Authors
1 Department of Midwifery, School of Nursing and Midwifery, Isfahan University of Medical Science, Isfahan, Iran
2 Epidemiology and Biostatistics, School of Public Health, Isfahan University of Medical Science
Abstract
INTRODUCTION: Pregnancy is one of the high‑risk periods for women’s health that the lack of
attention to healthy behaviors such as weight control behaviors can lead to adverse consequences
on the health of women and also the fetus. Therefore, the aim of this paper was to explore the
determinants of weight control self‑efficacy among pregnant women using Health Belief Model (HBM).
MATERIALS AND METHODS: In this cross‑sectional study were enrolled 202 pregnant women
referring to Health Care Center in Isfahan city, Iran. Sampling method was multistage random.
A researcher‑made instrument based on HBM structures was used after confirming the valid and
reliable. Data were analyzed by software SPSS 21 and descriptive statistics were represented
with (frequency, mean and standard deviation) and analytical (Pearson correlation, independent t
and liner regression) at the significant level of <0.05.
RESULTS: The average age of participants was 27.80 ± 5.08. HBM structures were able explained
31% of variance of weight control self‑efficacy. Also, of the studied structures, perceived benefits,
perceived barriers were statistically significant predictors of weight control self‑efficacy, within which
perceived barriers (β = 0.391) was the most significant predictor.
CONCLUSION: The findings of current study showed that the HBM model could be as a suitable
framework to identify effective factors for designing educational intervention to improve weight control
behaviors among pregnant women.
Keywords
1. Colón‑Ramos U, Racette SB, Ganiban J, Nguyen TG, Kocak M,
Carroll KN, et al. Association between dietary patterns during
pregnancy and birth size measures in a diverse population in
Southern US. Nutrients 2015;7:1318‑32.
2. Guo L, Liu J, Ye R, Liu J, Zhuang Z, Ren A. Gestational weight
gain and overweight in children aged 3‑6 years. J Epidemiol
2015;25:536‑43.
3. Kazemian E, Sotoudeh G, Dorosty‑Motlagh AR, Eshraghian MR,
Bagheri M. Maternal obesity and energy intake as risk factors of
pregnancy‑induced hypertension among Iranian women. J Health
Popul Nutr 2014;32:486‑93.
4. Tielemans MJ, Erler NS, Leermakers ET, van den Broek M,
Jaddoe VW, Steegers EA, et al. A Priori and a posteriori dietary
patterns during pregnancy and gestational weight gain: The
generation r study. Nutrients 2015;7:9383‑99.
5. Waring ME, Moore Simas TA, XiaoRS, Lombardini LM, Allison JJ,
Rosal MC, et al. Pregnant women’s interest in a website or mobile
application for healthy gestational weight gain. Sex Reprod
Healthc 2014;5:182‑4.
6. Ebrahimi F, Shariff ZM, Tabatabaei SZ, Fathollahi MS, Mun CY,
Nazari M. Relationship between sociodemographics, dietary
intake, and physical activity with gestational weight gain among
pregnant women in Rafsanjan City, Iran. J Health Popul Nutr
2015;33:168‑76.
7. Maslova E, Halldorsson TI, Astrup A, Olsen SF. Dietary
protein‑to‑carbohydrate ratio and added sugar as determinants
of excessive gestational weight gain: A prospective cohort study.
BMJ Open 2015;5:e005839.
8. Sun D, Li F, ZhangY, XuX. Associations of the pre‑pregnancy BMI
and gestational BMI gain with pregnancy outcomes in Chinese
women with gestational diabetes mellitus. Int J Clin Exp Med
2014;7:5784‑9.
9. Bjermo H, Lind S, Rasmussen F. The educational gradient
of obesity increases among Swedish pregnant women: A
register‑based study. BMC Public Health 2015;15:315.
10. Sharp GC, Lawlor DA, Richmond RC, Fraser A, Simpkin A,
Suderman M, et al. Maternal pre‑pregnancy BMI and gestational
weight gain, offspring DNA methylation and later offspring
adiposity: Findings from the Avon Longitudinal Study of Parents
and Children. Int J Epidemiol 2015;44:1288‑304.
