Neck pain is one of the common musculoskeletal disorders (MSDs) among working population especially in teachers. The disorder is one of the costliest health challenges in the workplace and might lead to several unpleasant consequences[1, 2]. These include reduced productivity due to absenteeism, early leave and retirement, missed working days, financial losses due to medical expenses and work-related discomfort among workforces especially teachers [3, 4]. According to the World Health Organization, neck pain is the fourth most common health problem among teachers, accounting for 44–61% of injuries [1, 5–7].
Teachers have a higher percentage of work-related musculoskeletal disorders than other occupations (39 to 95%). It has been reported that 57.8% of occupational injuries among teachers are related to neck pain [5, 8]. Therefore, planning and implementing appropriate educational intervention to eliminate and correct adverse health behaviors, and promote preventive behaviors for neck pain in teachers is essential and inevitable.
Any effort to understand and measure preventive behaviors among teachers is very important. Several questionnaires such as the Nordic Musculoskeletal Disorders Questionnaire[9], the McGill Pain Questionnaire (MPQ)[10, 11], the Chronic Pain Grad Scale (CPGS)[12] and the Roland–Morris Disability Questionnaire[10] have been designed to understand how musculoskeletal disorders, including neck pain, affect a person's ability to perform normal activities. However, these questionnaires cannot assess the causes, benefits, and barriers to neck pain preventing behaviors. Therefore, in order to develop any intervention to prevent work-related neck pain among different occupations, especially teachers, we must understand the related causes. This is in the realm of educational planning models [13].
There are several reasons why neck pain preventive behaviors are not performed. The main reason is the lack of belief in the extent of the disease and the severity of the damage caused by the disease (perceived sensitivity and severity). Furthermore, the lack of individuals’ evaluation of the benefits and barriers of preventive behaviors could be other reasons (perceived benefits and barriers) [14].
One of the best effective models in promoting preventive behaviors is the Health Belief Model (HBM)[8]. The model is comprehensive and is based on the premise that preventive behaviors are subsequent of personal beliefs on vulnerability to disease, the impact of disease on quality of life and the impact of health measures in reducing the sensitivity and severity of disease[15]. The health belief model has six constructs: perceived susceptibility, perceived severity, perceived benefits, perceived barriers, cues to action, and self-efficacy.
Perceived susceptibility refers to a person's abstract belief about getting sick or being harmed as a result of engaging in certain behaviors. Perceived severity refers to a person's abstract belief about the extent of harm that can result from an illness or harmful condition resulting from a particular behavior. Perceived benefits refer to the benefits of practicing recommended behaviors to reduce the risk or worsening of a disease or harmful condition resulting from a particular behavior. Perceived barriers refer to a person's abstract belief about the actual and perceived costs of pursuing new behaviors. Cues to action refers to the accelerating forces that make one feel the need to perform a particular behavior, which can be of internal (perception of a physical state) or external (interpersonal interactions, media communication). Self-efficacy refers to the ability that one could pursue a particular behavior [16, 17].
Based on the health belief model for adopting disease preventive behaviors, people must first feel threatened by the problem (perceived susceptibility), then understand the depth of the danger and the severity of its effects (perceived severity) with the positive symptoms they receive from their environment (cues to action), useful and capable believe in the implementation of preventive behaviors (perceived benefits) And find the factors that prevent this behavior from being less costly than its benefits (perceived barriers) and also consider themselves capable of performing preventive behaviors (self-efficacy) to ultimately perform the correct function in preventing the disease[16]. To this end we thought this model could be an appropriate platform for designing a proper instrument to measure neck pain preventive behaviors. Thus, the purpose of this study was to develop and psychometrically evaluate an instrument for measuring preventive occupational neck pain behaviors in teachers. In fact, the overall aim was to assess how teachers react to neck pain and how take preventive measures to prevent it. We thought the instrument could help to identify areas which need attention for implementing possible interventions.