Volume 33, Issue 128 (February 2021)                   IJN 2021, 33(128): 15-26 | Back to browse issues page

XML Persian Abstract Print

Download citation:
BibTeX | RIS | EndNote | Medlars | ProCite | Reference Manager | RefWorks
Send citation to:

Salehi T, Maroufi Z, Haghani S. Impact of Education Based on the Health Belief Model on the Nutritional Knowledge and Performance of Female Health Ambassadors. IJN 2021; 33 (128) :15-26
URL: http://ijn.iums.ac.ir/article-1-3328-en.html
1- Department of Nursing Management, School of Nursing and Midwifery, Iran University of Medical Sciences, Tehran, Iran
2- Community Education in the Health System, School of Nursing and Midwifery, Iran University of Medical Sciences, Tehran, Iran (Corresponding authors) Tel: 09188740200 Email: maroufi.z@tak.iums.ac.ir
3- Biostatistics, Nursing Care Research Center, Iran University of Medical Sciences, Tehran, Iran
Abstract:   (2718 Views)
Background & Aims: The nutrition of every individual is closely correlated with their physical and mental health. Adequate consumption of nutrients maintains health and increases efficiency, while improper nutrition leads to physical and mental complications. Foodborne illnesses constitute a very large group of diseases in the world and are considered to be a major health concern in different countries. Improper nutrition is an inherent element of an unhealthy lifestyle, as well as an important cause of this issue. Improper nutrition leads to the further progression of chronic diseases, such as type II diabetes, cardiovascular diseases, and cancers, which cost billions of dollars in medical care and reduce annual production. Malnutrition and obesity are among the major causes and contributing factors to mortality. Studies of the dietary patterns of Iranians have indicated significant deficiencies in the daily food consumption of various social groups. Furthermore, a national health survey has shown that Iranians consume more saturated fatty acids and energy than the recommended amount. Changing health behaviors is the greatest hope for reducing the burden of disease and mortality worldwide. The importance of women's nutritional health as part of the society and mothers and their impact on maintaining the health of other family members make them a suitable target group to improve nutritional behavior. Women constitute about half of the world's population, and their health guarantees community health and is of particular importance. With the implementation of the comprehensive program of health ambassadors in the urban and rural health centers in Iran, women were considered as the main educators of the family. The majority of health ambassadors are women, who are often selected from among the covered families by various healthcare units. Female health ambassadors are the housewives or employed women who help improve community health by receiving education and passing it on to other family members and the population under their care. Studies have indicated that using the patterns and theories of behavior change could increase the likelihood of the higher impact of health education programs by considering the individual and environmental characteristics that influence behaviors. Researchers have used multiple models for behavioral change, with the training primarily based on an educational model, so that the initiation and continuity of the training would be more effective. The health belief model is an effective model to provide education on various aspects of health, including nutritional behaviors. It is a waiting value model that emphasizes decision balance. The present study aimed to evaluate the effect of nutrition education based on the health belief model on the nutrition knowledge and performance of female health ambassadors.
Materials & Methods: This study was conducted as an evaluation research with effect analysis and a pretest-posttest design on the female health ambassadors of the health centers of Saqez, Iran in 2019. In total, 48 subjects were selected via simple random sampling using a random numbers table. Sampling started on November 5, 2019 and ended on December 12, 2019. A written training program in the field of nutrition based on the health belief model was implemented in three sessions (120 minutes each). Data were collected using the structured questionnaire of the Iranian Ministry of Health and Medical Education, which was designed in 2011 in collaboration with Tehran University of Medical Sciences (NUTRI-KAP). The questionnaire was completed by the participants before the training intervention and one month after the training in three sections containing questions on demographic characteristics (age, education level, marital status, occupation status, number of family members, and history of working as a health ambassador), nutrition knowledge, and nutrition performance regarding the basic principles of nutrition, food groups, nutrient sources, and nutritional needs at different stages of life. The reliability of the tool was measured using the retest method. For this purpose, the tool was completed by 18 individuals with the same characteristics as the research community (not among the research samples) and re-completed by the same individuals two weeks later. Based on these data, the reliability of the tool was calculated using the Kuder-Richardson formulas. The reliability for knowledge was estimated at 83% and 97% for performance, which indicated the acceptable reliability coefficient. The validity of the educational content was also examined by three faculty members of the School of Nursing and Midwifery, and corrections were made based on their opinions. In terms of ethical considerations, the required permit was obtained from the Ethics Committee of Iran University of Medical Sciences, and the necessary coordination was also made with Kurdistan University of Medical Sciences. The research process was explained to the participants, and they were morally informed that participating in the research was voluntary. In addition, the female health ambassadors were assured of the confidentiality of their personal information. After completing the training sessions and data collection, data analysis was performed in SPSS version 16 using descriptive and inferential statistics. With regard to the descriptive statistics, frequency distribution tables were used for the qualitative variables, and the numerical indices of minimum, maximum, mean, and standard deviation were used for the quantitative variables. As for the inferential statistics, paired t-test was used, and the P-value of less than 0.05 was considered significant in all the statistical analyses.
Results: Before the intervention, the mean score of the nutrition knowledge and performance of the participants was 18.39 ± 4.38 and 8.81 ± 1.87, respectively, which reached 24.70 ± 4.41 and 12.27 ± 2.67, respectively after the intervention. A significant difference was observed before and after the intervention in terms of knowledge (effect size: 1.43; P<0.001) and performance (effect size: 1.52; P<0.001). Moreover, the normality of the research variables was confirmed based on skewness and kurtosis.  
Conclusion: According to the results, the nutrition knowledge and performance of the female health ambassadors improved after the educational intervention based on the pattern of the health belief model, and the effects would persist even after the training. Given the efficiency, cost-effectiveness, and efficacy of this model, it could be used as a framework for nutrition educational programs alongside other educational methods in every healthcare center. It is also recommended that educational programs based on this model be developed and implemented for female health ambassadors on a larger scale, and model- and theory-based educational interventions are also suggested for this group, particularly training based on the health belief pattern.  
Full-Text [PDF 1057 kb]   (867 Downloads)    
Type of Study: Research | Subject: nursing
Received: 2020/11/4 | Accepted: 2021/02/3 | Published: 2021/02/3

