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Journal of Social Service Research

ISSN: 0148-8376 (Print) 1540-7314 (Online) Journal homepage: https://www.tandfonline.com/loi/wssr20

Health Education Intervention on HIV/AIDS Prevention Behaviors among Health Volunteers in Healthcare Centers: An Applying the Theory of Planned Behavior

Hadi Alizadeh Siuki, Nooshin Peyman, Mohammad Vahedian-Shahroodi, Mahdi Gholian-Aval & Hadi Tehrani

To cite this article: Hadi Alizadeh Siuki, Nooshin Peyman, Mohammad Vahedian-Shahroodi, Mahdi Gholian-Aval & Hadi Tehrani (2019) Health Education Intervention on HIV/AIDS Prevention Behaviors among Health Volunteers in Healthcare Centers: An Applying the Theory of Planned Behavior, Journal of Social Service Research, 45:4, 582-588, DOI: 10.1080/01488376.2018.1481177

To link to this article: https://doi.org/10.1080/01488376.2018.1481177

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Health Education Intervention on HIV/AIDS Prevention Behaviors among Health Volunteers in Healthcare Centers: An Applying the Theory of Planned Behavior

Hadi Alizadeh Siukia , Nooshin Peymanb , Mohammad Vahedian-Shahroodib , Mahdi Gholian-Avalb, and Hadi Tehranib

aDepartment of Health Education and Health Promotion, School of Health, Mashhad University of Medical Sciences, Mashhad, Iran; bDepartment of Health Education and Health Promotion, Social Determinants of Health Research Center, Mashhad University of Medical Sciences, Mashhad, Iran

ABSTRACT Present study aims to investigate the impact of health education intervention on improving HIV/AIDS preventive behaviors among Health volunteers in Torbat-e Heydarieh Iran. 120 Health volunteers were involved in this quasi-experimental study (60 participants in inter- vention group and 60 participants in control group). Data collection tool was a question- naire based on theory of planned behavior along with demographic questions which was applied before and 2 month after intervention. Data analysis was conducted using SPSS16 with descriptive analysis, and analytical tests (independent t-test, correlation coefficient) were conducted at 5% significance level. The findings of the study showed no significant difference between two groups in terms of mean scores of knowledge, attitude, perform- ance, behavioral intention, and behavioral control before intervention (p > 0.05). But a sig- nificant difference was observed between two groups after the health education intervention (p < 0.05). Health education intervention based on theory of planned behavior, regarding AIDS disease preventive behavior, significantly affects Health volunteers. Therefore, according to behavior theory, such educations lead to positive changes in AIDS preventive behaviors.

KEYWORDS Health behavior; education; health volunteers; AIDS

Introduction

The main cause of AIDS (acquired immune defi- ciency syndrome) is a retrovirus that when enters into body attacks to the T Helper cells which play a key role in defense system of the body, disables immune system cells, and increasingly disrupts body defense against diseases. Incubation period of the disease is long and may take 5–10 years or more, or HIV infection may remain a lifelong (Morlat et al., 2014). AIDS is a health, social, and psychological crisis that not only affects adults but also children and adolescents (Kelly & Lawrence, 2013), so that it can be said that currently AIDS is the problem of young peo- ple that 85 percent of them live in developing countries (Atwine, Cantor-Graae, & Bajunirwe, 2005). On the other hand, 50 percent of new cases infected with the virus happen in people

aged 10–24 years old (Joint United Nations Programme on HIV/AIDS, & World Health Organization, 2007). According to WHO 7.000 individuals per day, i.e., 5 young people per minute get infected with this virus (UNICEF, Joint United Nations Programme on HIV/AIDS, & World Health Organization, 2002).

