The purpose of this study was to investigate the effects of educational interventions on the promotion of colorectal cancer prevention nutritional behaviors.
The results of this study showed a significant difference in the intervention group in terms of the mean score of knowledge before and after the educational intervention. These results are consistent with the findings of Roozitalab [15], HO et al [16], Gimeno et al [17], and Abood et al [11] studies. Also, there was no significant difference in the control group before and after the intervention. Knowledge is an important determinant of CRC prevention, and the findings of this study showed the positive impact of interventions and education on individuals' knowledge. People's readiness to act in the right way to avoid illness requires the formation of behavior and raising people's knowledge is a primary step in creating the right behavior. Therefore, training programs, including public information campaigns, workshops, videos, websites, exhibitions, etc should be used to inform people about CRC symptoms and risk factors.
In the present study, the mean score of perceived susceptibility construct showed a significant difference between the intervention and control group after the educational intervention. Alidoosti et al [12], and Grace et al [18] reported the results consistent with the present study. The real and successful prevention of a health-related problem depends on the provision of real-life information about the susceptibility of individuals and the risks associated with it. The findings of this study and the above mentioned studies confirmed that, education has been able to play an important role in increasing the susceptibility of individuals regarding the complications of CRC and consequently, the adaption of positive health behaviors (including preventative nutritional behaviors). It should be noted that, perceived susceptibility seems to be considered as one of the most effective factors in the adoption of preventative behaviors. Therefore, designing interventional programs in different environments and tailoring the materials for each group (in terms of age, education, etc) and using various information sharing methods, including mass media as a widespread promotional platform can increase the knowledge of public about the importance of health-related issues.
The results of this study showed the difference between the mean scores of perceived severity construct before and after the training in the intervention group. These results are consistent with the findings of Alidoosti et al [12, 19], but they are not consistent with the study of Grace et al [18]. Studies by Kolutek et al [20], Wang et al [21], Cengiz et al [22] and Donadiki et al [23] reported the role of beliefs regarding public health threats, perceived susceptibility and perceived severity in the health promotion behaviors. Becker et al believed that, one’s intention to self-care is influenced by his or her perception of vulnerability and the severity of disease outcomes [24]. Therefore, the need for interventions to increase the perception of society about the irreparable complications of diseases caused by unhealthy behaviors (malnourished eating habits) seems necessary.
In this study, there was a significant difference between the two groups in terms of the constructs of perceived benefits after the educational intervention. This result is consistent with the findings of Grace et al [18], Alidoosti et al [12], and Abood et al [11] studies.
Therefore, informing and educating people about nutritional behaviors such as; food purchasing behaviors, food preparation and cooking, eating frequency and nutritional habits, and hygiene and food maintenance can prevent the irreparable detriment caused by CRC, which can be imposed on both the individual and the government.
In the present study, the mean score of perceived barrier construct decreased after the intervention. This was a good result, but it was not statistically significant. In the present study, the mean score of perceived barrier construct decreased after the intervention, which is not consistent with the results of studies by Moatari et al [25], Grace et al [18] and Gimeno et al [17]. The study of Rajabi et al (2000) identified some of the most important causes of barriers to nutrition in prevention of cancer [26], such as the difficulty of preventative measures, inappropriate economic status, and fear of cancer information. Therefore, strategies that overcome the individual and environmental barriers that affect nutritional behaviors should be addressed by planners and policymakers.
In the present study, the mean score of perceived self-efficacy construct significantly increased after the training in the intervention group. The results of the study by Braun [27], Alidoosti et al (12), and Hart et al [28] are consistent with this finding. Perceived self-efficacy is considered as a strong motivational source and, in fact, is an indicator of the ability of individuals to organize themselves in pursuit of certain goals[29]. Studies show that individuals with a high level of perceived self-efficacy have a greater commitment to engage in activities at a time of challenges and difficulties, and spent more time and effort on such activities [30]. Such individuals are more likely to contribute to maintaining healthy behaviors and retrieve them, even after failure, and they have stronger intention and motivation. This not only improves the target adjustment, but also ensures achievement and sustainability in pursuit of the goals [31]. Since self-efficacy is a prerequisite for behavioral change, it seems that the beliefs of employees regarding their ability to properly handle the health-related behaviors associated with the prevention of colorectal cancer, can be effective in preventing CRC. The more they believe in their efficiency and ability to take colorectal cancer prevention behaviors, the more they do the intended behaviors.
In this study, the mean score of behavioral intention construct was increased in the intervention group after the intervention. In the study of Braun [27] and Gimeno et al [17], similar to the results of present study, the mean score of behavioral intention construct was increased in the intervention group after the intervention. Also, in the present study, the mean score of behavioral construct increased after the intervention in the intervention group, and there was no significant difference between the two groups after the intervention in this regard. The results of this study are consistent with the findings of Abood et al [11], Hart et al [28], Roozitalabi et al [15], Alidoosti et al [12], and Davoodi et al [32] studies. Behavioral intention is the thought of doing a behavior, and is considered as the immediate determinant of that behavior. Although increasing knowledge is an important step in changing attitudes and behaviors, it is not a major contributor to CRC prevention. Achieving the intention to behave is influenced by individual and environmental factors, so in addition to enhancing individual aspects, overcoming the structural and environmental barriers of the health system regarding the use of cancer prevention nutritional behaviors is also vital.