11. Gardner RM, Lee BK, Magnusson C, Rai D, Frisell T, Karlsson H,
et al. Maternal body mass index during early pregnancy,
gestational weight gain, and risk of autism spectrum disorders:
Results from a Swedish total population and discordant sibling
study. Int J Epidemiol 2015;44:870‑83.
12. Gesell SB, Katula JA, Strickland C, Vitolins MZ. Feasibility
and initial efficacy evaluation of a community‑based
cognitive‑behavioral lifestyle intervention to prevent excessive
weight gain during pregnancy in latina women. Matern Child
Health J 2015;19:1842‑52.
13. Farajzadegan Z, Bahrami D, Jafari N. Weight Gain during
Pregnancy in Women Attending a Health Center in Isfahan City,
Iran. Int J Prev Med 2012;3:682‑6.
14. Seneviratne SN, McCowan LM, Cutfield WS, Derraik JG,
Hofman PL. Exercise in pregnancies complicated by obesity:
Achieving benefits and overcoming barriers. Am J Obstet Gynecol
2015;212:442‑9.
15. Leiferman J, Swibas T, Koiness K, Marshall JA, Dunn AL. My
baby, my move: Examination of perceived barriers and motivating
factors related to antenatal physical activity. J Midwifery Womens
Health 2011;56:33‑40.
16. Goodrich K, Cregger M, Wilcox S, Liu J. A qualitative study of
factors affecting pregnancy weight gain in African American
women. Matern Child Health J 2013;17:432‑40.
17. Agrahar‑Murugkar D, Pal PP. Intake of nutrients and food sources
of nutrients among the Khasi tribal women of India. Nutrition
2004;20:268‑73.
18. George GC, Hanss‑Nuss H, Milani TJ, Freeland‑Graves JH. Food
choices of low‑income women during pregnancy and postpartum.
J Am Diet Assoc 2005;105:899‑907.19. Esmaillzadeh A, Samareh S, Azadbakht L. Dietary patterns
among pregnant women in the West‑North of Iran. Pak J Biol Sci
2008;11:793‑6.
20. Robinson TD. Hypertension Beliefs and Behaviors of African
Americans in Seleceted Cleveland Public Housing [PhD Thesis].
USA: Kent State University; 2012.
21. Bonds DE, Camacho F, BellRA, Duren‑Winfield VT, AndersonRT,
Goff DC. The association of patient trust and self‑care among
patients with diabetes mellitus. BMC Fam Pract 2004;5:26.
22. Glance K, Marcus F, Barbara L. Health Behavior and Health
Education (Theory, Research, Operation). Translator. Shafiei F.
Tehran: Ladan Publication; 1997. p. 68‑84.
23. Strecher VJ, Champion VL, Rosenstock IM, Gochman DS. The
Health Belief Model and Health Behavior. 1th ed. New York:
Plenum Press Publisher; 1997.
24. Shojaezadeh D, Mehrabbaic A, Mahmoodi M, Salehi L. To
evaluate of efficacy of education based on health belief model
on knowledge, attitude and practice among women with low
socioeconomic status regarding osteoporosis prevention. Iran J
Epidemiol 2011;7:30‑7.
25. Azadbakht M, Garmaroudi GH, Taheri Tanjani P, Sahaf R,
Shojaeijadeh D, Gheisvandi E. Health promoting self‑care
behaviors and its related factors in elderly: Application of health
belief model. J Educ Community Health 2014;1:2‑29.
26. Saunders GH, Frederick MT, Silverman SC, Nielsen C,
Laplante‑Lévesque A. Description of adults seeking hearing
help for the first time according to two health behavior change
approaches: Transtheoretical model (stages of change) and health
belief model. Ear Hear 2016;37:324‑33.
27. Doak CC, Doak LG, Root Jane H. Teaching Patients with Low
Literacy Skills. 2nd ed. Philadelphia: Lippincott Co.; 1996. p. 57‑68.
28. Shannon J, Kirkley B, Ammerman A, Keyserling T, Kelsey K,
DeVellis R, et al. Self‑efficacy as a predictor of dietary change in
a low‑socioeconomic‑status Southern adult population. Health
Educ Behav 1997;24:357‑68.
