Document Type : Original Article

Authors

1 Department of Counseling, Pregnancy Health Research Center, Zahedan University of Medical Sciences, Zahedan, Iran

2 Health Promotion Research Center, Zahedan University of Medical Sciences, Zahedan, Iran

3 MSc Student of Midwifery Counseling, School of Nursing and Midwifery, Zahedan University of Medical Sciences, Zahedan, Iran

Abstract

INTRODUCTION: Acquired immune deficiency syndrome (AIDS) is a pervasive disease, and
its epidemic is spreading around the world. The only way to effectively fight against human
immunodeficiency virus (HIV)/AIDS is good‑quality health. The present study aimed to investigate
the effect of an educational intervention program on HIV/AIDS preventive behaviors based on the
Health Belief Model (HBM) in vulnerable women residing in peripheral neighborhoods.
MATERIALS AND METHODS: This study was a quasi‑experimental research conducted among 200
vulnerable women, randomly selected from four community health centers in peripheral neighborhoods
in 2019 in Zahedan, Iran. The data were collected using a researcher‑made questionnaire, containing
demographic information, HIV knowledge, and the HBM constructs. Besides, the data were collected
before, immediately after, and 1 month after the intervention in both groups. Data analysis was
performed in SPSS (version 24) using descriptive statistics, Chi‑square test, independent t‑test,
repeated‑measures analysis of variance, and multivariate linear regression.
RESULTS: The findings revealed no significant difference in the mean scores of knowledge and
the HBM constructs before the educational intervention (P > 0.05). However, after the intervention,
this difference was significant in three time intervals (P < 0.05). Despite the effectiveness of
the educational intervention in the mean scores of knowledge and the HBM constructs in the
intervention group compared with the controls, the largest effect size was observed, respectively, in
knowledge (d = 0.762) and perceived barriers (d = 0.612), and the smallest effect size was reported
in cues to action (d = 0.421). As well, the F‑statistic ratio (0.847) demonstrated that the selected
demographic variables had failed to explain variations in knowledge mean scores (P = 0.497).
CONCLUSION: HBM‑based training interventions were positive for HIV/AIDS prevention behaviors.
However, training alone does not seem to have enough effect on behavior persistence. Therefore,
further research is recommended to investigate the role of predictive factors, especially social
determinants of health and their relationship to different parts of the model, to take more effective
measures for behavioral stability at the same time as training.

