The effect of Multi-Theory model educational intervention on preventive behaviors of Covid-19 in Yazd students: a protocol study

doi:10.21203/rs.3.rs-2453156/v1

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The effect of Multi-Theory model educational intervention on preventive behaviors of Covid-19 in Yazd students: a protocol study

https://doi.org/10.21203/rs.3.rs-2453156/v1

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Introduction: Identifying preventive behaviors from Covid-19 can be useful for planning short-term and long-term interventions for students washing hands, wearing masks and receiving vaccines. The aim of this study is to investigate the effect of educational intervention based on multi-theory model on preventive behaviors of Covid-19 in students in Yazd.

Methods and analysis: This study will be a randomized controlled trial based on case and control groups on undergraduate students in Yazd universities. Received a clinical trial code and an ethics code in the research. The random cluster sampling method will be two-step. The data collection tool is a questionnaire consisting of 4 parts: the first part is demographic information, the second part is a hand washing behavior questionnaire based on a multi-theory model, the third part is a vaccine acceptance behavior questionnaire based on a multi-theory model, the fourth part is a questionnaire The behavior of wearing a mask is based on a multi-theory model. Questionnaires will be completed in 2 rounds. First before the intervention and one month after the intervention. After completing the pre-test, an educational intervention based on the multi-theory model will be performed for the case group and no intervention will be performed for the control group. Data analysis will be performed in SPSS software version 24.

Ethics and dissemination: The ethical approval of this research was obtained by the Ethics Committee of Shahid Sadoughi University of Medical Sciences, Yazd. (Approval date: 9/24/1400) Reference number: IR.SSU.SPH.REC.1400.179. The results will be disseminated through peer-reviewed journals and conferences. The present study was carried out in accordance with the Declaration of Helsinki and approved by IRCT. The participants of this study were students, they were not patient, no special intervention was done on them, we only gave them a series of trainings to increase their awareness about preventive behaviors of COVID-19.

Trial registration number: IRCT20211226053527N1

Educational intervention

preventive behaviors

covid-19

students

multi-theoretical model

Background and rationale

The coronavirus (COVID-19) caused by the SARS-CoV-2 virus spread rapidly around the world and started a pandemic ^1,2. As of October 9, 2022, there have been 6,209,30,851 confirmed cases of COVID-19, 6,556,086 deaths attributable to COVID-19 have been reported, and a total of 1,279,2851,481 vaccine doses have been administered worldwide as of October 9, 2022 ². In Iran, according to the latest news announced by the Ministry of Health, 7551022 confirmed cases of covid-19, 144471 deaths due to this disease and 154472443 doses of vaccine have been reported until October 17, 1401 ³.

Since the main way of transmission of SARS-CoV-2 is through small droplets released when talking, coughing or sneezing, the Center for Disease Prevention and Control has provided guidelines for preventing the spread of COVID-19 has prepared. The CDC recommends that people wash their hands regularly, disinfect surfaces regularly, practice social distancing, and protect themselves by wearing masks when in contact with people ^4,5. Currently, the use of masks is considered as one of the effective strategies to control the spread of COVID-19. In many countries of the world, including Iran, people are required to wear masks in public places and workplaces ⁶. Various masks, including surgical masks, N95 respirators, N95 surgical masks, and face filtering masks (FFRs), are used to protect against COVID-19. If people do not use the mentioned masks according to the manufacturer's and standard instructions, their effectiveness will decrease and lead to an increase in the risk of transmission of COVID-19 ^7,8. Misinformation about mask effectiveness in the media, along with conflicting messages from government officials, has led to confusion, skepticism, and reinforced anti-mask attitudes ⁵. Intra-individual factors affecting mask wearing behavior are different. Recently, the use of masks associated with COVID-19 requires a comprehensive study to understand the factors associated with adherence to guidelines ⁹. Also, to reduce the spread of COVID-19, public health officials have recommended various safety strategies, including hygiene measures such as hand washing, sneezing into the elbow, avoiding touching surfaces, and using personal protective equipment ¹. One of the effective measures recommended by governments is frequent and thorough hand washing ^{2, 10}. Hand washing is an effective public health measure that has been proven to minimize the prevalence of gastrointestinal and respiratory tract infections by 31% and 21%, respectively ^{11, 12}. Hand washing removes microorganisms from hands and prevents their transmission. ¹³. The CDC recommends washing hands thoroughly with soap and water under running water for at least 20 seconds ¹⁴. It also encourages people to wash their hands at least in the following situations: (1) after being in public; (2) before and after providing care to someone who is sick, (3) after sneezing or coughing, (4) before, during and after preparing food; (5) before eating; (6) after using the toilet (7) after touching an animal; and (8) after handling waste ¹⁴. In health care systems and services, awareness campaigns have been conducted almost continuously to encourage hand washing among health care personnel, patients, and visitors ¹⁵. The research conducted before this epidemic reported non-observance of hand washing instructions among university students and the university community ^16-18. Previous theory-based interventions have successfully promoted good handwashing practices in young adults ^{19, 20}.