29. Peyman N, Ezzati Rastegar KH. Effect of an educational program
on job tension management in nurses, based on self‑efficacy
theory. Modern Care Sci Quart Birjand Nurs Midwifery Faculty
2012;9:1‑9.
30. Murphy DA, Stein JA, Schlenger W, Maibach E; National Institute
of Mental Health Multisite HIV Prevention Trial Group, National
Institutes of Health. Conceptualizing the multidimensional nature
of self‑efficacy: Assessment of situational context and level of
behavioral challenge to maintain safer sex. National Institute
of Mental Health Multisite HIV Prevention Trial Group. Health
Psychol 2001;20:281‑90.
31. Sarkar U, Fisher L, Schillinger D. Is self‑efficacy associated with
diabetes self‑management across race/ethnicity and health
literacy? Diabetes Care 2006;29:823‑9.
32. Aghamolaei T, Tavafian SS, Hasani L. Exercise self‑efficacy,
exercise perceived benefits and barriers among students in
Hormozgan University of medical sciences. Iran J Epidemiol
2009;4:9‑15.
33. Gharlipour Gharghani Z, Sayarpour SM, Moeini B. Associated
factors with regular physical activity among emergency medical
personnel in Hamadan: Applying health belief model. J Health
Syst 2011;7:710‑7.
34. Da Costa D, Ireland K. Perceived benefits and barriers to
leisure‑time physical activity during pregnancy in previously
inactive and active women. Women Health 2013;53:185‑202.
35. Solhi M, Ahmadi L, Taghdisi MH, Haghani H. The Effect of
Trans Theoretical Model (TTM) on exercise behavior in pregnant
women referred to Dehaghan Rural health center in. Iran J Med
Educ 2012;11:942‑50.
36. Evenson KR, Moos MK, Carrier K, Siega‑Riz AM. Perceived
barriers to physical activity among pregnant women. Matern
Child Health J 2009;13:364‑75.
37. Babazadeh T, Nadrian H, Banayejeddi M, Rezapour B.
Determinants of skin cancer preventive behaviors among rural
farmers in Iran: An application of protection motivation theory.
J Cancer Educ 2016.
38. Ghafari M, Nasirzadeh M, Aligol M, Davoodi F, Nejatifar M,
Kabiri S, et al. Determinants of physical activity for prevention
of osteoporosis among female students of Shahid Beheshti
University of Medical Sciences: Application of health belief model.
Pajoohandeh J 2014;19:244‑50.
39. Soleiman Ekhtiari Y, Majlessi F, Rahimi Foroushani A.
Measurement of the constructs of health belief model related to
self‑care during pregnancy in women referred to South Tehran
health network. Community Health 2015;1:89‑98.
40. Babaei V, Babazadeh T, Kiani A, Garmaroodi G, Batebi A. The
role of effective factors in preventive behaviors of brucellosis in
stockbreeder of Charaoymaq County: A health belief model. J Fasa
Univ Med Sci 2016;5:470‑8.
41. Vazini H, Barati M. Predicting factors related to self‑care behaviors
among type 2 diabetic patients based on health belief model.
J Torbat Heydariyeh Univ Med Sci 2014;1:16‑25.
42. Akbari Z, Tol A, Shojaeizadeh D, Aazam K, Kia F. Assessing of
physical activity self‑efficacy and knowledge about benefits and
safety during pregnancy among women. RJMS 2016;22:76‑87.
43. Salahshoori A, Sharifirad G, Hassanzadeh A, Mostafavi F.
An assessment of the role of perceived benefits, barriers and
self‑efficacy in predicting dietary behavior in male and female
high school students in the city of Izeh, Iran. J Educ Health Promot
2014;3:8.
44. Ribeiro CP, Milanez H. Knowledge, attitude and practice of
women in Campinas, São Paulo, Brazil with respect to physical
exercise in pregnancy: A descriptive study. Reprod Health
2011;8:31.
