Original ResearchEffect of educating mothers on injury prevention among children aged <5 years using the Health Belief Model: a randomized controlled trial
Introduction
The world has made considerable progress in controlling and reducing the number of communicable diseases over recent decades. Nonetheless, injuries are still one of the major causes of death among children aged <14 years worldwide,1, 2 and an important cause of mortality and long-term morbidity in children aged <5 years.3, 4, 5 Annually, injuries result in hundreds of thousands of deaths among children aged <5 years worldwide. More than 95% of these deaths occur in low- and middle-income countries.5, 6
Injuries, road traffic injuries, drowning, burns, falls, poisoning and choking are the main causes of mortality and morbidity in children.6, 7 Injuries in children result from interaction between genetic, behavioural and environmental factors and the parents' characteristics.7, 8, 9, 10 Evidence shows that injuries are more common in boys than girls.6, 11, 12
In Iran, the number of deaths among children aged <5 years has reduced from 56 per 1000 to 34 per 1000 over recent decades. However, the number of deaths due to injuries has remained constant, and accounts for 6% of all deaths in this age group; this is higher than the global average.2
Reducing the burden of injury is an international health goal that requires consensus and an interdisciplinary perspective. Injuries of any type have one thing in common, which is the reality that all injuries are preventable.13 Despite recognition of the importance of behavioural research in injury prevention, behavioural solutions in planning injury prevention and control were not emphasized until recently. Indeed, the behaviours that lead to violence and injury are amenable to preventive intervention. Therefore, behavioural science is an integral part of an injury prevention programme.14
Health education models at individual, interpersonal and social levels can be implemented in planning educational programmes to increase safety and injury prevention in children. These models may be helpful in needs assessment, programme design, content development, data collection and evaluation of preventive programmes.15
The Health Belief Model (HBM), which is a model for changing behaviour, can be implemented to improve the attitudes of caregivers towards injury prevention and control in children, and hence improve their quality of life. On one hand, the constructs of the model (perceived sensitivity and perceived severity) enable the subjects to identify the health threats, and on the other hand, behavioural incentives (perceived benefits, perceived barriers, cues to action and self-efficacy) encourage them to adopt healthy behaviours.16 Indeed, the main objective of health education professionals in planning educational programmes is changing the attitudes and beliefs of the subjects, using the HBM to encourage healthy behaviours.17
A pilot descriptive study was conducted in Hamadan City in 201118 to identify factors associated with mothers' beliefs and practices concerning injury prevention in children aged <5 years. Knowledge, perceived severity, perceived barriers, cues to action and self-efficacy were found to be among the most important predictive constructs, and this information is useful when planning education programmes. The present trial was conducted to assess the effect of HBM-related education on mothers' knowledge, attitudes and practices to increase safety and injury prevention in children aged <5 years, focusing on prognostic factors of safety behaviours.
Section snippets
Methods
This randomized controlled trial was conducted in Hamadan City, West Iran from December 2011 to April 2012. One hundred and twenty mothers with at least one child aged <5 years were enrolled in the study. Only women who had medical records at the local health centre, who had given their signed informed consent to take part in the study, and who participated regularly in training sessions were eligible for inclusion in the study. Mothers whose children had congenital or chronic diseases were
Results
None of the 120 participants dropped out of the study. The characteristics of the study population are shown in Table 1. Mean maternal age was 25.65 [standard deviation (SD) 4.61] years in the intervention group and 28.42 (SD 5.24) years in the control group. There was no significant difference between the intervention and control groups except for mothers' occupation (P < 0.012).
Table 2 shows mothers' knowledge, practices and HBM constructs in the intervention and control groups before and
Discussion
This study showed that an educational intervention based on the HBM model can improve knowledge, attitudes and practices of mothers regarding injury prevention in children aged <5 years. Khorsandi et al.22 investigated the effect of a combined HBM model among nulliparous women, and showed that the educational intervention based on the integrated theory was effective in reducing the rate of primary caesarean section. Shojaeizadeh et al.23 showed that education based on the HBM model can enhance
Conclusion
Educational programmes based on the HBM, as one of the models of behaviour change, can be used to train caregivers of children aged <5 years. This approach can increase their awareness of childhood injuries, and improve their attitudes towards prevention and control of injuries in children. Therefore, this model can be used as an effective approach in planning and developing preventive programmes for injury prevention and safety promotion in children.
Author statements
The authors wish to thank the Vice-Chancellor of Education and the Vice-Chancellor of Research and Technology, Hamadan University of Medical Sciences, who approved this study.
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