This study aimed to investigate the effect of education based on the health belief model on the physical activity of the staff of the University of Medical Sciences.
This semi-experimental study was conducted on 130 university staff aged 25-50 years from the Hamadan University of Medical Sciences. Inclusion criteria were having at least 1 year of work experience, lack of acute and chronic physical and mental illnesses, and not using drugs that affect physical activity. The samples were randomly divided into two groups. The experimental group received three training sessions based on the health belief model. Before and 2 months after training, the control and experimental groups were evaluated via the following questionnaires: (1) demographic information questionnaire, (2) Health Belief Model Questionnaire, and (3) International Physical Activity Questionnaire. Finally, data were analyzed statistically.
The training process resulted in a significant increase in the mean scores of the health belief model constructs in the experimental group, but changes in the control group were not significant. Self-efficacy was the strongest predictor of physical activity.
The health belief model is a useful model for improving individuals' understanding of the benefits of physical activity.
Physical activity is any movement produced following skeletal muscle contraction, which increases energy consumption relative to the basal state [
Physical movement is one of the most important behaviors that can affect the occurrence of diseases. Physical inactivity increases the risk of breast and colon cancers, hypertension, lipid disorders, osteoporosis, depression, and anxiety [
Despite the importance of adequate and regular physical activity, sedentary lifestyle is prevalent globally. According to worldwide statistics, >60% of adults do not have the amount of physical activity necessary for health [
Managers and employees are at high risk of inactivity and various diseases resulting from the uniformity of their work. Overweight and obesity are common and problematic side effects of desk jobs, and ignoring it will increase the susceptibility to various diseases. Therefore, educating people rightly and informing them are key to a healthy life [
This semi-experimental study (pretest, posttest) was carried out on 130 teaching staff at Hamadan University of Medical Sciences from February 2018 to February 2019. The inclusion criteria of the study were as follows: (1) have at least 1 year of work experience, (2) lack of acute and chronic physical and mental illnesses, (3) aged 25-50 years, (4) not using drugs that affect physical activity, (5) have sufficient opportunity to participate in the educational course, and (6) no previous experience of training related to the subject of the present study during the past year. Those who were absent for more than one training session and those who were not satisfied with the study were excluded. People who missed more than one training session and those who did not consent to participate in the study were excluded. The samples were selected using a convenience sampling method from different faculties. Samples were divided into experimental and control groups using a block randomization method with a block size of 4. Values of
Data were collected using a three-part tool: (1) demographic information questionnaire, (2) HBM Questionnaire, and (3) International Physical Activity Questionnaire (IPAQ). The demographic information questionnaire included questions about age, sex, marital status, education level, family income level, tobacco use, transportation to work, professional sports s location, height, weight, and body mass index. The HBM Questionnaire consisted of 47 questions with six major constructs: (1) perceived susceptibility (6 questions), (2) perceived severity (6 questions), (3) perceived benefits (11 questions), (4) perceived barriers (8 questions), (5) perceived self-efficacy (6 questions), and (6) cues to action (6 questions). The questions were answered on a five-choice Likert scale (ranging from very high to very low). In all questions (with the exception of perceived barriers), very high responses were given a score of 5, and a very low response was given a score of 1. In perceived barriers questions, very high response was given a score of 1, and very low response was given a score of 5.
The HBM Questionnaire was given to 10 science committee members of nursing and midwifery faculty with sufficient expertise and experience to assess the validity of the questionnaire (content validity index [CVI], content validity index [CVR]). After the validity assessment, questions with CVI and CVR less than the limit were corrected, modified, or removed. The reliability of the questionnaire in a pilot study of 10 university staff was calculated using Cronbach’s alpha. Cronbach’s alpha for the entire questionnaire was 0.767. Cronbach’s alpha values for the dimensions of perceived susceptibility, perceived severity, perceived benefits, perceived barriers, perceived self-efficacy, and practice guidelines were 0.810, 0.752, 0.742, 0.779, 0.704, and 924, respectively.
The IPAQ measures an individual’s overall physical activity over the past 7 days in terms of vigorous, moderate, walking, and sitting activities. The validity and reliability of the IPAQ have been assessed and confirmed in previous studies [
After providing the necessary explanations to the participants, the questionnaires were distributed among the experimental and control groups, and they were given enough time to respond to the questions. After the pretest phase, a training course based on the HBM was implemented for the experimental group. The experimental group was divided into six groups of 11 each, and three training sessions were held for each group. The training sessions were conducted by the first author (PhD in nursing). The duration of each training session was 90 min with a 10-min interlude. The training session was held weekly. In the last training session, an educational booklet was provided to the intervention group. The booklet content was approved by several science committee members of the faculty of nursing and midwifery. Two months after the last training session, a posttest was performed by redistributing the questionnaires.