The severity and spread of the COVID-19 pandemic has necessitated the use of the vaccine, and the majority of communities have administered two doses of the vaccine, but there are still doubts about injecting the third and fourth doses of the vaccine among some groups, including students, if the injection of subsequent doses of the vaccine can lead to the immunization of the body as much as possible. Recent research shows that certain subgroups of the population, including people with lower income levels, conservative political affiliations, certain religious beliefs, women, people with black and Hispanic racial identities, and young people are hesitant to get vaccinated. A variety of factors have led to reluctance to administer the third and fourth doses of the vaccine among young adults in the United States; including fear of side effects, previous experiences with health care providers, social acceptance by peers, negative perceptions of vaccine manufacturers (e.g., pharmaceutical companies), belief in conspiracy theories, concern about rapid vaccine development, and distrust of Government policy makers ^{21, 22}.

An important group of young people who are the target of COVID-19 vaccination are students. Students are exposed to SARS-Cov-2 infection due to various factors; Such as: staying in dormitories and housing outside the university, reopening universities and activities, and the necessity of traveling between home and university. Research among university students in Italy on the intention of the COVID-19 vaccine suggests that some subgroups of students may have higher vaccination intentions, including: medical students, students who have previously received the influenza vaccine, students with Higher concern about COVID-19 and students with high vulnerability to COVID-19²³. Therefore, it is necessary to adopt effective strategies to increase the vaccination of COVID-19, especially in students who are hesitant to inject the vaccine.

Health education is a process that builds a bridge between health information and health behavior and motivates a person to obtain and apply the available information to avoid harmful behaviors and create beneficial behavior in himself. One of the effective methods in changing health behavior is the use of models, and models have significant effects. Considering the effectiveness of models and the significant role they play in changing people's health behavior, in this research, a fourth generation theoretical framework, multi-theory model (MTM), was used to change health behavior, in order to investigate the behavior of washing hands, wearing masks and Acceptance of the vaccine will be used among students of different universities in Yazd. Theory-based interventions are more effective in facilitating behavior change than interventions without such a theoretical basis ²⁴. In addition, the multi-theoretical model (MTM) of health behavior change combines the conceptual strengths of existing social behavioral theories and uses them to predict behavior initiation and maintenance ²⁴. The multitheory model is a theory of health behavior change with the unique ability to explain factors related to one-time (eg, initiation) and long-term (eg, maintenance) engagement in health behaviors ²⁵. These constructs are consistent in health behaviors and have been used to explain a variety of health behaviors among students ^26-30. To begin with, the constructs of participatory dialogue (eg, benefits and barriers to handwashing), behavioral trust (ie, confidence in the correct steps to follow thorough handwashing despite barriers) and change in the physical environment (eg, availability and access to necessary resources for hand washing) will be effective in changing behavior. Whereas, for behavior maintenance, the constructs of emotional transformation (for example, turning emotions into goals for regular hand washing), training for change (i.e. creating a habit of hand washing and the existence of self-monitoring of hand washing) and change in The social environment (eg social nurturing and supportive environment) exist for long-term adherence to changed behaviors ²⁵. Previous theoretical models of health behavior, which focused more on acquiring behavior instead of changing it, have produced different results when examining behavior change and lack real predictive power and are not suitable for determining long-term behavior change. The multi-theoretical model is a unique theoretical framework for behavior initiation and maintenance. Identifying the factors related to the initiation and maintenance of hand washing, wearing a mask, and the initiation of vaccine acceptance using MTM can be useful for planning hand washing, mask wearing, and vaccine acceptance interventions for students (Figure 1).

The studies conducted on three behaviors (hand washing, vaccine acceptance, and mask use) are descriptive, and the necessity of conducting an intervention study based on this model is evident; Therefore, this study will be conducted with the aim of the effect of the educational intervention based on the multi-theory model on the preventive behaviors of getting infected with Covid-19 in students.