Keywords

  1. Ashrafi E, Kasmaei P, Mehrabian F, Omidi S, Zareban I,
    Haryalchi K. Predictive factors of behavioral intention in AIDS
    prevention in nursing and midwifery students at guilan university
    of medical sciences. Drug Invention Today 2019;12:239‑42.
    2. Ghys PD, Williams BG, Over M, Hallett TB, Godfrey‑Faussett P.
    Epidemiological metrics and benchmarks for a transition in the
    HIV epidemic. PLoS Med 2018;15:e1002678.
    3. UNAIDS. Miles to go. Global AIDS Update 2018. Geneva:
    UNAIDS; 2018.
    4. Zarei E, Khabiri R, Tajvar M, Nosratnejad S. Knowledge of and
    attitudes toward HIV/AIDS among Iranian women. Epidemiol
    Health 2018;40:e2018037.
    5. Heidary M, Nasiri MJ. Why Has HIV/AIDS Prevalence Increased
    in Iran? Clin Infect Dis 2016;63:846.
    6. World Health Organization. Global Health Sector Strategy on HIV
    2016‑2021. Towards Ending AIDS. World Health Organization;
    2016.
    7. Moeini B, Hazavehei SM, Bashirian S, Soltanian A, Mousavi AA,
    Kafami V. Effect of an educational program to encourage safe
    sexual behaviors among addicted men referred to substance abuse
    treatment centers in Hamadan, Western Iran: Applying the theory
    of planned behavior. J Educ Community Health 2014;1:1‑10.
    8. Lewis O. The culture of poverty. Sci Am 1966;215:19‑25.
    9. Saberifar R, Vafayi E. Investigating the impact of Residential
    Environment in Increasing the Risk of AIDS (Case Study of
    Mashhad). Med J Mashhad Univ Med Sci 2018;61:1025‑35.
    10. Gielen AC, Ghandour RM, Burke JG, Mahoney P, McDonnell KA,
    O’Campo P. HIV/AIDS and intimate partner violence:
    Intersecting women’s health issues in the United States. Trauma
    Violence Abuse 2007;8:178‑98.
    11. Li X, Lin C, Gao Z, Stanton B, Fang X, Yin Q, et al. HIV/AIDS
    knowledge and the implications for health promotion programs
    among Chinese college students: Geographic, gender and age
    differences. Health Promot Int 2004;19:345‑56.
    12. Ayodele O. The theory of planned behavior as a predictor of HIV
    testing intention. Am J Health Behav 2017;41:147‑51.
    13. Khazaeian S, Kariman N, Ebadi A, Nasiri M. Effect of an
    educational intervention on AIDS prevention among the female
    heads of household: Application of the health belief model. Shiraz
    E Med J 2019;20:1‑7.
    14. Glanz K, Rimer BK, Viswanath K. Health Behavior and Health
    Education: Theory, Research, and Practice: John Wiley & Sons;
    2008.
    15. Zareiyan A, Roshandel M, emlai khozani S. The effect of training
    sessions based on the health belief model on soldiers in the
    prevention of smoking persons’ attitude. Military Caring Sci J
    2015;2:63‑8.
    16. Najarkolaei FR, Niknami S, Shokravi FA, Ahmadi F, Jafari MR,
    Rahnama P. The implication of health belief model in planning
    educational programs for preventing HIV/AIDS among
    university students. Payesh 2009;8:349‑59.
    17. Ebrahimipour H, Akerdi B, Solhi M, Esmaeli H. Effect of
    educational intervention based on Self‑Efficacy Theory (SET) on
    the behavior of prevention of HIV/AIDS in high‑risk women.
    Iranian J Obstet Gynecol Infertil 2015;18:19‑27.
    18. Biradar MK, Biradar SM. Knowledge, attitude, and perception
    of HIV/AIDS among married women. Indian J Pharm Biol Res
    2014;2:36‑40.
    19. Khan H, Mishra S, Srivastava DK, Srivastava R. An assessment of
    the awareness and practices regarding HIV/AIDS among married
    women of the reproductive age group in urban slums of Eastern
    Uttar Pradesh. Int J Community Med Public Health 2019;6:3496.
    20. Haroun D, El Saleh O, Wood L, Mechli R, Al Marzouqi N,
    Anouti S. Assessing knowledge of, and attitudes to, HIV/AIDS
    among University students in the united arab emirates. PLoS One
    2016;11:e0149920.
    21. Montazeri A, Fallahi H. Effect of educational interventions on
    sexual high‑risk behavior between drug addicts ex‑users based on
    the Health Belief Model. J School Public Health Ins Public Health
    Res 2014;12:93‑104.
    22. Khani Jeihooni A, Arameshfard S, Hatami M, Mansourian M,
    Kashfi SH, Rastegarimehr B, et al. The effect of educational
    program based on health belief model about HIV/AIDS among
    high school students. Int J Pediatr 2018;6:7285‑96.
    23. Kharazi SS, Peyman N. Effect of educational interventions based
    on the health belief model on the promotion of aids preventive
    behaviors among female High School Students in Mashhad, Iran,
    in 2016. Health System Res 2017;13:14‑8.
    24. Abebe A, Mitikie G. Perception of high school students towards
    voluntary HIV counseling and testing, using the health belief
    model in Butajira, SNNPR. Ethiop. J. Health Dev 2009;23:148‑53.
    25. Pirzadeh A, Sharifirad Gh. Effect of educational program on
    knowledge and health belief model structures about acquired
    immune deficiency syndrome (AIDS) among high school female