Different statistics show that approximately 39.5 million people are infected with this disease around the world and every year 2 million people die due to this disease (Heald, 2006). From 1999 to 2009, a growth of 27% has happened in the number of peo- ple with HIV infection (Mee et al., 2014). According to the latest statistics on HIV/ADIS in the Islamic Republic of Iran, published by the Ministry of Health, Treatment and Medical Education, from the beginning of the epidemic until April 2011, 22,727 individuals infected with

CONTACT Hadi Tehrani [email protected] Department of Health Education and Health Promotion, Social Determinants of Health Research Center, Mashhad University of Medical Sciences, 91778-99191 Mashhad, Iran. � 2018 Taylor & Francis Group, LLC

JOURNAL OF SOCIAL SERVICE RESEARCH 2019, VOL. 45, NO. 4, 582–588 https://doi.org/10.1080/01488376.2018.1481177

HIV are identified in the country, where 91.7 per- cent of them are men and 8.3 percent are women (Fallahzadeh, Morowatisharifabad, & Ehrampoosh, 2009). In Torbat-e Heydarieh, 4 cases are reported that 1 of them is male and three others are female. The first case was reported in 2010 and one of the cases has led to death (Fallahzadeh et al., 2009). Currently, a large num- ber of health volunteers around the Iran’s country cooperate with healthcare centers and after pass- ing training courses, convey the acquired infor- mation to the covered household and attempt to realize healthcare objectives as well as providing other services such as case-finding, health educa- tion, patient care, raising awareness, and provid- ing public health services (Eslami, Marzban, & Mazloomy, 2016).

Theory of planned behavior is one of the healthcare theories which is considered the best and most perfect theory to study behavior (Vafaeenajar et al., 2015). This theory was presented in 1988 by Ajzen and through develop- ment of reasoned action theory (Ajzen & Madden, 1986). The structures of the model include: behavior_intention of behavior_attitude toward behavior_control of perceived behavior_ subjective norm (Gebreeyesus Hadera, Boer, & Kuiper, 2007). In present study, using theory of planned behavior as theoretical framework of the study, a training program will be developed and implemented to improve the awareness and attitude of health contact persons toward AIDS and its preventive methods. According to some studies, training based on theory of planned behavior helps to the creation of the required skills to postpone the suggestions of high risk behaviors regarding AIDS and leads to training and attitude improvement through peers and consequently leads to attitudes and awareness reinforcement (Armitage & Conner, 2001; Eggers, Taylor, Sathiparsad, Bos, & de Vries, 2015; Tyson, Covey, & Rosenthal, 2014). Today, AIDS is an obstacle to economic, social, and cultural development, so that it has turned to a compli- cated social and economic emergency. Given eco- nomic and social loses resulted from expansion of this disease, it is considered the most import- ant challenge against development (Duflo, Dupas, & Kremer, 2015). Informing the community to a

large extent can decrease the number of people affected with AIDS (Shojaeizadeh, Taheri, & Tehrani, 2012). To that end, using theory of planned behavior, the present study aims to improve HIV/AIDS preventing behaviors among Health volunteers of Torbat-e Heydarieh in Iran.

Method

Study Design and Study Target

Present study is a quasi-experimental study (60 participants in intervention group and 60 partici- pants in control group) which was conducted in 2016 in healthcare centers. The study population included health volunteers. Consideration a loss rate of 10%, the total sample size was calculated 120 participants. The participants were in the age range of 18–50 years. The inclusion criteria were to have at least middle school education and not moving resident place since the beginning of the study. The participants were entered into study through cluster sampling method. The participants were permitted to leave the study at any stage; if they were not interested to con- tinue and they were excluded if didn’t take part in two or more training sessions. To that end, after coordination with University authorities the author referred to health deputy of the Torbat-e Heydarieh City and obtained the list of healthcare centers. Then two centers were selected randomly as intervention centers and two other centers as control centers. It should be noted that interven- tion centers had similar conditions in terms of cultural and geographical characteristics.

