruction, there was not a significant difference in mean scores of Health Belief Model constructs ( knowledge, performance, susceptibility, perceived severity, perceived benefits and barriers, self-efficacy and cues to action) between two groups of control and intervention. Independent t-test showed that there was a significant difference in constructs of knowledge, performance, perceived susceptibility, perceived barriers, self-efficacy and cues to action between two groups after instruction (Table 2). Paired t-test was used after two months of instruction for studying its influence and according to the findings, knowledge mean score of intervention group changed from 49.69% to 75.15% after instruction and paired t-test showed significant difference between before and after instruction's mean score (p<0.001). Also, perceived susceptibility score of intervention group was 70.80% before instruction and increased to 81.19% after instruction (p<0.001). Perceived severity score of intervention group was 60.37% before instruction and reached to 64.53% after instruction that was not statistically significant (p=0.077). Perceived benefits score of intervention group was 61.74% before instruction and 64.23% after instruction (p=0.503). Perceived barriers score of intervention group was 57.44% before instruction and 51.09% after instruction (p<0.001). Self-efficacy score of intervention group was 63.58% before instruction and 71.45% after instruction (p<0.001). Cues to action score in intervention group was 64.78% before instruction and 77.05% after instruction (p<0.001). Performance score in intervention group was 64.70% before instruction and 85.86% after instruction (p<0.001). In addition, performance score of control group changed from 65.19% to 68.38% that was statistically significant (p=0.027).
Main comparison to the similar studies
In current study, there was not statistically significant difference between intervention and control group's knowledge mean score, however, it was increased after instruction in the intervention group; and this increase was significant. These findings are compatible with the study conducted by Ebrahimi et al. [18], Zendehtalab [19] and SharifiRad et al. [20]. … [21-28]. There was not a significant statistical difference between perceived self-efficacy scores of intervention and control group before instruction, however, study results indicated a significant statistical difference between scores mean of two groups after instruction. Findings of the study conducted by Karimi and et al. were compatible with current study [29]; result of the study conducted by Hazavei and et al. [21] and SharifiRad and et al. [20] confirms the result of current study, too. Although studies conducted by Ebrahimi and et al. [18] and Kinsler and et al. [30] were not compatible with results of current study. [31].
Suggestions
Involving parents in educational programs could be effective in improving students’ performance.
Limitations
Increasing the performance mean score in students of control group is one of the limitations of the current study. Using self-report method for completing questionnaires and studying of students' performance are other limitations of this study.
Conclusions
Instruction based on Health Belief Model could be effective in improving students’ performance in preventing of damages.
Acknowledgments
Hamedan Medical Sciences University Research Council, education directorate of Famenin city, first grade of high school's principals and associate principals of Famenin city, and all participating students in the study are appreciated.
Conflict of interest
Non-declared
Ethical Permissions
Written consent from parents and conscious consent from students were taken.
Funding Sources
This study is the thesis outcome of a master student (Ms. Zahra Farhadi, first writer) majored in health education at Hamedan Medical Sciences University that has been approved in research council of this university and it has been conducted by confirmation and financial support of Hamedan Medical Sciences University Research Council (Project No. 9211154266).

TABLES and CHARTS

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