    students in Isfahan, Iran. J Gorgan Univ of Med Sci 2012;14:66‑71.
    26. Solhi M, Haghighi M, Rahmati Najarkolaei F, Zemestani A. HIV
    prevention perception among barbers according to health belief
    model case study from Marand. J Res Health 2014;4:592‑8.
    27. Karimi M, GHofranipor F, Heidarnia A. The effect of health
    education based on health belief model on preventive of aids
    on addict in Zarandieh. Gillan J Univ Med Sci Health Serv
    2009;70:6‑73.
    28. Montanaro EA, Bryan AD. Comparing theory‑based condom
    interventions: Health belief model versus theory of planned
    behavior. Health Psychol 2014;33:1251‑60.
    29. Garcia K, Mann T. From ‘I wish to ‘I will’: Social‑cognitive
    predictors of behavioral intentions. J Health Psychol 2003;8:347‑60.
    30. Lance Coleman C. Health beliefs and high‑risk sexual behaviors
    among HIV‑infected African American men. Appl Nurs Res
    2007;20:110‑5.
    31. HountonSH, CarabinH, HendersonNJ. Towards an understanding
    of barriers to condom use in rural Benin using the Health Belief
    Model: A cross sectional survey. BMC Public Health 2005;5:8.
    32. Eshrati B, Asl RT, Dell CA, Afshar P, Millson PM, Kamali M, et al.
    Preventing HIV transmission among Iranian prisoners: Initial
    support for providing education on the benefits of harm reduction
    practices. Harm Reduct J 2008;5:21.
  2. 33. Baiden P, Rajulton F. Factors influencing condom use among
    women in Ghana: An HIV/AIDS perspective. SAHARA J
    2011;8:46‑54.
    34. Reisner SL, Perez‑Brumer AG, McLean SA, Lama JR,
    Silva‑Santisteban A, Huerta L, et al. Perceived barriers and
    facilitators to integrating HIV prevention and treatment with
    cross‑sex hormone therapy for transgender women in Lima, Peru.
    AIDS Behav 2017;21:3299‑311.
    35. Bauermeister JA, Hickok AM, Meadowbrooke C, Veinot T,
    Loveluck J. Self‑efficacy among young men who have sex with
    men: An exploratory analysis of HIV/AIDS risk behaviors across
    partner types. AIDS Behav 2014;18:69‑77.
    36. Khumsaen N, Stephenson R. Beliefs and Perception About HIV/
    AIDS, Self‑Efficacy, and HIV Sexual Risk Behaviors Among
    Young Thai Men Who Have Sex With Men. AIDS Educ Prev
    2017;29:175‑90.
    37. Kaneko N. Association between condom use and perceived
    barriers to and self‐efficacy of safe sex among young women in
    Japan. Nurs Health Sci 2007;9:284‑9.
    38. Mantell JE, Smit JA, Beksinska M, Scorgie F, Milford C, Balch E,
    et al. Everywhere you go, everyone is saying condom, condom.
    But are they being used consistently? Reflections of South African
    male students about male and female condom use. Health Educ
    Res 2011;26:859‑71.
    39. Mahat G, Scoloveno MA, Scoloveno R. HIV/AIDS knowledge,
    self‑efficacy for limiting sexual risk behavior and parental
    monitoring. J Pediatr Nurs 2016;31:e63‑9.
    40. Sarafian I. Process assessment of a peer education programme
    for HIV prevention among sex workers in Dhaka, Bangladesh:
    A social support framework. Soc Sci Med 2012;75:668‑75.
    41. Bandura A. Perceived self‑efficacy in the exercise of control over
    AIDS infection. Eval Program Plann 1990;13:9‑17.
    42. Villegas N, Cianelli R, Gonzalez‑Guarda R, Kaelber L, Ferrer L,
    Peragallo N. Predictors of self‑efficacy for HIV prevention among
    Hispanic women in South Florida. J Assoc Nurses AIDS Care
    2013;24:27‑37.
    43. Lee YH, Salman A, Cooksey‑James T. Gender Differences in HIV/
    AIDS Preventive Self‑Efficacy Among Taiwanese Adolescents.
    AIDS Educ Prev 2016;28:77‑89.
    44. Phillips DY, Walsh B, Bullion JW, Reid PV, Bacon K, Okoro N. The
    intersection of intimate partner violence and HIV in US women:
    A review. J Assoc Nurses AIDS Care 2014;25:S36‑49.
    45. Swan H, O’Connell DJ. The impact of intimate partner violence
    on women’s condom negotiation efficacy. J Interpers Violence
    2012;27:775‑92.
    46. Gullette DL, Lyons MA. Sensation seeking, self‑esteem, and
    unprotected sex in college students. J Assoc Nurses AIDS Care
    2006;17:23‑31.
    47. Crosby RA, DiClemente RJ, Salazar LF, Wingood GM,
    McDermott‑Sales J, Young AM, et al. Predictors of consistent
    condom use among young African American women. AIDS Behav
    2013;17:865‑71.
    48. Ghanbari A, Khiaban MO, Aslani A, Faraji AR, Mohammadi M,
    Kazemi AF. Assessment of adherence to therapy and exploring
    of barriers and facilitators in HIV positive patients in Tabriz‑Iran:
    A mixed method study protocol. Reprod Health 2019;16:108.
    49. Klein H. Condom use self‑efficacy and HIV risk practices among
    men who use the internet to find male partners for unprotected
    sex. Am J Mens Health 2014;8:190‑204.
    50. Baker DP, Leon J, Collins JM. Facts, attitudes, and health
    reasoning about HIV and AIDS: Explaining the education effect
    on condom use among adults in sub‑Saharan Africa. AIDS Behav
    2011;15:1319‑27.