Study design

This study will be conducted as a randomized controlled trial according to case and control groups on students of Yazd universities. The studied population is the students who are studying undergraduate in the universities of Yazd city. To implement the educational intervention, after coordinating with the educational vice-chancellor of Yazd universities and obtaining permission, the studied students will be selected using a two-stage random cluster sampling method. After people enter the study, the researcher gives explanations about the objectives, the method of implementing the project and the confidentiality of the information. If they agree and complete the consent form, the required information will be measured by a questionnaire whose validity and reliability will be measured and it will consist of 4 parts: the first part is demographic information, the second part is the hand washing behavior questionnaire, the third part is the behavioral questionnaire. Vaccine acceptance, the fourth part of the mask wearing behavior questionnaire will be collected. It should be noted that the questionnaires are based on the MTM model.

Eligibility criteria

Inclusion criteria: Studying in universities in Yazd, having a smartphone, access to the Internet, having WhatsApp-Telegram applications and being a member of them, undergraduate students.

Exclusion criteria: absence from more than 10% of training sessions, occurrence of severe physical or mental illness and hospitalization, death or traveling for more than 10 days in the intervention group, withdrawal from the virtual group (WhatsApp-Telegram).

Interventions

In the second phase of the study; Pre-examination part: Questionnaire on hand washing behavior, acceptance of vaccine and use of mask will be completed by undergraduate students of Yazd city in two groups of case and control. The data collection will be online and the questionnaire will be designed on the Porsline website and the link will be provided to the students.

Hand washing behavior, acceptance of vaccine and use of mask will be designed. The educational content will be prepared using reliable and up-to-date scientific sources (including the CDC-WHO website, books and related articles). For the case group, after completing the questionnaires, the compiled educational intervention will be implemented. The teaching method will be chosen according to the type of content and access of the audience. Based on the conditions at the time of implementation, the training will be virtual, face-to-face or a combination of both. In the study, blinding is not done. The nature of the study is in the form of an educational program and people find out whether they are being educated or not. And in the control group, no educational intervention will be implemented (table 1).

Table 1.

Table of lesson plans for educational sessions

Structures used :

Collaborative dialogue (behavioral advantages and disadvantages), behavioral trust, change in physical environment, emotional transformation, practice for change, change in social environment

target group:

1- Primary target group: undergraduate students

2- Secondary target group: family – peers

General purpose:

Improving the level of awareness, attitudes and preventive behaviors of contracting Covid-19 in the studied population

Special objectives:

Objectives of cognitive domain:

- The person should name the benefits of preventive behaviors against contracting Covid-19.

- The person should name the disadvantages of preventive behaviors against contracting Covid-19.

- The person can name the preventive behaviors of contracting Covid-19.

- The person can express the solutions of not getting infected with Covid-19.

- The person can mention the necessary accesses and facilities to prevent the infection of Kovid-19.

- The person can express the ways of creating interest and motivation in performing preventive behaviors against contracting Covid-19.

- The person can identify the ways to monitor the preventive daily behaviors of getting infected with Covid-19.

- A person can name the influential people in his life who are influential in carrying out preventive activities against contracting Covid-19.

Objectives of the attitude field:

- A person should consider it valuable to overcome the disadvantages of performing preventive behaviors against contracting Covid-19.

- The person should value the strategies to adapt to the preventive behaviors of getting infected with covid-19.

- The person should consider the available facilities and access to prevent the spread of Covid-19 in their living environment as important.

- The person should be interested in the behaviors of compliance with the preventive behaviors of contracting Covid-19.

- The person can be self-motivated towards the behaviors of matching with the preventive behaviors of contracting Covid-19.

- A person should value self-monitoring of daily preventive activities against contracting Covid-19.

- The person should consider the support of his family members and those around him to be important in accordance with preventive behaviors against contracting Covid-19.

Behavioral goals:

- A person can overcome the disadvantages of performing adaptation behaviors with preventive behaviors against getting infected with Covid-19.

- A person can adopt a suitable solution according to the symptoms of Covid-19.

- A person should make good use of the facilities and access he has in his living environment.

- A person can perform the behaviors of compliance with the preventive behaviors of contracting Covid-19 with interest and motivation.

- The person writes down his daily activities in a notebook.

