This study was designed to examine the effect of virtual education and multimedia based on the Health Belief Model (HBM) in preventing COVID-19 among pregnant women in Ahvaz, Iran, in 2021. Our study showed that before the intervention, none of the HBM constructs was significant in the intervention and control groups, and both groups had the same status in terms of underlying variables.
In this study, the mean score of perceived susceptibility in the intervention group increased from 22.15 before intervention to 24.45 after the intervention. This can be due to the possibility of negative consequences or representing complications and dangers caused by COVID-19 for pregnant mothers and their fetuses on social media. The higher the perceived sensitivity, the higher the probability of adopting preventive behaviors because the perceived susceptibility is considered one of the effective factors in adopting preventive behaviors (20). While our findings were not in line with a previous study (25), they were consistent with several studies that demonstrated increased perceived susceptibility in pregnant women after intervention (19, 21, 22–24). Considering that high perceived susceptibility is necessary to promote people's motivation to adopt preventive health behavior, part of the educational program regarding issues such as the prevention of Covid-19 should be focused on this construct.
In the present study, the mean score of perceived severity increased significantly from 19.6 before intervention to 23.55 after intervention in the intervention group, which is consistent with previous studies (19, 26, 27, 28). In contrast, our results were not in agreement with some studies (25, 29). In the present study, the complications of COVID-19 for pregnant women and the risk of unknown complications for the fetus were important factors in improving the perceived severity of pregnant women. Moreover, since covid-19 symptoms in pregnant women are more severe, they may consider contracting COVID-19 to themselves and their fetuses deadly and dangerous. Hence, perceived severity can lead to adopting COVID-19 preventive behavior.
Regarding perceived benefits, the mean score of this construct increased in the intervention group after intervention. For more effectiveness of the perceived benefits construct, health educators should focus on specifying the precise behavior that needs to be done and highlight its benefits (30). Our result is in tune with previous studies (19, 31, 27), whilst this was not found in other studies (23, 26). This may be due to differences in studies' methodology and participants' sociodemographic characteristics, as well as the lack of use of multimedia in other studies.
In the current study, the mean score of perceived barriers increased in the intervention group after intervention. Perceived barriers refer to a person's beliefs about the actual costs and obstacles to performing a recommended health action. A person weighs the effectiveness of the actions against the perceptions that they may be expensive, dangerous, unpleasant, time-consuming, or inconvenient (30). Also, the perceived barriers are the factors preventing the adoption of disease prevention behaviors, which makes the pregnant woman perform an analysis of the benefits of the preventive behavior for the costs, risks, fetal complications, fatigue, and time, and based on that, adopts a health behavior. This finding is in agreement with studies conducted on different populations (19.26.32). However, this is not in line with the study of Rafiei et al. (23). It seems that health educators must reduce such barriers so that these barriers do not prevent a person from performing the recommended actions/behaviors, and do this by reassurance, resolving misunderstandings, or providing incentives.
We found that the mean score of self-efficacy increased from 29.83 before intervention to 32.25 after intervention in the intervention group. A similar result was found in studies conducted in different parts of Iran and with different populations (19, 33). However, this is not consistent with the study of Hashemi et al. and Nik Sadat et al. (26, 25). This difference can be due to differences in the study population and educational programs. It seems that those with more self-efficacy would have more resistance and persistence to cope with challenges. Therefore, improving this construct can make problems and challenges easier for them. Moreover, considering the role of this construct in empowering pregnant women to adopt COVID-19 preventive behaviors, more attention should be paid to designing educational programs. Since the improvement of self-efficacy appears to influence the promotion of other constructs, greater attention should be given to it when conducting the intervention.
We found that the mean score of cues to action increased in the intervention group after intervention. Cue to action refers to the stimulus needed that makes a person feel the need to perform an action. Such cues can be internal (e.g., understanding a physical condition) or external (e.g., interpersonal interactions, media communication, or receiving a postcard from a doctor to follow up on a test) (30). This is congruent with previous studies, in which similar results were found (19, 26, 20).
Promoting the adoption of preventive behaviors through mass media, emphasizing the sense of social responsibility and sending notifications through mobile phones and social media can improve COVID-19 preventive behaviors (34). Using preventive behaviors by doctors and health experts and promoting and advertising preventive behaviors on social networks, mass media, and sending notifications via mobile phones, as well as internal factors such as fear of infection and quarantine, can increase preventive behaviors of COVID-19.