Document Type : Original Article


1 Department of Health Education and Health Promotion, School of Health, Rafsanjan University of Medical Sciences, Rafsanjan, Iran

2 Department of Health Education and Health Promotion, School of Health, Occupational Safety and Health Center, NICICO, World Safety Organization and Rafsanjan University of Medical Sciences, Rafsanjan, Iran


BACKGROUND: Fruits and vegetable (F.V) consumption is the most pivotal strategy of preventing 
cardiovascular diseases, obesity, diabetes, and cancers. The present study aims to evaluate the 
effect of educational intervention based on social cognitive theory (SCT) on consumption of F.Vs 
among female high schools’ students in Rafsanjan (South of Iran).
SUBJECTS AND METHODS: This quasi‑experimental study was carried out among 272 
students (intervention = 134 and control group = 138) using a multistage sampling method. The 
instrument used in this study included demographic characteristics, the students’ F.V consumption 
during the past 7 days and its determinants based on the theory. Educational interventions were 
made in three sessions for students and two sessions for parents, teachers, and school officials. 
The data were analyzed by SPSS version 18 using the statistical tests of Chi‑square, independent 
samples t‑test, paired‑samples t‑test, and univariate model at a significant level of 0.05.
RESULTS: Three months after the educational program, mean scores and standard deviation 
of F.V consumption and constructs in the intervention group increased significantly (P < 0.001). 
Respectively, 22.2% and 36.1% of the changes in the average unit of F.V consumption were the 
result of the present educational intervention.
CONCLUSION: The intervention based on SCT with an emphasis on the interaction between student, 
family, and school has had an effect on F.V consumption behavior. Therefore, in forming behavior, 
attention is paid to the interaction of individual and interpersonal factors.


