Analysis of the results showed that training based on the theory of planned behavior increases the tendency towards childbearing in marrying couples. The results of the study by Ajzen [16] conducted to investigate the effect of planned behavior on promoting health-related behavior showed that changing the attitudes and mental norms along with behavioral control could lead to an increase in health-related behaviors. This effect has also been observed in other areas related to health behaviors; a study by Wiles et al [17]. carried out to investigate the effect of pre-pregnancy counseling on women with chronic renal disorders showed that training and raising awareness before pregnancy facilitate the decision-making process for pregnancy. In the effectiveness of the theory of planned behavior on behavioral changes, the results of the studies by Ajzen [16] and Donald et al [18]. are consistent. Explaining the results, it can be concluded that according to the theory of planned behavior, the most important constituent that determines the behavior of an individual is “behavioral intention”. The individual's intention to perform a behavior is a combination of attitude towards behavior, behavioral belief, evaluation of behavioral consequences, abstract norms, normal beliefs, and motivation for performing the behavior [19]. Regarding the effectiveness of the conducted intervention, it can be noted that employing the techniques for identifying the negative thoughts and differentiate them from facts, as well as showing the happy life of parents with infants via presentation of videos and slideshows, have positively affected the attitudes and mental norms of the individuals towards childbearing and led to an increase in childbearing tendencies.
In this respect, the results of the researches conducted in Iran indicate that attitudes and beliefs such as childbearing constraints, high responsibilities of the parents, social and marital restrictions for parents, high costs of childbearing, and pregnancy-related risks for women are of the most important mental impediments to childbearing among Iranian couples [3, 19]. Therefore, it can be noted that through evaluating the negative thoughts and attitudes towards childbearing and differentiating these thoughts from facts, the present intervention has, partly, been able to modify and balance negative mental norms and attitudes. The reason behind the importance of attitudes and norms in behavioral intention is that the idea of the individual regarding the results of his behavior and evaluation of these results, lead to the formation of an attitude. If one thinks that the result of a particular behavior is positive, then he will obtain a positive attitude towards it and, therefore, his tendency to perform that behavior will increase [20]. It should also be considered that the intervention was conducted in the form of group; the researcher's take-away from the atmosphere of the group's meetings was that during the final sessions, the members of the group had positive views on childbearing, which may have a positive effect on the tendency of childbearing because mental norms are also influenced by personal ideas. Individual’s idea of others’ expectations and his motivation to meet these expectations lead to the formation of mental norms. The one who is motivated to meet group expectations, finds a positive attitude towards the behavior; but if he thinks negatively of the group’s view on the behavior and tries to meet the expectations, then negative abstract norms are likely to be formed in his mind and hinder performing the behavior [21].
Although the present study did not affect the external factors such as occupation and income status of intervention groups to improve the understanding of behavioral control in tendency towards childbearing, group discussions on fertility and childbearing and brochures and educational books were employed to strengthen the internal factors of controlling behavioral understanding (such as acquiring the necessary skills and knowledge and reducing fertility and childbearing-related stress). In this regard, a research [22] on the obstacles and needs in the way of improving the tendency towards childbearing suggests that parents need to be informed and trained on pregnancy and its changes to increase childbearing potential. Therefore, it can be concluded that the present study, trying to change and modify the negative attitudes and norms and also improve the understanding of behavioral control, has had a positive effect on the behavioral intention of the intervention groups regarding childbearing.
In the present study, an association was observed between the tendency towards childbearing with income status and the place of residence in men and fears of financial difficulties in both men and women. It has been shown that socioeconomic factors such as educational attainment, occupation, and place of residence are the main factors in decreasing fertility and childbearing [23]. The men and women’s ideas of negative impacts of infant on comfort and welfare, prevention from social activities, and the possibility of getting physically ill as a result of childbearing are other socio-economic factors observed in this study that suggest examining the association between childbearing and the other non-biological aspects of it. Fertility, aside from being biological, is always considered as a social phenomenon and to understand it, the values and beliefs, norms and, in short, the culture of each society must be studied. Therefore, for decision-making in this regard, it is logical to even consider social, cultural, economic and political changes of society including modernization, urbanization and the level of development in human societies [24].
According to the theory of planned behavior, humans are, also, logical beings who use existing information regularly and systematically and think about the concept before making a decision for doing or not doing a behavior [25]. Therefore, it can be suggested that in the intervention sessions designed for couples, the information provided in the form of group discussion, presentation of slideshows and brochures, as well as videos, have influenced the decision of couples for childbearing. In other words, the presentation of the information performed in such a way that the couples logically and without any bias tend to make decision on childbearing (by modifying negative thoughts and beliefs through group discussion and showing videos of happy aspects of the life of parents with children). Therefore, it can be assumed that when it comes to thinking about childbearing, the couples in the intervention group of this research, after participating in the sessions, have realistic and more positive idea of the notion that could reinforce their decision on childbearing.
Given that in this study participants were marrying couples, the results of the research are limited to this population and cannot be extended to the already married couples. Also, the results of this study are limited to non-clinical population and, therefore, it cannot be generalized to include clinical populations.