Results of the first step
Key findings emerged from the needs assessment:
The systematic review conducted as part of this programme of plan, the findings of the present review indicated two outcomes by considering the impact of the backpack on musculoskeletal injuries and pains among adolescents. The results of the review studies specified that there was a statistically significant positive relationship between the prevalence of musculoskeletal injuries and pain using a backpack among most of the male and female adolescents.
The first intervention mapping step of conducting a needs assessment helps to identify the health problem and its related behavioral and environmental determinants for the at-risk population the results were categorized into 3 outcomes:1- Increasing student information about backpacks and musculoskeletal injuries 2- Increasing student information about all kinds of backpacks 3- Proper use of backpacks. Also The literature suggests that there are a range of barriers. This mapping process revealed that the main barriers fell into the theoretical categories of knowledge, beliefs about capabilities (self-efficacy), environmental context and resources. Facilitators reversal of these barriers; for example, if a barrier was a lack of knowledge about healthy behavior about musculoskeletal health and how to use a school bag, a facilitator was improved knowledge of what healthy behavior about musculoskeletal health or how to use a school bag of course in simple language. However, other facilitators included the use of rewards, such as sticker charts for children.
1- Increasing student information about backpacks
The weight of backpack and musculoskeletal symptoms related to backpack carriage on student [19]. also back pain is a common affliction and a leading cause of disability in adults, but only recently has back pain been documented in teenage students [20]. ergonomics awareness and posture training is an important preventive approach to back pain, it is important for teenage students to learn about the structure of spine and back care [19]. One common suspect for back pain in children is the school backpack, which has also received a greater deal of attention in the past few years [21]. A study in Italy found that the average load of backpack was 22% of the student’s weight and that 1/3 of the student surveyed carried excess of 30% of their body weight at least one time per weak, their point prevalent for reporting back pain was nearly 16%. With life time prevalence is estimated to be 48% [22].
2. Increasing student information about All kinds of backpacks
A backpack is a cloth sack put on somebody's back. It usually has two straps that go over the shoulders. People often use backpacks on camping trips, hikes, or any form of outdoor activity where people need to carry many things. Backpacks are also being used in the military by soldiers. It can be also used in school, or in this case, it also called a book bag or backpack [4].It is important to increase students' knowledge of the types of backpacks and standard backpacks while most students choose their backpack according to its appearance why so studies show that most bags and school backpacks are not standard [23].
3. Proper use of backpacks
When the backpack load is greater than the carrying capacity of the muscle teenage students, there is overhead, reflecting the spine, causing pain, structural changes or dysfunction [24] Special attention has been paid when the weight is more than 15% of their body mass. According to the Italian Backpack Study, in Italy students carry backpacks with 22% of their body weight, and 34.8% of them carry backpacks with weight corresponding to 30% of their body weight, at least once a week, exceeding even the proposed limits for adult also They found that when carrying backpack with a load of 15% of body weight major changes occurs in angles of the head, neck affect the posture [25].
Results of the second step:
The planning team drafted the performance goals based on theories of planned self-efficacy at the beginning of this phase according to the 3 individual outcomes of the program. Then, they got help from a three-person group including a health education specialist, an adolescent psychologist, and a health educator to evaluate the validity, and based on their views, the drafted performance goals were revised (Tables 1 and 2).