45. MahmoodiH, Asghari‑JafarabadiM, BabazadehT, MohammadiY,
Shirzadi S, Sharifi‑Saqezi P, et al. Health promoting behaviors in
pregnant women admitted to the prenatal care unit of Imam
Khomeini Hospital of Saqqez. J Educ Community Health
2015;1:58‑65.
46. Borowski SC, Tambling RB. Applying the health belief model
to young individuals’ beliefs and preferences about premarital
counseling. Fam J 2015;23:417‑26.
47. Barzegar Mahmudi T, Khorsandi M, Shamsi M, Ranjbaran M.
Knowledge, Beliefs and Performance of health volunteers in
Malayer city about Hepatitis B: An application of health belief
model. Pajouhan Sci J 2016;14:24‑33.
48. Bishop AC, Baker GR, Boyle TA, MacKinnon NJ. Using the health
belief model to explain patient involvement in patient safety.
Health Expect 2015;18:3019‑33.
Carroll KN, et al. Association between dietary patterns during
pregnancy and birth size measures in a diverse population in
Southern US. Nutrients 2015;7:1318‑32.
2. Guo L, Liu J, Ye R, Liu J, Zhuang Z, Ren A. Gestational weight
gain and overweight in children aged 3‑6 years. J Epidemiol
2015;25:536‑43.
3. Kazemian E, Sotoudeh G, Dorosty‑Motlagh AR, Eshraghian MR,
Bagheri M. Maternal obesity and energy intake as risk factors of
pregnancy‑induced hypertension among Iranian women. J Health
Popul Nutr 2014;32:486‑93.
4. Tielemans MJ, Erler NS, Leermakers ET, van den Broek M,
Jaddoe VW, Steegers EA, et al. A Priori and a posteriori dietary
patterns during pregnancy and gestational weight gain: The
generation r study. Nutrients 2015;7:9383‑99.
5. Waring ME, Moore Simas TA, XiaoRS, Lombardini LM, Allison JJ,
Rosal MC, et al. Pregnant women’s interest in a website or mobile
application for healthy gestational weight gain. Sex Reprod
Healthc 2014;5:182‑4.
6. Ebrahimi F, Shariff ZM, Tabatabaei SZ, Fathollahi MS, Mun CY,
Nazari M. Relationship between sociodemographics, dietary
intake, and physical activity with gestational weight gain among
pregnant women in Rafsanjan City, Iran. J Health Popul Nutr
2015;33:168‑76.
7. Maslova E, Halldorsson TI, Astrup A, Olsen SF. Dietary
protein‑to‑carbohydrate ratio and added sugar as determinants
of excessive gestational weight gain: A prospective cohort study.
BMJ Open 2015;5:e005839.
8. Sun D, Li F, ZhangY, XuX. Associations of the pre‑pregnancy BMI
and gestational BMI gain with pregnancy outcomes in Chinese
women with gestational diabetes mellitus. Int J Clin Exp Med
2014;7:5784‑9.
9. Bjermo H, Lind S, Rasmussen F. The educational gradient
of obesity increases among Swedish pregnant women: A
register‑based study. BMC Public Health 2015;15:315.
10. Sharp GC, Lawlor DA, Richmond RC, Fraser A, Simpkin A,
Suderman M, et al. Maternal pre‑pregnancy BMI and gestational
weight gain, offspring DNA methylation and later offspring
adiposity: Findings from the Avon Longitudinal Study of Parents
and Children. Int J Epidemiol 2015;44:1288‑304.
11. Gardner RM, Lee BK, Magnusson C, Rai D, Frisell T, Karlsson H,
et al. Maternal body mass index during early pregnancy,
gestational weight gain, and risk of autism spectrum disorders:
Results from a Swedish total population and discordant sibling
study. Int J Epidemiol 2015;44:870‑83.
12. Gesell SB, Katula JA, Strickland C, Vitolins MZ. Feasibility
and initial efficacy evaluation of a community‑based
cognitive‑behavioral lifestyle intervention to prevent excessive
weight gain during pregnancy in latina women. Matern Child
Health J 2015;19:1842‑52.
13. Farajzadegan Z, Bahrami D, Jafari N. Weight Gain during
Pregnancy in Women Attending a Health Center in Isfahan City,
Iran. Int J Prev Med 2012;3:682‑6.