Data were analyzed using SPSS software (version 22). The mean and standard deviation were used for quantitative data description, and frequency and percentage were used for quantitative data description. Data analysis was performed using chi-square, paired t-test, Wilcoxon signed-rank test, independent
Prior to starting the study, all participants received written informed consent and were assured that all their information would remain confidential. People were given the option to withdraw at any stage of the study. The questionnaires were anonymous. The researcher pledged that the results of this research would not be reported individually. The control group was also given a prepared educational booklet at the end of the study. This study was approved by the research ethics committee of Hamadan University of Medical Sciences (approval code: IR.UMSHA.REC. 1396.815).
The subjects included 56 men (43.08%) and 74 women (56.92%) with a mean age of 39.93 ± 8.74 years. The results of statistical tests (
Perceived susceptibility, perceived severity, perceived benefits, perceived barriers, perceived self-efficacy, and cues to action were compared between the control and experimental groups before and after the educational intervention (
In
In this study, the effect of HBM-based education on the physical activity of university staff was evaluated. The two groups were matched for all demographic variables. Therefore, the observed differences in outcome variables can be attributed to the direct effect of education. The findings of this study showed an increase in the level of perceived susceptibility in the experimental group, unlike that in the control group, after the training course. The improvement of perceived susceptibility in the experimental group means that the experimental group felt more at risk of disease than that in the control group after training. This can be attributed to increased staff information on susceptibility to diseases. However, our study did not measure the awareness level of staff before and after the educational intervention, which is consistent with the findings of Deleted [
In the present study, training significantly increased the mean scores of perceived severity in the experimental group, but the perceived severity scores of the control group did not change significantly. These findings indicate that the experimental group had a greater understanding of the inactivity consequences than that in the control group. This finding is in line with those of other studies [
In the present study, perceived benefits and barriers scores showed a significant increase in the experimental group after training, whereas in the control group, it did not change significantly. The study results of Romano et al. and Oiji et al. [
The findings of our study showed a significant increase in self-efficacy in the experimental group after training, but this change was not observed in the control group. Additionally, self-efficacy was identified as the most important predictor of physical activity in our study. In Moschny et al” self-efficacy served as a predictor of physical activity behavior in older adults [
In our study, the mean score of cues to action in the experimental group increased significantly after training compared to that pre-training, whereas no significant change was observed in the control group. This finding is in line with the results of Gristwood et al. and Kim et al. [
In the present study, training improved the physical activity performance of the experimental group. However, this increase was not significant, which may be due to the high dispersion of data. The level of physical activity in the control group slightly decreased. However, in this study, a self-report method was used to measure the physical activity of staff which seems to be associated with some errors. This finding was observed in similar studies, such as those by James et al. [
The limitations of this study include a short follow-up time, difficulty in measuring physical activity due to the use of self-report methods, and lack of evaluation of participants' awareness.
The training-based HBM model led to an improvement in the scores of perceived susceptibility, perceived severity, perceived benefits, perceived barriers, perceived self-efficacy, cues to action, and physical activity levels among the staff of Hamadan University of Medical Sciences. Self-efficacy constructs were also identified as strong predictors of physical activity. It is suggested that long-term follow-up should be performed in future studies. In addition, a method is used to measure the physical activity levels with more reliability. It is ako recommended to use more sample volumes in future studies. Comparative studies are ako recommended to compare the efficacy of the HBM with other models in increasing physical activity.
health belief model
International PhysicalActivity Questionnaire
content validity index
content validity ratio
Statistical Package forthe Social Sciences
This study was extracted from a research project at Hamadan University of Medical Sciences. The authors thank the Vice-Chancellor for Research and Technology of Hamadan University of Medical Sciences for the financial and administrative support. This study was supported by Hamadan University of Medical Sciences. The study was conducted after receiving an ethics code (no. IR.UMSHA. REC.1396.815) by the Research Ethics Committee of Hamadan University of Medical Sciences. Additionally, the participants were ensured ofinformation confidentiality, and written consent was obtained for their participation in the study.
Comparison of qualitative demographic variables between the control and intervention groups.