1. Ivari TK, Heshmati H, Faryabi R, Goudarzian Z, Ghodrati A, Najafi F, Alizadeh H. Effect of health belief model based education on nutritional behaviors of pregnant women referred to health centers in Torbat-e-heydariyeh City. J Health Field. 2016;3(4):23-31.
2. Nemati A, Abbasgolizadeh N, Rahimi K. Nutritional knowledge and patterns of women in Ardabil Province. Journal of Health. 2011;2(3):33-9.
3. Adams KM, Butsch WS, Kohlmeier M. The state of nutrition education at US medical schools. J Biomed Educ. 2015;2015(Article ID 357627):1-7. [DOI:10.1155/2015/357627]
4. Galligan l. Malnutrition and obesity are 'unacceptably high' around the world, costing the world trillions each year: Global Nutrition Report. 2018.
5. Sutliffe JT, Gardner JC, Gorman MM, Carnot MJ, Wetzel WS, Fortin T, Sutliffe CA, Adams A. Impact of a 6-month micronutrient-dense plant-rich nutrition intervention on health and well-being at the worksite. J Nutrit Metab. 2019 Apr 30;2019. [DOI:10.1155/2019/2609516] [PMID] [PMCID]
6. Tavakoli HR, Dini-Talatappeh H, Rahmati-Najarkolaei F, Fesharaki MG. Efficacy of HBM-based dietary education intervention on knowledge, attitude, and behavior in medical students. Iranian Red Crescent Medical Journal. 2016;18(11). [DOI:10.5812/ircmj.23584] [PMID] [PMCID]
7. Verstraeten R, Van Royen K, Ochoa-Avilés A, Penafiel D, Holdsworth M, Donoso S, Maes L, Kolsteren P. A conceptual framework for healthy eating behavior in Ecuadorian adolescents: a qualitative study. PloS one. 2014;9(1):e87183. [DOI:10.1371/journal.pone.0087183] [PMID] [PMCID]
8. Ahadi Z, Heshmat R, Sanaei M, Shafiee G, Ghaderpanahi M, Homami MR, Salehi F, Abdollahi Z, Azemati B, Larijani B. Knowledge, attitude and practice of urban and rural households towards principles of nutrition in Iran: results of NUTRIKAP survey. Journal of diabetes & metabolic disorders. 2014;13(1):1-7. [DOI:10.1186/s40200-014-0100-7] [PMID] [PMCID]
9. Heshmat R, Abdollahi Z, Salehi A. Country Report on Knowledge, Attitudes and Practices of Urban and Rural Households and Different Health Nursing Staff. 2015.
10. Glanz K, Rimer BK, Viswanath K, editors. Health behavior and health education: theory, research, and practice. John Wiley & Sons; 2008 Aug 28.
11. Cleland J. A critique of KAP studies and some suggestions for their improvement. Stud Fam Plan. 1973;4(2):42-7. [DOI:10.2307/1964829]
12. Kigaru DM, Loechl C, Moleah T, Macharia-Mutie CW, Ndungu ZW. Nutrition knowledge, attitude and practices among urban primary school children in Nairobi City, Kenya: a KAP study. BMC Nutrition. 2015;1(1):1-8. [DOI:10.1186/s40795-015-0040-8]
13. Ziaee R, Jalili Z, Tavakoli Ghouchani H. The effect of education based on Health Belief Model (HBM) in improving nutritional behaviors of pregnant women. Journal of North Khorasan University of Medical Sciences. 2017;8(3):427-37. [DOI:10.18869/acadpub.jnkums.8.3.427]
14. Fadakar SK, Ghavi A, Niknami M, Kazemnejad LE. Relationship between Mothers'nutritional Status and Weight Gain During Pregnancy with Low Birth Weight.. Journal of Guilan university of medical Sciences. 2012;21(83):27-35.
15. Rejeski WJ, Fanning J. Models and theories of health behavior and clinical interventions in aging: a contemporary, integrative approach. Clin Interven Aging. 2019;14:1007. [DOI:10.2147/CIA.S206974] [PMID] [PMCID]
16. Sparks PJ. Rural health disparities. InInternational handbook of rural demography 2012 : 255-71. [DOI:10.1007/978-94-007-1842-5_18]
17. Khumros W, Vorayingyong A, Suppapitiporn S, Rattananupong T, Lohsoonthorn V. Effectiveness of modified health belief model-based intervention to reduce body mass index for age in overweight junior high school students in Thailand. J Health Res. 2019 Mar 11. [DOI:10.1108/JHR-08-2018-0065]