Before filling the questionnaires regarding research objectives, the manner of filling the questionnaire and other required explanations were presented and the questionnaires were completed at the presence of the author. After conducting the initial test, the data were extracted and analyzed. Then, emphasizing theoretical structures of planned behavior (attitude toward behavior, behavior or performance, behavior intention, subjective norms, perceived behavior control) and awareness and performance regarding AIDS preventive behaviors, the author embarked for developing training materials and implement- ing intervention. Training materials regarding

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HIV/AIDS were formulated according to the latest epidemiological information of Iran and other countries of the world, in accordance with social and cultural conditions, and were presented by author to 30 people groups through two workshops using PowerPoint slides, pam- phlets, and leaflets.

One week after first workshop, the second workshop was held and besides reviewing the headlines of educational materials, the ground was prepared for group discussion and answering the questions. Two month after completion of educational interventions, using a written ques- tionnaire similar to the initial test, the second test was conducted simultaneously for interven- tion and control groups.

Measures

Data collection tool was a two-part questionnaire. The first part included demographic questions and second part included awareness questions (9 items), attitude toward behavior (10 items), behavior or performance (6 items), behavior intention (4 items), subjective norms (4 items), and Perceived behavioral control (6 items). The content validity was obtained by 7 professors and reliability was calculated 82.0 through Cronbach’s alpha. Scoring the questionnaire was in this way that regarding awareness questions yes answers received two points and I don’t know answers received one point. Scoring attitude, subjective norms, and Perceived behavioral control was in this way that yes answers received two points, no answers received zero points, I have no idea answers received 2 negative points and I disagree answers received one point. Regarding reverse questions in the part of attitude, subjective norms, and Perceived behavioral control, scoring was in this way that I agree answers received one point, I have no idea answers received two nega- tive points, and I’m disagree answers received 3 points. In the part of behavioral questions, yes answers received 1 point, and no answers received any points and scoring was reverse regarding the question with negative load. Regarding behavioral intention, the questions always take 3 or 2 points and never take one point.

Statistical Analyses

After collecting the questionnaires, data analysis was conducted using SPSS version 16 and descriptive analysis (frequency, percentage, mean, and standard deviation), and analytical tests (independent t-test, paired t-test, correlation coef- ficient) were conducted in a significance level of 0.05.

Ethics Approvals

Ethical approval was gained from the Torbat-e Heydarieh University of Medical Sciences Ethics Committee. The health volunteers were explained the purpose of the study and consent letter was taken. Written informed consents were obtained from all the study participation. Moreover, they were assured that all the information would be kept confidential and would not be revealed unless for research purposes and in an anonym- ous form. Participants were allowed to decline participation at any stage of research. As part of the consenting process, participants were reminded that their participation in this research was confidential and that no personal identifiable information will be stored with the data.

Results

In the study, the mean age and standard deviation of the intervention and control groups were 33.13 ±7.10 and 32.68 ±6.62years, respectively. According to the results, two groups are homoge- neous in terms of demographic variables (age, edu- cation, marital status, and occupation) (Table 1).

According to independent t-test, no significant difference was observed between two groups before intervention in terms of all structures of theory of planned behavior, but after intervention the scores increased and the differences were stat- istically significant (Table 2). Paired t statistical test shows that the mean of awareness, perform- ance, behavioral intention, subjective norms, and the control of intervention and control groups behaviors before training had no significant dif- ference (p > 0.05) but after training and holding education course, the mean score of above men- tioned variables showed a significant difference in intervention and control groups (p < 0.05). It can

584 H. A. SIUKI ET AL.

be said that training intervention significantly affected all structures of planned behaviors in health contact persons (Table 2).

Also, a significant correlation was observed regarding the components of theory of planned behavior between health contact persons in inter- vention and control groups after training inter- vention (awareness and behavioral intention (p ¼ 0.01), attitude and performance (p ¼ 0.08) and subjective norms (p ¼ 0.003), performance and subjective norms (p ¼ 0.003), behavioral intention and subjective norms (p ¼ 0.002), sub- jective norms and behavioral control (p ¼ 0.01)) (Table 3).