- With the support of his family members and those around him, the person can adopt behaviors that are compatible with preventive behaviors against contracting Covid-19.

activities:

- Training through PowerPoint and slides

- Show the movie

- Playing a role

-Presenting pamphlets and notebooks to record daily activities

-social networks

- Holding group discussion meetings

Number and time of meeting:

- Four virtual sessions and one face-to-face session for 20 minutes

Sources:

- Educational aids: whiteboard, video projector, internet, pamphlets

teaching method:

- Speech with PowerPoint, question and answer, group discussion, virtual space

Monitoring and evaluation method:

Questionnaire

Evaluation time:

Before the intervention and one month after the intervention

In the post-test part: Finally, the changes in behavior are measured 1 month after the implementation of the intervention, using the mentioned questionnaires. The data collection will be online and the questionnaire will be designed on the Porsline website and the link will be provided to the students.

Patient and public involvement

no patient involved on the trial design. The participants of this project were students

Outcome measures:

The present study will be conducted in two phases. So that in the first phase, the considered questionnaires will be psychometric and localized, and in the second phase, an educational intervention study will be conducted (Chart 1).

In the first phase of the study; After obtaining the code of ethics, the standard questionnaire designed by Sharma's study^18,44 will be translated from English to Farsi with the standard 'forward-backward' method. Two health professionals will independently translate the items and the other two will They will translate the answer and a temporary version will be prepared. After that, it will be translated back into English, and after a careful cultural adaptation, the final version will be presented. The validity of the form, content, structure and reliability of the final Persian version will be examined by a panel of experts ^38-40.

To determine the validity of the content quantitatively, the questionnaire will be provided to the panel of experts and they will be asked to rate the content validity of the questionnaire[1] in three items (necessary, useful but not necessary) according to the purpose of the research (CVR). (not necessary) about the 'necessity' of the items and about the (CVI) content validity index[2] (qualitative) of the questionnaire, comment on the four items 'not relevant, somewhat relevant, relevant and completely relevant'. Also, the validity of the content will be evaluated by 10 experts using a qualitative method (observance of grammar, use of appropriate words, etc.) ^41-43 (Table 2).

Table 2. Decision table about the minimum acceptable CVR value based on the number of scoring experts

Number of specialists	value CVR	Number of specialists	value CVR	Number of specialists	value CVR
5	0/99	11	0/59	25	0/37
6	0/99	12	0/56	30	0/33
7	0/99	13	0/54	35	0/31
8	0/75	14	0/51	40	0/29
9	0/78	15	0/49
10	0/62	20	0/42

In order to evaluate the face (qualitative) validity, the questionnaire will be given to 10 experts and 20 students similar to the target group to study it and evaluate the items in terms of 'simplicity and fluency', 'relevance or specificity'. and evaluate 'clarity'. After modifying the items based on the respondents' opinions, in the next step, in order to evaluate the face validity (quantitative) and determine the importance of each item, a 5-point Likert scale including: 'It is completely important', 'It is important', 'Very important' Moderately important', 'slightly important' and 'not important at all' are considered ^44-48.

Construct validity examines the adequacy of instruments to measure existing constructs. In this study, factor analysis method was used to measure and determine construct validity. In this method, items with consistent correlations were summarized in the form of new variables called factors. In order to determine the reliability of the tool, Cronbach's alpha internal consistency method will be used with a pilot study ⁴⁹.

The hand washing behavior questionnaire was designed by Sharma and colleagues at Las Vegas University in America ¹⁸. This questionnaire contains 36 questions that have a benefit structure with a scale: never (0), almost never (1), sometimes (2), most of the time (3), often (4). Possible range: 0-20, where a high score is associated with the possibility of starting behavior change. Scale structure of disadvantages: never (0), almost never (1), sometimes (2), most of the time (3), often (4). Probability range: 0-20, with a low score associated with the likelihood of initiating behavior change. To calculate the collaborative dialogue construct score, subtract the disadvantage score from the advantage score. A positive score will indicate a change in behavior. Behavioral trust structure with a scale: not at all sure (0), a little sure (1), fairly sure (2), very sure (3), completely sure (4). Possible range: 0-24, where a high score is associated with the probability of starting to change behavior. The structure of changes in the physical environment with a scale: not at all sure (0), a little sure (1), fairly sure (2), very sure (3), completely sure (4). The possible range is 0-12, where a high score is associated with the probability of initiating behavior change. Emotional transformation structure with a scale: not sure at all (0), a little sure (1), fairly sure (2), very sure (3), completely sure (4). The possible range is 0-12, with a high score in relation to the probability of behavior change. Exercise structure for change with scale: not at all sure (0), somewhat sure (1), fairly sure (2), very sure (3), completely sure (4). The possible range is 0-12, where a high score changes in relation to the probability of behavior change. The structure of changes in the social environment with a scale: not sure at all (0), a little sure (1), fairly sure (2), very sure (3), completely sure (4). The possible range is 0-8, where a high score changes in relation to the probability of behavior change. To model the start of the dependent variable can be 35 items: not at all likely (0), somewhat likely (1), very likely (2), very likely (3) and quite likely (4) and multiple regression can be used. Is. For maintenance modeling, the dependent variable can be 36 items: not at all likely (0), somewhat likely (1), very likely (2), very likely (3), and quite likely (4) and multiple regression, can be used.