18. Green EC, Murphy EM, Gryboski K. The Health Belief Model. The Wiley Encyclopedia of Health Psychology. 2020 2:211-4. [DOI:10.1002/9781119057840.ch68] [PMID] [PMCID]
19. Mohammadi N, Hooshian M, Omidi A, Soltanian A. The effect of health belief model education on nutrition behavior of boys in secondary schools in Hamadan. Avicenna Journal of Nursing and Midwifery Care. 2019;26(6):397-406. [DOI:10.30699/sjhnmf.26.6.397]
20. Zareipour M, Jadgal MS, Movahed E. Health ambassadors role in self-care during COVID-19 in Iran. Journal Mil Med. 2020;22(6):672-4.
21. Fatehi F, Salem Z, Shikh Fatholahi M, Khalili P. Study on Nutritional Knowledge, Attitude and Practice of Health Care Workers in Rafsanjan University of Medical Sciences in 2016. Community Health Journal. 2017;11(1):49-58.
22. Rafieyfar S, Soleimanian A, Sarbandi F, Mines A, Javadi A, Nasiri A. Executive Order of Health Education and Promotion Program. Ramin: Statue; 2015.
23. Azemati B, Heshmat R, Sanaei M, Salehi F, Sadeghi F, Ghaderpanahi M, Mirarefin M, Abdollahi Z, Hemami MR, Larijani B. Nutritional knowledge, attitude and practice of Iranian households and primary health care staff: NUTRIKAP Survey. Journal of Diabetes & Metabolic Disorders. 2013;12(1):1-4. [DOI:10.1186/2251-6581-12-12] [PMID] [PMCID]
24. Diddana TZ, Kelkay GN, Dola AN, Sadore AA. Effect of nutrition education based on health belief model on nutritional knowledge and dietary practice of pregnant women in Dessie Town, Northeast Ethiopia: A cluster randomized control trial. J Nutrit Metab. 2018 21;2018. [DOI:10.1155/2018/6731815] [PMID] [PMCID]
25. Tariku B, Whiting SJ, Mulualem D, Singh P. Application of the health belief model to teach complementary feeding messages in Ethiopia. Ecology of food and nutrition. 2015;54(5):572-82. [DOI:10.1080/03670244.2015.1049344] [PMID]
26. Choi JH, Lee ES, Lee YJ, Lee HS, Chang HJ, Lee KE, Yi NY, Ahn Y, Kwak TK. Food safety and nutrition education program for elderly and assessment of program effectiveness based on health belief model. J Korean Society f Food Sci Nutrition. 2016;45(9):1366-74. [DOI:10.3746/jkfn.2016.45.9.1366]
27. Mirzaei H, Shojaeizadeh D, Tol A, Shirzad M. Application of Health Belief Model (HBM) to promote preventive behaviors against iron-deficiency anemia among female students of High School Fereydan City: A quasi-experimental study. Iranian Journal of Health Education and Health Promotion. 2017;5(4):260-9. [DOI:10.30699/acadpub.ijhehp.5.4.260]
28. AlizadehS H, Keshavarz M, Jafari A, Ramezani H, Sayadi A. Effects of nutritional education on knowledge and behaviors of Primary Students in Torbat-e-Heydariyeh. Journal of Torbat Heydariyeh University of Medical Sciences. 2013;1(1):44-51.
29. Mulualem D, Henry CJ, Berhanu G, Whiting SJ. The effectiveness of nutrition education: Applying the Health Belief Model in child-feeding practices to use pulses for complementary feeding in Southern Ethiopia. Ecology of food and nutrition. 2016;55(3):308-23. [DOI:10.1080/03670244.2016.1161617] [PMID]
30. Davari S, Dolatian M, Maracy MR, Sharifirad G, Safavi SM. The Effect of A Health Belief Model (HBM)-based Educational Program on the Nutritional Behavior of Menopausal Women in Isfahan. Iranian Journal of Medical Education. 2011;10(5):1263-72.

Add your comments about this article : Your username or Email:

Rights and permissions
Creative Commons License This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

© 2015 All Rights Reserved | Iran Journal of Nursing

Designed & Developed by : Yektaweb