Discussion

The significant changes in awareness scores in intervention group, compared to control group, have been due to direct impact of training inter- vention on health contact persons and this

training has increased awareness. This increase is in line with many other related studies. A study by Alizadeh Siuki et al. (2013) and Pakpour Hajiagha, Mohammadi Zeidi, and Mohammadi Zeidi (2012) showed an increase in awareness score which is in line with the findings of present study. Since the first step to change behavior is increasing awareness, different ways exist to that end, such as training through self-learning voice messages, face to face training, group discussion, and movies (Reeves, Perrier, Goldman, Freeth, & Zwarenstein, 2013). In present study, PowerPoint slides, pamphlets, and leaflets were used to increase awareness in health contact persons and were identified as useful tools.

In present study, a significant difference was observed between attitude scores before and after intervention which indicates substantial changes in the attitudes of health contact persons. It seems that the increase of attitude score among health surveyed health contact persons is due to their awareness increase and positive impact of training interventions. A study by Mohammadi Zeidi, Pakpour Hajiagha, and Mohammadi Zeidi, (2013) shows also an increase in attitude com- pared to behavior after intervention which is con- sistent with the findings of present study.

The mean score of behavior performance before and after training showed a significant dif- ference in intervention group. This significant increase in intervention group was an expected finding and shows positive impact of presented training course regarding AIDS preventive

Table 2. Comparison between changes in the behavior and constructs of TPB before and after the intervention. Post-intervention Pre-intervention

p Value�Mean ± SD Mean ± SD Knowledge Control group 12/11 ± 2/40 12/15 ± 2/42 0/673

Experimental group 11/03 ± 2/82 12/48 ± 1/85 0/0001 p value�� 0/34 0/001

Attitude toward behavior Control group 24/68 ± 2/24 2/26 ± 7340 0/49 Experimental group 22/26 ± 2/19 25/36 ± 3/13 0/0001 p value 0/24 0/002

Behavior Control group 1/10 ± 2/58 1/11 ± 2/61 0/159 Experimental group 0/98 ± 2/98 1/49 ± 3/83 0/001 p value 0/15 0/0001

Subjective norm Control group 1/31 ± 11 1/49 ± 11/15 0/172 Experimental group 1/09 ± 11/46 1/82 ± 12/20 0/003 p value 0/922 0/002

Perceived behavioral control Control group 1/07 ± 14/21 1/09 ± 14/30 0/199 Experimental group 0/46 ± 14/13 0/68 ± 14/33 0/013 p value 0/170 0/003

Behavioral Intention Control group 0/68 ± 9/55 0/71 ± 9/70 0/162 Experimental group 2/09 ± 9/30 1/30 ± 11/13 0/001 p value 0/001 0/392

��Independent t-test; �Paired t-test.

Table 1. Mean and standard deviations of demographic varia- bles in the intervention and control groups.

Control group Intervention group Number (%) Number (%)

Level of education

Diploma 48 (80) 49 (81/7) Associate Degree 9 (15) 7 (11/6) Bachelor Degree 3 (5) 4 (6/6)

Total 60 (100) 60 (100) Job Housewife 41 (68/3) 42 (70)

Employee 9 (15) 8 (13/3) Student 2 (3/4) 3 (5) Others 8 (13/3) 7 (11/7) Total 60 (100) 60 (100)

Marital status Single 10 (16/7) 9 (15) Married 50 (83/3) 51 (85) Total 60 (100) 60 (100)

JOURNAL OF SOCIAL SERVICE RESEARCH 585

behaviors on improvement of the above men- tioned concept. Also, as the results show, the intervention has been successful in present study. This finding is consistent with the findings of a related study by Medley, Kennedy, O’Reilly, and Sweat (2009). Behavior usually happens following intention and without intention no behavior happens. In present study, the mean score of behavioral intention was good in both groups and a significant increase was observed in behavioral intention of the intervention group after intervention. Highness of behavioral intention in both groups before intervention has positive impact on increase in AIDS protective behaviors among participants. In a related study by Pakpour Hajiagha et al. (2012) Training inter- vention led to improving the skills of rejecting and postponing high-risk behaviors. The increase in behavioral intention mean score probably has been because of appropriate training of health contact persons through lectures and group discussions.