The vaccine acceptance questionnaire was designed by Sharma and colleagues at Las Vegas University in the United States ³¹. This questionnaire contains 27 questions that have the structure of advantages: on a scale (0-4) with a score of 0-12 units. Disadvantage structure: on a scale (0-4) with a possible score of 0-12 units. Collaborative dialogue structure: with a possible score of -12 to +12. Behavioral trust structure unit: on a scale (0-4) with a possible score of 0-12 units. The structure of changes in the physical environment: on a scale (0-4) and a possible score of 0-12. Behavior initiation structure: 0-4 scale with a possible score of 0-4 units. It should be noted that this questionnaire has only the beginning of the behavior because the behavior will not be repeated.

Mask use behavior questionnaire was designed by Sharma and colleagues at Las Vegas University in America ³². This questionnaire contains 33 questions. Structure of benefits: Scale: never (0), almost never (1), sometimes (2), most of the time (3), often (4) Possible range: 0 to 20. A high score is associated with the likelihood of initiating behavior change. Disadvantages: Scale: never (0), almost never (1), sometimes (2), mostly (3), often (4) Possible range: 0 to 20. Low score associated with likelihood of initiating behavior change. To calculate the collaborative dialogue construct score, subtract the disadvantage score from the advantage score. A positive score indicates a change in behavior. Structure of behavioral trust: scale: not at all sure (0), somewhat sure (1), fairly sure (2), very sure (3), completely sure (4) possible range 0-16. A high score associated with the likelihood of initiating behavior change. Structure of changes in the physical environment: scale: not at all sure (0), somewhat sure (1), fairly sure (2), very sure (3), completely sure (4) possible range 0-12. A high score associated with the likelihood of initiating behavior change. Structure of emotional transformation: scale: not at all sure (0), somewhat sure (1), fairly sure (2), very sure (3), completely sure (4) possible range 0-12. A high score is related to the probability of maintaining behavior change. Exercise Structure for Change: Scale: Not at all sure (0), Somewhat sure (1), Fairly sure (2), Very sure (3), Completely sure (4) Possible range 0-12. A high score is related to the probability of maintaining behavior change. The structure of changes in the social environment: scale: not at all sure (0), somewhat sure (1), fairly sure (2), very sure (3), completely sure (4) possible range 0-8 high score in connection with the possibility of maintaining Behavior change.

sample size:

The students under study will be selected using a two-stage random cluster sampling method, and the sample size will be based on the confidence level of 95% and the power of 80%, and the standard deviation of the behavior score. Hand washing, vaccine acceptance, wearing a mask and taking into account the difference between the average of this score in the two case groups and the control group, a minimum sample size of 50 samples was considered in each group. The sample size was determined using the following formula and PASS15 software.

Recruitment

The research team will select eligible students to participate in the project.

Data collection

The data collection will be online and the questionnaire will be designed on the Porsline website and the link will be provided to the students.

Data analysis plan

After coding, the collected data will be analyzed using SPSS 24 software. In addition to descriptive statistics indicators (central and dispersion indices), parametric or non-parametric analytical statistics tests will be used after checking the normality or non-normality of the data by the Smirnov Kolmogorov test.

In addition to descriptive statistics (central and dispersion indices), independent t-tests and chi-square tests will be used to compare demographic variables in the case and control groups. Also, repeated measures analysis of variance and Ben Feroni's pairwise comparison test will be used for the changes in the scores of multi-theoretical model constructs in the pre-test and post-test in both case and control groups. In order to compare the average scores of the constructs of several theories of behavior change in the context of preventive behaviors against contracting Covid-19 in two groups of cases and controls, an ANCOVA analysis of covariance test will be used to compare the intervention in the two groups, taking into account the results of the pre-test. Covariance test or multiple regression will be used to adjust the effect of covariances. In this research, p<0.05 will be considered as a significant level.