14. Seneviratne SN, McCowan LM, Cutfield WS, Derraik JG,
Hofman PL. Exercise in pregnancies complicated by obesity:
Achieving benefits and overcoming barriers. Am J Obstet Gynecol
2015;212:442‑9.
15. Leiferman J, Swibas T, Koiness K, Marshall JA, Dunn AL. My
baby, my move: Examination of perceived barriers and motivating
factors related to antenatal physical activity. J Midwifery Womens
Health 2011;56:33‑40.
16. Goodrich K, Cregger M, Wilcox S, Liu J. A qualitative study of
factors affecting pregnancy weight gain in African American
women. Matern Child Health J 2013;17:432‑40.
17. Agrahar‑Murugkar D, Pal PP. Intake of nutrients and food sources
of nutrients among the Khasi tribal women of India. Nutrition
2004;20:268‑73.
18. George GC, Hanss‑Nuss H, Milani TJ, Freeland‑Graves JH. Food
choices of low‑income women during pregnancy and postpartum.
J Am Diet Assoc 2005;105:899‑907.19. Esmaillzadeh A, Samareh S, Azadbakht L. Dietary patterns
among pregnant women in the West‑North of Iran. Pak J Biol Sci
2008;11:793‑6.
20. Robinson TD. Hypertension Beliefs and Behaviors of African
Americans in Seleceted Cleveland Public Housing [PhD Thesis].
USA: Kent State University; 2012.
21. Bonds DE, Camacho F, BellRA, Duren‑Winfield VT, AndersonRT,
Goff DC. The association of patient trust and self‑care among
patients with diabetes mellitus. BMC Fam Pract 2004;5:26.
22. Glance K, Marcus F, Barbara L. Health Behavior and Health
Education (Theory, Research, Operation). Translator. Shafiei F.
Tehran: Ladan Publication; 1997. p. 68‑84.
23. Strecher VJ, Champion VL, Rosenstock IM, Gochman DS. The
Health Belief Model and Health Behavior. 1th ed. New York:
Plenum Press Publisher; 1997.
24. Shojaezadeh D, Mehrabbaic A, Mahmoodi M, Salehi L. To
evaluate of efficacy of education based on health belief model
on knowledge, attitude and practice among women with low
socioeconomic status regarding osteoporosis prevention. Iran J
Epidemiol 2011;7:30‑7.
25. Azadbakht M, Garmaroudi GH, Taheri Tanjani P, Sahaf R,
Shojaeijadeh D, Gheisvandi E. Health promoting self‑care
behaviors and its related factors in elderly: Application of health
belief model. J Educ Community Health 2014;1:2‑29.
26. Saunders GH, Frederick MT, Silverman SC, Nielsen C,
Laplante‑Lévesque A. Description of adults seeking hearing
help for the first time according to two health behavior change
approaches: Transtheoretical model (stages of change) and health
belief model. Ear Hear 2016;37:324‑33.
27. Doak CC, Doak LG, Root Jane H. Teaching Patients with Low
Literacy Skills. 2nd ed. Philadelphia: Lippincott Co.; 1996. p. 57‑68.
28. Shannon J, Kirkley B, Ammerman A, Keyserling T, Kelsey K,
DeVellis R, et al. Self‑efficacy as a predictor of dietary change in
a low‑socioeconomic‑status Southern adult population. Health
Educ Behav 1997;24:357‑68.
29. Peyman N, Ezzati Rastegar KH. Effect of an educational program
on job tension management in nurses, based on self‑efficacy
theory. Modern Care Sci Quart Birjand Nurs Midwifery Faculty
2012;9:1‑9.
30. Murphy DA, Stein JA, Schlenger W, Maibach E; National Institute
of Mental Health Multisite HIV Prevention Trial Group, National
Institutes of Health. Conceptualizing the multidimensional nature
of self‑efficacy: Assessment of situational context and level of
behavioral challenge to maintain safer sex. National Institute
of Mental Health Multisite HIV Prevention Trial Group. Health
Psychol 2001;20:281‑90.