Table 1
Individual-level matrix the first behavioral consequence: Increasing teenage student’s information about backpacks
Performance Objective (PO)
|
Determinant 1
|
Determinant 2
|
Determinant 3
|
Awareness
|
Self-efficacy
|
Behavior barriers
|
Teenage students know and express tips about backpacks and proper use
|
Change objectives:
teenage students state the weight of standard backpack
Teenage students explain musculoskeletal symptoms related to heavy backpack carriage
|
Change objectives:
teenage students regularly plan to use the recommended about proper use of backpack
|
Change objectives:
teenage students’ express barriers to proper use of backpack
|
Individual-level matrix the Second behavioral outcome: Increasing teenage student’s information about All kinds of backpacks |
Table 2
Interpersonal level matrix Behavioral outcome: Positive family support
Performance Objective (PO)
|
Determinant 1
|
Determinant 2
|
Determinant 3
|
Awareness
|
Self-efficacy
|
Behavior barriers
|
Proper use of backpacks
|
Change objectives:
Teenage students show proper use of backpacks
Teenage students express proper use of backpacks
|
Change objectives:
Teenage students are sure can use their backpacks properly
|
Change objectives:
Teenage students name barriers use backpacks properly
|
Performance Objectives:
In order to specifically target the behavioral change among teenage students, the research team next identified performance objectives that would clarify the exact behavior performance expected of an individual affected by the intervention. In this case, they asked themselves what the target population exposed to the intervention must do in order to engage.
Determinants of musculoskeletal health:
Once the target behavior and performance objectives had been specified, the next step was to identify determinants, that is, the factors found to be associated with the performance of the behavior. The research team undertook a review of available evidence about determinants contributing to musculoskeletal health. knowledge, beliefs about capabilities (self-efficacy), environmental context and resources. was the most important determinants tables 1and 2 provides an example of the matrices of the performance objectives, which is to plan musculoskeletal health.
Results of step three:
In this step, the theoretical methods and practical applications for each determinant were defined with the participation of the planning team (Table 3). When examining various behavioral theories that addressed behavior barriers [44,45]. The third step in intervention mapping consists of determining which theories and theoretically based methods would be most effective in achieving the intervention’s performance objectives and then deciding which practical strategies would best operationalize those theoretical methods. Considering these theoretical determinants, it was decided that practical strategies, such as using workbook activities, work/note books to allow mothers or teenagers to specify a series of implementation how healthy behaviors about and encouraging the use of reminders and environmental cues to prompt healthy behaviors may be useful. Furthermore, the use of leaflets can be used to convey the costs and benefits of engaging in healthy behaviors. not engaging .
Table 3
Theoretical methods, practical applications, communication tools channels
Performance Objective (PO)
|
Determinant 1
|
Determinant 2
|
Awareness
|
Self-efficacy
|
Family members talk to teenage students about their safe backpack and all kinds of it
|
Change objectives:
Mothers are confident in their ability to communicate with Teenage students
|
Change objectives:
Mothers recognize that if they do not have a positive relationship with their teenage students, they prefer non-standard bags
|
Mothers support teenage students in maintaining a healthy diet
|
Change objectives:
Mothers are confident in their ability to support their teenage students to buy a beautiful ergonomic backpack
|
Change objectives:
Mothers are confident in their ability to support their Teenage students to buy a beautiful ergonomic backpack
|
Results of step four:
Step 4 of intervention mapping entails determining the scope and sequence of the intervention’s components and producing the materials for Intervention (27–28).
The programme development involved two groups of people including programme developers, health workers. The programme developers were recruited from the University of Medical Sciences on the basis of their expertise in curriculum development and experience in developing teenagers and Musculoskeletal health related programmes.
Health workers came from University of Medical Sciences and And the Department of Education or the school representative. These parties formed a programme development team that met on a regular basis to review progress on the programme development process until the programme was produced.
The programme comprised five lessons delivered in 5 sessions over 7 hours. The lessons were delivered in two modes. First, there were classroom sessions involving teacher and mothers group discussions, storytelling, role-plays, motion graphic and hand book.
Secondly, teenagers were given homework book (These books were prepared by experienced people) assignments to be accomplished at home with the help of mothers. Mothers were informed of the homework book assignments by letters that were sent through their children. The aim of homework book assignments was to foster The plan involved implementation objectives, methods and strategies.