The mean score of subjective norms in inter- vention group had a significant increase, while this difference wasn’t significant in control group. Subjective norms occur due to the performance of some believes that particular people may con- firm or not confirm conducting them. Present study shows that community members and the households of health contact persons have high expectations of health contact persons in terms of adopting AIDS protective behaviors. The findings are consistent with a related study by Meister,

Grugel, & Meis (2014), where using theory of planned behavior they showed the significant impact of training on attitude change in interven- tion group. But as it was mentioned before, no significant increase was observed regarding the behavior performance of health contact persons in control group. The results of control group suggest that so long as there is no motivational initial condition and training plans are not devel- oped regarding AIDS protective behaviors, no significant change happens in behaviors.

The results of the study regarding the impact of training intervention show an increase in perceived behavior control variable in intervention group after training, while the mean score of behavioral control in control group shows no significant difference. This finding is consistent with findings of a related study by Sadeghi & Khanjani (2015).

In present study, the author faced some limita- tions, such as: difficulties in developing training materials due to age difference in target groups, coordination with Department of Health to implement training interventions in health cen- ters, participants’ attrition in different steps of the program. Given the findings of the study it is suggested that some more studies should be con- ducted regarding effectiveness of other healthcare models and theories in adopting AIDS protective behaviors. Also theory of planned behavior and other models in adopting AIDS protective behaviors should be compared. Finally, present study is conducted regarding adopting AIDS protective behaviors among health contact persons

Table 3. Correlation between constructs of the TPB. Perceived

behavioral control Subjective norm

Behavioral intention Behavior

Attitude toward behavior Knowledge

Knowledge Correlation coefficient

1 0/16 0/01 0/30 0/17 0/21

p value 0/20 0/88 0/01 0/18 0/10 Attitude toward behavior

Correlation coefficient

0/16 1 0/22 0/11 0/25 0/10

p value 0/20 0/08 0/37 0/04 0/44 Behavior Correlation

coefficient 0/01 0/22 1 0/04 0/37 0/07

p value 0/88 0/08 0/71 0/003 0/55 Behavioral intention

Correlation coefficient

0/30 0/11 0/04 1 0/38 0/12

p value 0/01 0/37 0/71 0/002 0/33 Subjective norm Correlation

coefficient 0/17 0/25 0/37 0/38 1 0/12

p value 0/18 0/04 0/003 0/002 0/33 Perceived behav- ioral control

Correlation coefficient

0/21 0/10 0/07 0/12 0/30 1

p value 0/10 0/44 0/55 0/33 0/019

586 H. A. SIUKI ET AL.

in Torbat-e Heydarieh city. It is suggested that the same study should be conducted among health contact persons in other cities.

The results of the study indicate the impact of training intervention on AIDS protective behaviors based on theoretical structures of theory of planned behavior. Theory of planned behavior is one of the best theories to predict behaviors which were used as main framework in present study. The findings of the study reaf- firmed effectiveness of this health training theory in changing behaviors.

Acknowledgements

The authors of the study express their sincere gratitude of all authorities of Torbat-e Heydarieh University of Medical Sciences, Deputy of Health and health contact persons who helped us in conducting this research.

Disclosure Statement

No potential conflict of interest was reported by the authors.

ORCID

Hadi Alizadeh Siuki https://ORCID.org/0000-0003- 2053-3229 Nooshin Peyman http://orcid.org/0000-0002-6218-4787 Mohammad Vahedian-Shahroodi http://orcid.org/0000- 0002-5402-1646 Hadi Tehrani http://orcid.org/0000-0001-8747-8717

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