1. Husseini AS, Jalali SM. The study of the relationship between diet 
and depression in Adults. J Fundam Ment Health 2016;18:365‑73.
2. JeihooniAK, HatamiM, Zarei S, Safdar S, MalekiZ, AkbarzadehZ. 
Investigating the effect of educational program based on precede 
model on the consumption of F.Vs in high school girl students of 
Fasa City. J Fasa Univ Med Sci 2017;7:361‑70.
3. World Health Organization. Global, Newsroom, Healthy Diet, 
Key Facts; 2019. Available from:
news‑room/fact‑sheets/detail/healthy‑diet. [Last accessed on 
2020 Apr 29].
4. World Health organization. Global Strategy on Diet, 
Physical Activity and Health, Promoting F.V Consumption 
around the World. Available from:
dietphysicalactivity/fruit/en/. [Last accessed on 2020 Nov 13].
5. Gold A, Larson M, Tucker J, Strang M. Classroom nutrition 
education combined with F.V taste testing improves children’s 
dietary intake. J School Health 2017;87:106‑13.
6. Godrich SL, Davies CR, Darby J, Devine A. Strategies to address 
the complex challenge of improving regional and remote 
children’s fruit and vegetable consumption. Nutrients 2018; 
10 (11): 1603.
7. Yarmohammadi P, Sharifirad Gh.R, Azadbakht L, Pirzadeh A, 
Yarmohammadi P. Survey of factors associated with fruit and 
vegetable Consumption among high school students’ using the 
Theory of Planned Behavior in Isfahan: 2011‑2012. J Health Syst 
Res 2013;9 (S1):1595‑04.
8. MoeiniB, TaheriM, RoshanaeiGH, VahidiniaAA, Rostami MoezM. 
High school girl’s adherence to 5‑a‑day serving’s F.Vs: An 
application theory of planned behavior. J Educ Community 
Health 2014;1:10‑9.
9. Ramezankhani A, Tavassoli E, Babaei Heydarabadi A, 
Gharlipour Z, Motlagh Z, Alidosti M. Association between SCT 
constructs and F.V’s consumption in adolescent girls. Int J Pediatr 
10. Nasirzadeh M, Abdolkarimi M, Asadollahi Z, Hashemian M. 
Investigating factors effect on fruit and vegetable consumption: 
Applying social cognitive theory. JCHR 2020;9:159‑71.
11. Ganann R, Fitzpatrick‑Lewis D, Ciliska D, Peirson L. 
Community‑based interventions for enhancing access to or 
consumption of fruit and vegetables among five to 18‑year olds: 
A scoping review. BMC Public Health 2012;12:711.
12. Sutter C, Taylor JC, Nishina A, Ontai LL. Parental and family 
predictors of fruits and vegetables in elementary school 
children’s home‑packed lunches across a school week. Appetite 
13. Costa FF, Assis MA, González‑Chica D, Bernardo C, Barros MV, 
Nahas MV. Effect of school‑based intervention on diet in high 
school students. Rev. bras. cineantropom. desempenho hum 
14. Kargar M, Moattari M. The effect of osteoporosis prevention education by peers and health personnel on self‑efficacy of 
adolescents with nephrotic syndrome. IJN 2013;26:44‑53.
15. Sharifirad Gh.R, Hazavehei M, Hasanzadeh A, Daneshamoz A. 
The effect of health education based on health belief model 
on preventive actions of smoking in grade one, middle school 
students. J Arak Uni Med Sci 2007;10:2‑6.
16. Dehdari T, Ramezankhani A, Zarghi A. Principles of Health 
Promotion. Tehran: Nashrenazari Pub; 2010. p. 35‑150.
17. Saffari M, Shojaeizadeh D. Principles and Foundations of Health 
Promotion and Education. Tehran: Samat; 2014. p. 8‑105.
18. Saffari M, Shojaeizadeh D, Ghofranipour F, Heydarnia A, 
Pakporhajiagha A. Theories, Models and Methods of Health 
Education and Health Promotion. Tehran: Sobhan Pub; 2012. 
p. 100‑11.
19. Glanz K, Rimer BK, Viswanath K. Health Behavior and Health 
Education: Theory, Research, and Practice. Hoboken, New Jersey, 
United States: John Wiley and Sons; 2015.
20. Adineh HA, Zarban I, Izadi RaD H. Health Education Models 
and Theories (A Practical Look at Models and Theories of Health 
Education and Health). Iranshahr: Moin Science and Technology; 
2018. p. 100‑8.
21. World Health organization. Newsroom, Fact Sheets, Detail, 
Obesity and Overweight. Available from:
news‑room/fact‑sheets/detail/obesity‑and‑overweight. [Cited 
2021 June 9].
22. Hashemi B, Omidvar N, Bondarianzadeh D, Shakibazadeh E, 
Rashidkhani B, Abbasian F. Effect of a family‑based intervention 
based on social‑cognitive theory on F.V intake of middle school 
female students in a district of Tehran. Hakim Health Syst Res J 
23. Abbasian F, Omidvar N, Bondarianzadeh D, Rashidkhani B, 
Shakibazadeh E, Hashemi B. Effect of a school‑based intervention 
based on SCT on F.V consumption in middle school students in 
Tehran. Hayat 2012;17:73‑84.
24. Rakhshandehroo S. Application of SCT to Determine Factors 
Associated with F.V Consumption among Adolescents Tehran: 
A Cross‑Sectional Study of Psychometrics: [PhD Thesis], The 
SBMU School of Public Health. Tehran; 2013.
25. Woo T, Lee KH. Factors affecting vegetable preference 
in adolescents: Stages of change and SCT. Nutr Res Pract 
26. Abdi J, Eftekhar H, Mahmoodi M, Shojayezadeh D, Sadeghi R, 
Saber M, et al. The Effect of theory and new communication 
technologies‑based lifestyle intervention on the weight control of 
the employees with overweight and obesity. Iran J Health Educ 
Health Promot 2015;3:188‑97.
27. Bashirian S, Jalili M, Karimi‑Shahanjarini A, Soltanian AR, 
Barati M. Effectiveness of educational program based on SCT 
constructs to promote nutritional behaviors among pregnant 
women in Tabriz. Iran J Nutr Sci Food Technol 2017;12:1‑10.
28. Stacey FG, James EL, Chapman K, Lubans DR. SCT mediators of 
physical activity in a lifestyle program for cancer survivors and 
carers: Findings from the enrich randomized controlled trial. Inter 
J Behav Nutr Phys Act 2016;13:49.
29. Haß J, Hartmann M. What determines the fruit and vegetables 
intake of primary school children? – An analysis of personal and 
social determinants. Appetite 2018;120:82‑91.
30. Reyes Fernández B, WarnerLM, KnollN, Montenegro MontenegroE, 
Schwarzer R. Synergistic effects of social support and self‑efficacy 
on dietary motivation predicting fruit and vegetable intake. 
Appetite 2015;87:330‑5.
31. Lubans DR, Morgan PJ, Okely AD, Dewar D, Collins CE, 
Batterham M, et al. Preventing obesity among adolescent girls: 
One‑year outcomes of the nutrition and enjoyable activity for 
teen girls (NEAT Girls) cluster randomized controlled trial. Arch 
Pediatr Adolesc Med 2012;166:821‑7.
32. Xu X, Pu Y, Sharma M, Rao Y, Cai Y, Zhao Y. Predicting 
physical activity and healthy nutrition behaviors using SCT: 
Cross‑sectional survey among undergraduate students in 
Chongqing, China. Inter J Envir Res Public Health 2017;14:1346.
33. Methner S, Maschkowski G, Hartmann M. The European 
School Fruit Scheme: Impact on children’s fruit and vegetable 
consumption in North Rhine‑Westphalia, Germany. Public Health 
Nutr 2017;20:542‑8.
34. Heeren GA, Jemmott JB, Marange CS, Rumosa Gwaze A, 
Batidzirai, JM, Ngwane Z, et al. Health‑promotion intervention 
increases self‑reported physical activity in sub‑Saharan African 
university students: A randomized controlled pilot study. J Behav 
Med 2018; 44(4): 297‑305.