The planning team involved researchers, teachers, students, and government officials from health and health workers. Prior to programme implementation, mothers and teachers were trained on the content and facilitation skills. Training activities included administration of pre-test and post-test assignments. These were aimed at measuring teachers’ knowledge about teenagers and Musculoskeletal health. The training programme was also used to pre-test the programme materials as well as teaching methods and strategies among mothers and teachers. Teachers were asked to comment on the attractiveness, completeness, suitability and relevance of the programme materials and methods to teenagers. A professional graphic designer was employed to draw illustrations to enhance the attractiveness and easy understanding of the teenagers. The students, for example, advised on the suitability of the learning materials, while teachers advised on the appropriate time and mode of programme implementation. The health workers played a key role. that they were relevant to social-cultural context of the implementation setting.
Results of Step Five:
it has been recommended that health promotion interventions should to provide a community-based intervention with regard to the universal intervention, it was decided to deliver the intervention through officials and health school health workers that already have regular contact with mothers and teenagers. In respect to the targeted programme delivered through parenting programmes, it was decided that the parenting programme facilitators would be best placed to deliver the intervention[26].
Results of the sixth stage:
Since one of the significant goals of evaluation is using evaluation results [27], at this stage, the planning team identified the evaluation stakeholders - such as planners, study participants, program managers and executives - to evaluate the effect of the program, designed questions based on outcomes, performance goals, and individual and environmental determinants (Table 4). In this study, 30 students were selected to participate in the study performance. Those included attended training sessions for 4 weeks once a week [27] (not more than 5% of participants should have been absent in each training session).
Table 4 Evaluation of outcome, effect, and program process (sample questions)
Evaluating program outcomes
|
Life quality
|
How much has the adherence to teenage student’s health behavior changed? (use proper backpack)
|
Personal level
|
Do the teenage students do more healthy behaviors (use proper backpack) after program implementation compared to before program implementation?
|
Interpersonal level
|
Do mothers have more verbal and nonverbal communication with their teenage students (about use proper backpack) after program implementation?
|
Assessment of the effect of program based on functional goals
|
Personal level
|
Do the teenage students adhere to health behaviors (use proper backpack) more after program implementation compared to before?
|
Interpersonal level
|
Do mothers support teenage students about ergonomic backpack training and shopping after implementing health behaviors more compared to before the implementation?
|
Assessment of the effect of change-based programs
|
Personal level
|
Do the teenage students state the significance of observing health behaviors (use proper backpack) after the program is implemented?
|
Interpersonal level
|
Do the mothers consider it important to have effective conversations after the implementation? (use proper backpack)
|
Determinant-based program effect assessment
|
Personal level
|
Awareness
|
Do teenage students report the disadvantages Non-ergonomic backpack after the program is implemented?
|
Self-efficacy
|
Do the teenage students feel more confident about adhering to healthier behaviors (use proper backpack) after the program compared to before?
|
Behavioral barriers
|
Do the teenage students develop an appropriate program to reduce the barriers to adhering to healthier behaviors (use proper backpack) than before after implementing the program?
|
Interpersonal level
|
Self-efficacy
|
Do the mothers express greater confidence in supporting their teenage students after the program has been implemented compared to before? (use proper backpack)
|
Assessment of program development process
|
Attainment
|
What proportion of the teenage student’s community participated in the program?
|
Accuracy
|
Is the educational curriculum done according to the protocol?
|
Organizing the program
|
Has the executive schedule been developed for the musculoskeletal health program
|
Program Index
|
Improving mothers' behavior by 30% over one period of program implementation
|
Improving the behavior of teenage students by 30% over one period of program implementation
|
Curriculum index: Individual and interpersonal performance change was determined. According to the studies conducted, the mothers and teenage student’s behavior improvement index was considered to be 30% over one period of program implementation [28]. Then, a measurement tool was designed to evaluate the outcomes, behaviors, and determinants of personal and interpersonal levels. The evaluation program was implemented three months later, and to examine the made changes, the experimental study design with randomly dividing the participants into intervention and control groups was used [27].