Neck pain is one of the most common musculoskeletal disorders, teachers due to the nature and context of work and job responsibilities, are exposed to various factors that threaten the health of the neck[6, 11]. The aim of this study was to investigate the effect of educational intervention based on the health belief model on the adoption of neck pain prevention behaviors on teachers in social networks. Based on the findings of this study, after the educational intervention, the mean score of awareness, perceived sensitivity, perceived severity, perceived benefits, cues to action, self-efficacy and neck health-promoting behaviors in the intervention group increased significantly compared to the control group and the mean score of barriers. Perceived showed a significant decrease.
Findings from the present study showed that various factors such as age, physical activity, work experience and job satisfaction have been effective in teachers' neck pain. These results were confirmed by the study of Patience N Erick et al . The findings of the study also showed that repetitive movements, inappropriate physical postures during activity and excessive use of force are the main factors in causing neck pain, the findings by the study of Maghsoudian et al and Cheng and Et al[24, 30] confirmed. The findings of the study also showed that contributing factors can play an effective role in the occurrence of behavior and facilitate the occurrence of the behavior, and their absence can prevent behavior change. These findings were confirmed by Goetsch DL study and colleagues.
The results of the evaluation of the educational intervention in the present study showed that the areas of awareness, perceived sensitivity, perceived intensity, perceived benefits, perceived barriers, Cues to Action, self-efficacy and behavior improved during the 3 months of follow-up in the intervention group. Educational intervention the present study was consistent with previous studies that stated that the use of the model in educational interventions can be effective in adopting health behaviors [32_34]. Increasing the average score of awareness in the intervention group is valuable, because having knowledge about neck pain, risk factors for this disease, as well as behaviors that promote neck health can create the right attitude about neck pain and adopt appropriate behavior. In the present study, teachers' awareness of neck pain increased for the intervention group during 3 months.
This finding was confirmed by the Janssens study. Also, the results of the present study showed that the perceived barriers and benefits after educational intervention in the two groups are statistically significant. There was also a positive and significant relationship between perceived benefits and neck health-promoting behaviors. Increasing the score of perceived benefits after training, it is consistent with the results of Ghofranipour study. In the present study, perceived sensitivity and severity, teachers' self-efficacy in adopting neck health-promoting behaviors increased during the 3 months in the intervention group, these findings were confirmed by the study of Sharafkhani N and et al and study of Thompson R and et al . The present study showed that there is a positive correlation between self-efficacy and neck health-promoting behavior and higher self-efficacy indicates health behavior. This finding was confirmed by the study of Fung Seri et al, and the study of Fida et al. The results show that managerial factors and organizational policies can play a very important role in adopting and promoting health behaviors. School administrators can equip the environment in terms of sports facilities, and spaces for teachers to rest and control stress at work.
A study by Ross et al confirms this finding. In the present study, the intervention based on social media was very successful. Social media facilitates user interaction and expands knowledge because it removes barriers to geographical distance and physical presence. The results of several studies confirm these finding[18,41_43]. The results of the present study show the positive effect of the educational program designed based on the health belief model in the context of social networks, increasing perceived sensitivity, perceived severity, perceived benefits, Cues to Action and self-efficacy and reducing perceived barriers in the intervention group, this is followed by an increase in neck health-promoting behaviors in teachers.
Study strengths and weaknesses
One of the most important strengths of the present study is the lack of similar studies in Iranian teachers. Other strengths include a combination of qualitative study and clinical trial, as well as the specific design and implementation of educational intervention and He mentioned the use of social media to provide educational content. As well, the presence of male and female participants and evaluating the effect of educational intervention on the adoption of neck health-promoting behaviors in both sexes were other strengths of the present study. It is also possible to follow the effect of the intervention 3 months after the intervention on the continuation of promotional behaviors as strengths of the study. One of the limitations of the present study was the teachers' self-report on the severity of neck pain and recommended health behaviors. Also, another limitation of the study was the selection of teachers from the first high school of public schools in Tehran. This is because the views of these teachers, as well as the severity of the neck pain and the impact of the educational intervention, may be different from those of teachers in other grades, cities, and non-governmental schools.
Since the present study was conducted in the master's degree, due to lack of time, 6-month and 1-year follow-ups were not possible, so it is suggested that in future studies, the long-term follow-up to investigate the effect of the intervention on the continuation of behavior. It is also suggested to study and compare the effect of educational intervention based on health belief model in adopting neck pain prevention behaviors in teachers of different grades (preschool, primary and secondary school).