31. Sarkar U, Fisher L, Schillinger D. Is self‑efficacy associated with
diabetes self‑management across race/ethnicity and health
literacy? Diabetes Care 2006;29:823‑9.
32. Aghamolaei T, Tavafian SS, Hasani L. Exercise self‑efficacy,
exercise perceived benefits and barriers among students in
Hormozgan University of medical sciences. Iran J Epidemiol
2009;4:9‑15.
33. Gharlipour Gharghani Z, Sayarpour SM, Moeini B. Associated
factors with regular physical activity among emergency medical
personnel in Hamadan: Applying health belief model. J Health
Syst 2011;7:710‑7.
34. Da Costa D, Ireland K. Perceived benefits and barriers to
leisure‑time physical activity during pregnancy in previously
inactive and active women. Women Health 2013;53:185‑202.
35. Solhi M, Ahmadi L, Taghdisi MH, Haghani H. The Effect of
Trans Theoretical Model (TTM) on exercise behavior in pregnant
women referred to Dehaghan Rural health center in. Iran J Med
Educ 2012;11:942‑50.
36. Evenson KR, Moos MK, Carrier K, Siega‑Riz AM. Perceived
barriers to physical activity among pregnant women. Matern
Child Health J 2009;13:364‑75.
37. Babazadeh T, Nadrian H, Banayejeddi M, Rezapour B.
Determinants of skin cancer preventive behaviors among rural
farmers in Iran: An application of protection motivation theory.
J Cancer Educ 2016.
38. Ghafari M, Nasirzadeh M, Aligol M, Davoodi F, Nejatifar M,
Kabiri S, et al. Determinants of physical activity for prevention
of osteoporosis among female students of Shahid Beheshti
University of Medical Sciences: Application of health belief model.
Pajoohandeh J 2014;19:244‑50.
39. Soleiman Ekhtiari Y, Majlessi F, Rahimi Foroushani A.
Measurement of the constructs of health belief model related to
self‑care during pregnancy in women referred to South Tehran
health network. Community Health 2015;1:89‑98.
40. Babaei V, Babazadeh T, Kiani A, Garmaroodi G, Batebi A. The
role of effective factors in preventive behaviors of brucellosis in
stockbreeder of Charaoymaq County: A health belief model. J Fasa
Univ Med Sci 2016;5:470‑8.
41. Vazini H, Barati M. Predicting factors related to self‑care behaviors
among type 2 diabetic patients based on health belief model.
J Torbat Heydariyeh Univ Med Sci 2014;1:16‑25.
42. Akbari Z, Tol A, Shojaeizadeh D, Aazam K, Kia F. Assessing of
physical activity self‑efficacy and knowledge about benefits and
safety during pregnancy among women. RJMS 2016;22:76‑87.
43. Salahshoori A, Sharifirad G, Hassanzadeh A, Mostafavi F.
An assessment of the role of perceived benefits, barriers and
self‑efficacy in predicting dietary behavior in male and female
high school students in the city of Izeh, Iran. J Educ Health Promot
2014;3:8.
44. Ribeiro CP, Milanez H. Knowledge, attitude and practice of
women in Campinas, São Paulo, Brazil with respect to physical
exercise in pregnancy: A descriptive study. Reprod Health
2011;8:31.
45. MahmoodiH, Asghari‑JafarabadiM, BabazadehT, MohammadiY,
Shirzadi S, Sharifi‑Saqezi P, et al. Health promoting behaviors in
pregnant women admitted to the prenatal care unit of Imam
Khomeini Hospital of Saqqez. J Educ Community Health
2015;1:58‑65.
46. Borowski SC, Tambling RB. Applying the health belief model
to young individuals’ beliefs and preferences about premarital
counseling. Fam J 2015;23:417‑26.
47. Barzegar Mahmudi T, Khorsandi M, Shamsi M, Ranjbaran M.
Knowledge, Beliefs and Performance of health volunteers in
Malayer city about Hepatitis B: An application of health belief
model. Pajouhan Sci J 2016;14:24‑33.
48. Bishop AC, Baker GR, Boyle TA, MacKinnon NJ. Using the health
belief model to explain patient involvement in patient safety.
Health Expect 2015;18:3019‑33.
)