Variables | Groups | Chi-squre test results | ||
---|---|---|---|---|
Frequency (%) | ||||
Control | Experimental | |||
Sex | Male | 27(41.5) | 29 (44.6) | P = 0.733 |
Female | 38 (58.5) | 36 (55.4) | ||
Education level | Under the diploma | 0(010) | 0(0.0) | P = 0.715 |
Diploma | 16 (24.6) | 18 (27.7) | ||
Associate degree | 11 (16.9) | 10 (15.4) | ||
Undergraduate | 18 (27.7) | 21 (32.3) | ||
Master’s degree | 20 (30.8) | 15 (23.1) | ||
Doctorate | 0(0.0) | 1 (1.5) | ||
Marital status | Single | 12 (18.5) | 10 (15.4) | P = 0.528 |
Married | 52 (80.0) | 54 (83.1) | ||
Divorced | 0(0.0) | 1 (1.5) | ||
Deceased partner | 1 (1.5) | 0(010) | ||
Family income level | <10 million rials | 0(0.0) | 1 (1.5) | P = 0.513 |
10-20 million rials | 29 (44.6) | 30 (46.2) | ||
>20 million rials | 22 (33.8) | 25 (38.5) | ||
Unwillingness to respond | 14 (21.5) | 9 (13.8) | ||
Tobacco using | Cigarette | 3 (4.6) | 1 (1.5) | P = 0.093 |
Hookah | 4 (6.2) | 0(010) | ||
Others | 1 (1.5) | 0(010) | ||
None | 57 (87.7) | 64 (98.5) | ||
Transportation to work | Private vehicles | 40 (61.5) | 38 (58.5) | P = 0.823 |
Public transportation | 14 (21.5) | 17 (26.2) | ||
None | 11 (16.9) | 10 (15.4) | ||
Professional sports history | Yes | 31 (47.7) | 24 (36.9) | P = 0.287 |
No | 34 (52.3) | 41 (63.1) | ||
Living location | City | 51 (78.5) | 53 (81.5) | P = 0.716 |
Village | 2 (3.1) | 3 (4.6) | ||
The surrounding settlements | 12(18.5) | 9(13.8) |
Comparison of quantitative demographic variables between the control and intervention groups.
Variables | Groups | Statistical test results | |
---|---|---|---|
Mean ± standard deviation | |||
Control | Experimental | ||
Age (year) | 40.72 ± 9.36 | 39.14 ± 8.06 | Mann-Whitney U |
P = 0.303 | |||
Height (cm) | 169.98 ± 7.14 | 168.35 ± 7.56 | Mann-Whitney U |
P = 0.231 | |||
Weight (kg) | 74.03 ± 11.12 | 70.92 ± 74.03 | Independent samples T |
P = 0.101 | |||
BMI (kg/m2) | 25.61 ± 3.52 | 24.97 ± 3.02 | Independent samples T |
P = 0.303 |
Comparison of dimensions of the health belief model between the control and intervention groups before and after training.
Groups | Before training | After training | Statistical test results |
---|---|---|---|
Mean ± standard deviation | |||
Control | 17.78 ± 5.10 | 18.33 ± 4.72 | |
Experimental | 17.43 ± 4.59 | 22.43 ± 3.53 | |
Statistical test results | |||
Mean ± standard deviation | |||
Control | 19.47 ± 5.22 | 19.93 ± 5.07 | |
Experimental | 19.87 ± 4.91 | 22.26 ± 4.33 | |
Statistical test results | |||
Mean ± standard deviation | |||
Control | 42.44 ± 8.02 | 41.87 ± 7.73 | |
Experimental | 43.92 ± 8.93 | 48.64 ± 5.27 | |
Statistical test results | |||
Mean ± standard deviation | |||
Control | 29.49 ± 7.15 | 29.09 ± 5.99 | |
Experimental | 27.66 ± 6.02 | 31.64 ± 7.00 | |
Statistical test results | |||
Mean ± standard deviation | |||
Control | 28.64 ± 9.37 | 29.01 ± 8.20 | |
Experimental | 36.26 ± 7.12 | 28.29 ± 6.65 | |
Statistical test results | |||
Mean ± standard deviation | |||
Control | 17.67 ± 4.43 | 19.04 ± 4.95 | |
Experimental | 18.13 ± 4.96 | 21.49 ± 3.65 | |
Statistical test results |
Paired samples f-test,
Wilcoxon signed-rank test,
independent samples Mest,
Mann-Whitney U-test.
Comparison of physical activity between the control and intervention groups before and after training.
Groups | Physical activity | Statistical test results | |
---|---|---|---|
Mean ± standard deviation | |||
Before training | After training | ||
Control | 3,648.30 ± 4,760.72 | 3,625.69 ±3,941.87 | P = 0.977 |
Experimental | 2,679.47 ± 2,995.59 | 3,943.15 ±5,567.34 | P = 0.333 |
Statistical test results | P = 0.172 | P = 0.297 |
Prediction of physical activity using health belief model constructs.
Independent variables | Unstandardized coefficients | Standardized coefficients | t | P-value | |
---|---|---|---|---|---|
B | Standard error | Beta | |||
Constant | -805.37 | 3,249.56 | - | -0.24 | 0.805 |
Perceived Susceptibility | -0.55 | 104.74 | -0.54 | -0.53 | 0.594 |
Perceived severity | 119.80 | 90.96 | 0.12 | 1.31 | 0.190 |
Perceived benefits | -53.15 | 70.95 | -0.08 | -0.74 | 0.455 |
Perceived barriers | -119.21 | 67.96 | 0.16 | 1.75 | 0.082 |
Perceived self -efficacy | -170.37 | 68.13 | 0.30 | 2.50 | 0.014 |
Cues to action | -182.38 | 115.25 | -0.17 | -1.58 | 0.116 |