An educational intervention was applied in this randomized controlled trial. The Ethics Committee of Arak University of Medical Sciences (ethics code: 93-169-4) and Ethic Committee of Babol County approved the study protocol.
To determine the effect of education based on the health belief model on promoting preventive behaviors from child iron deficiency anemia in mothers with children aged one to six years.
- To compare the mean score of knowledge about preventive behaviors from iron deficiency anemia, after educational intervention in the intervention and control group.
- To compare the mean score of perceived susceptibility , perceived severity, perceived benefits, perceived barriers and perceived self-efficacy regarding iron deficiency anemia, before and after intervention in the intervention and control group.
- To compare the average performance score for behaviors that prevent iron deficiency anemia, after educational intervention in the Intervention and control group
- To compare the mean score of cues to action on preventive behaviors from iron deficiency anemia, after educational intervention in the intervention and control group
Sample size estimation
The sample size was calculated 132 mothers (66 in the intervention group and 66 in the control group) with regards to a similar previous study (17), standard deviation of 25.33, mean difference of 15, confidence interval of 95%, statistical power of 90%, and attrition of 10%. Finally, the data of 59 intervention and 60 controls were analyzed. Multi-stage random sampling was applied to select the participants. All rural health centers of Babol were considered as strata. In each region, one rural health center, and in each rural health center, two rural health houses were randomly selected. One health house was used as the intervention center and the other was used as the control center. In total, four health houses were used as intervention centers and four were used as control centers. Seventeen children were randomly selected in each health house using the infant care register and their mothers were contacted. The objectives of the study were explained to mothers and their informed consent was obtained if they agreed to participate in the study. The inclusion criteria were having a 1-6 year-old child, being selected in random sampling, and no history of anemia or other related diseases like Gastero Intestinal diseases in the child according to medical records and mother’s statement and mothers with literate at least for reading and writing skills.
The exclusion criteria were lack of interest in participation in the study, loss of motivation during the study, and missing more than one educational session. First, the participants were randomly assigned to the intervention and control groups (each group included 66 participants). Then, the level of knowledged , perceived susceptibility, perceived severity, perceived benefits, perceived barriers, cues to action, behavior, and self-efficacy regarding IDA preventive behaviors was assessed in both groups using a pretest questionnaire.
The data collection tool before and after the intervention was a researcher-made questionnaire containing demographic data and an IDA questionnaire according to the HBM. This questionnaire contained 16 questions on knowledge. Moreover, perceived susceptibility (7 questions), perceived severity (4 questions), perceived benefits (7 questions), perceived barriers (9 questions), perceived self-efficacy (6 questions), external and internal cues to action (10 questions), and performance of the mothers regarding IDA preventive behaviors in their 1-6 year-old children were assessed using a checklist (20 questions) with a 5-point Likert scale. As for scoring, in the awareness section, a correct answer scored one and a wrong answer scored zero, and the total score of this section was calculated out of 100 through dividing the number of correct answer by the total number of questions multiplied by 100. For perceived susceptibility, severity, benefits, and barriers, the score of each question ranged from 1 to 5 (I completely disagree= 1, I disagree=2, I have no idea=3, I agree=4, I completely agree=5). The score of these sections was also calculated out of 100. In the performance section, a correct behavior scored one and a wrong behavior scored zero. The score of this section was also calculated out of 100.
The content validity of the instrument was evaluated and confirmed by experts. To assess the reliability of the questionnaire, it was administered to 30 mothers of children aged 1-6 years who were demographically similar to the study population. The Cronbach’s alpha of awareness, perceived susceptibility, perceived severity, perceived benefits, perceived barriers, perceived self-efficacy, cues to action, and performance was 0.62, 0.69, 0.80, 0.9, 0.83, 0.72, 0.73, and 0.74, respectively. The Cronbach’s alpha of the instrument was 0.85.
The educational intervention was performed in the intervention group (based on the pretest results as an educational needs assessment) after determining knowledge and other components of the HBM and preparing the educational content accordingly. The educational intervention was presented in four educational sessions, each lasting 40 minutes, using lecture, group discussion, and Role playing. Moreover, the pamphlets, booklets, and video CDs were used for a more effective content delivery. Finally, three months after the educational intervention, the same questionnaire was used in both groups for pretest.
in the first session that was designed to promote knowledge of mothers ,they became familiar with IDA and its signs and symptoms as well as the causes and preventive factors. In the second session, the participants were provided with HBM-based education to enhance their perceived susceptibility and severity regarding IDA in order to improve the mothers’ attitude towards the complications, causes, and preventive factors of this disease in their children. In the third session, the researcher discussed the benefits and barriers of IDA preventive behaviors in children and tried to underline the perceived benefits (to downplay the barriers). The fourth session was spent on perceived self-efficacy, cues to action, empowering of mothers regarding IDA preventive behaviors in their children, familiarizing mothers with different information sources about IDA preventive behaviors, and enhancing their performance using internal and external cues to action. Since acquiring information from “health centers staff” received the highest score in cues to action on the pretest, education was provided by the researcher as a health care provider in the health house, or upon agreement of mothers, in a nearby large mosque. In these sessions, PowerPoint slides, pamphlets, booklets, and videos were employed to achieve educational objectives (cognitive, emotional, and psychological).(figure 1)
Data analyses were performed using IBM SPSS Statistics for Windows, Version 20 through descriptive and inferential statistics (including independent t-test, paired t-test, Chi-square). The significance level was considered at 0.05. To investigate the normality of the data, Histogram, Q-Q plot and Kolmogorov-Smirnov test was used and normal distribution of the data was obtained.
The Ethics Committee of Arak University of Medical Sciences (ethics code: 93-169-4) and Ethic Committee of Babol County approved the study protocol. This trial has been registered at IRCT, IRCT2014082118892N1.Written informed consent was obtained from all the participants.educational material was shared with the control group at the end of the study.