Data monitoring:

In this study, educational intervention does not pose any danger to people. To monitor the accuracy of the data, people are given a code and they are asked to enter their code at each stage when filling the online questionnaire.

[1] Content Validity Ratio (CVR)

[2] Content Validity Index (CVI)

- Psychometry of the instrument has been carried out on a large scale.

- The results of the study will be provided to the health department.

- The intervention based on this model and the issue of Covid-19 has not existed so far and has been designed for the first time.

- The information is based on self-report.

ETHICS AND DISSEMINATION

Ethics and safety consideration

This study involves human participants.The ethical approval of this research was obtained by the Ethics Committee of Shahid Sadoughi University of Medical Sciences, Yazd. (Approval date: 9/24/1400) Reference number: IR.SSU.SPH.REC.1400.179. Participants gave informed consent to participate in the study before taking part. The investigator will explain the study to the particepants and will give them an informational form. The students willing to participate in the study will also sign a written consent form (online supplemental data). The present study was carried out in accordance with the Declaration of Helsinki and approved by IRCT. The participants of this study were students, they were not patient, no special intervention was done on them, we only gave them a series of trainings to increase their awareness about preventive behaviors of COVID-19.

Confidentiality

All data used in this study will be confidential and students’ identity will be protected by a coded number specific to the study. The contact details will never be accessible . Data processing will be implemented to allow analysis of the results of the research in relation to the objectives of the study.

Dissemination plan

The final report will be written by the investigator .The final version will be sent to the competent authority and to the Ethic committee after the effective end of the research. A report of the overall results of the study will be issued so that each investigator can transmit who wish to know these results. The results will be the subject of communication and publication.

Author affiliations:

¹ Professor, Department of Health Education and Health Promotion, school of public health, Shahid Sadougi University of Medical Sciences, Yazd, Yazd, Iran.

² Assistant Professor, Department of Health Education and Health Promotion, school of public health, Shahid Sadougi University of Medical Sciences, Yazd, Yazd, Iran.

³ Master's student in Health Education and Health Promotion, Department of Health Education and Health Promotion, school of public health, Shahid Sadoughi University of Medical Sciences, Yazd, Iran.

⁴ Professor, Department of Health Education and Health Promotion, school of public health, Shahid Sadougi University of Medical Sciences, Yazd, Yazd, Iran.

⁵ Assistant Professor, Department of Health Education and Health Promotion, school of public health, Shahid Sadougi University of Medical Sciences, Yazd, Yazd, Iran.

⁶ Assistant Professor, Department of Statistics and Epidemiology, school of public health, Shahid Sadougi University of Medical Sciences, Yazd, Yazd, Iran.

⁷ Assistant Professor, Torrens University Australia Melbourne · Public Health PhD, Public Health, GCHPE

Acknowledgements: This article is the result of the master's thesis of health education and health promotion. We hereby thank and appreciate all the colleagues who helped us in conducting this research.

Authors' contributions: SSMM, NY and MKhM are the main researchers of this protocol design. MM, MShY and FSh participated in the design of this research as members of the academic board.MM in the psychometrics of the instrument, FSh in statistical analysis, MShY as a scientific consultant in the field of Corona and FH as a scientific consultant in The research design context has contributed. All authors contributed to drafting the manuscript or revising it critically and approved the final version for publication.

Funding: This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.

Disclaimer: The funding source had no role in the design of this study and will not have any role during its execution, analyses, interpretation of the data or decision to submit results.

Competing interests: None declared.

Patient and public involvement: Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.

Patient consent for publication: Not applicable.

Ethical approval: This study involves human participants.The ethical approval of this research was obtained by the Ethics Committee of Shahid Sadoughi University of Medical Sciences, Yazd. (Approval date: 9/24/1400) Reference number: IR.SSU.SPH.REC.1400.179. Participants gave informed consent to participate in the study before taking part.

Consent for publication: Not applicable

Availability of data and materials: This article is under the title of a protocol article and no data is available. After data collection, all collected data will be available to the public.

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Diagram 1 is available in the Supplementary Files section.

No competing interests reported.

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Diagram 1: Study steps

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The effect of Multi-Theory model educational intervention on preventive behaviors of Covid-19 in Yazd students: a protocol study

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