تاثیر آموزش براساس مدل اعتقاد بهداشتی بر ارتقای رفتار دفع بهداشتی فاضلاب

زمینه. دفع غیر بهداشتی فاضلاب و رهاسازی آن در معابر عمومی، آب های جاری و محیط زیست روستا باعث آلودگی آب های سطحی و زیرزمینی، خاک و ایجاد مناظر نازیبا شده و محیط مناسبی را برای رشد و تکثیر انواع حشرات و جوندگان و تولید بوهای نامطبوع ایجاد خواهد کرد، لذا این مطالعه با هدف بررسی تاثیر آموزش بر اساس مدل اعتقاد بهداشتی بر ارتقای رفتار دفع بهداشتی فاضلاب در خانوارهای روستایی شهرستان آق قلا انجام شد. روش کار. این مطالعه مداخله ای، بر روی 72 سرپرست خانوار روستایی شهرستان آق قلا از توابع استان گلستان انجام شد. ابتدا دو روستا با شرایط یکسان انتخاب و بر اساس تخصیص تصادفی ساده در دو گروه مداخله و شاهد قرار گرفتند. از هر روستا 36 سرپرست خانوار انتخاب شده و پرسش نامه استاندارد اعتقاد بهداشتی دفع بهداشتی فاضلاب را قبل و بعد از مداخله آموزشی تکمیل نمودند. داده ها با استفاده از نرم افزار آماری spss.17 و آزمون های تیزوجی، ویلکاکسون، تیمستقل و منویتنی تحلیل شدند. یافته ها. قبل از مداخله، ویژگی های جمعیت شناختی و تمامی سازه های مدل بین دو گروه تفاوت معناداری نداشت (p>0/05). در گروه مداخله، میانگین نمرات آگاهی، حساسیت درک شده، شدت درک شده، منافع درک شده و خودکارآمدی در پس آزمون به طور معناداری افزایش یافته و موانع درک شده به طور معناداری کاهش داشته است (p<0/05). اما میانگین نمرات حیطه عملکرد در قبل و بعد از مداخله، تفاوت معناداری نداشت. نتیجه گیری. مداخله آموزشی بر روی آگاهی و سازه های مدل اعتقاد بهداشتی موثر بود اما بر رفتار دفع بهداشتی فاضلاب تاثیر نداشت، از آن جایی که حفر چاه جاذب فاضلاب نیازمند صرف هزینه می باشد، توصیه می شود علاوه بر افزایش تعداد جلسات آموزشی، از همکاری بین بخشی مانند شورای روستا نیز استفاده شود.

The Effect of Education Based on the Health Belief Model on the Promotion of Sanitary Wastewater Disposal Behavior

Background. Disposal of nonsanitary wastewater in the rural area leads to the pollution of surface water, groundwater, and soil. It also creates unpleasant landscapes and a suitable environment for the growth and propagation of various types of insects and rodents. Therefore, the aim of this study was to investigate the effect of education based on the Health Belief Model (HBM) on the promotion of sanitary wastewater disposal behaviors of rural residents. Methods. This interventional study was conducted on 72 heads of rural households in AqQala, Iran. Two similar villages in the area were selected and assigned to experimental and control group through simple random allocation. Then, 36 heads of the households were selected from each village. Data were collected before and after the intervention through a reliable and valid HBM questionnaire. Paired samples ttest, Wilcoxon, independent samples ttest and MannWhitney test were employed to analyze the data by SPSS version 17. Results. Before the intervention, there wasn’t significant difference between two groups in terms of knowledge, HBM constructs, behavior and demographic characteristics (p>0.05). After the intervention, the mean score of knowledge, perceived susceptibility, perceived severity, perceived benefits, and selfefficacy increased significantly and the mean score of perceived barriers decreased significantly in the experimental group (p<0.05). However, no significant difference was found in the mean score of behavior (p>0.05). Conclusion. The educational intervention was effective in promoting knowledge and HBM constructs, but it was not effective in the domain of behavior. As far as digging absorptive well is costly, so in addition to increasing the number of training sessions, intersectoral cooperation between village councils is recommended. Background Disposal of nonsanitary wastewater in the rural area leads to the pollution of surface water, groundwater, and soil. It also creates unpleasant landscapes and a suitable environment for the growth and propagation of various types of insects and rodents. Therefore, the aim of this study was to investigate the effect of education based on the Health Belief Model (HBM) on the promotion of sanitary wastewater disposal behaviors of rural residents in AqQala. Methods This interventional study was conducted on 72 heads of rural households in AqQala, Iran. Two villages were selected and assigned to experimental and control group through simple random allocation. Then, 36 heads of households were selected from each village. For the experimental group, the intervention consisted of holding three training sessions about sanitary wastewater disposal. The classes were held in the rural health house. Each training session lasted at least one hour. The trainings were conducted in the form of lectures followed by questioning and answering. No training classes were held for the control group. Data were collected before and after the intervention through a researcher structured questionnaire which was built based on HBM. The questionnaire consisted of 4 sections: demographic characteristics (6 question); knowledge (5 question); HBM constructs (35 questions) including: perceived susceptibility (5 questions), perceived severity (8 questions), perceived benefits (8 questions), perceived barriers (8 questions), selfefficacy (4 questions), and cues to action (2 questions); and behavior (3 questions). The questionnaires were completed through interviews by the trained people who knew the language of the participants. The data were analyzed through conducting paired t test, Wilcoxon, independent ttest and MannWhitney test by the use of SPSS. 17. Results Mean age of the participants in the experimental group and control group was 40.4± 15.5 and 42.8± 14.1 years, respectively. In both groups 80.6% of participants were male. Rural health worker's opinion was important for 86% and 100% of people in the interventional and control group respectively. 75% of the participants in the experimental group and 100% of the participants in the control group had received information about the sanitary disposal of sewage from rural health workers. Before the intervention, no significant difference in the mean score of knowledge, HBM constructs, behavior and demographic characteristics was found between the two groups (p>0.05). After the intervention, the mean score of knowledge, perceived susceptibility, perceived severity, perceived benefits, and selfefficacy significantly increased and the mean score of perceived barriers significantly decreased in the experimental group (p<0.05), However, there was no significant difference in the mean score of behavior (p>0.05). Conclusion The results of the present study showed that designed education was successful in having a positive and significant effect on the knowledge and HBM constructs, but the intervention did not affect the domain of behavior in the experimental group. As far as digging absorptive well is costly, so in addition to increasing the number of training sessions, intersectoral cooperation between village councils is recommended. Practical Implications of Research Health education specialists as well as the health education unit of health care networks should pay attention to the fact that since digging absorptive well is costly, besides holding training sessions by health houses and health centers, intersectoral cooperation between village councils is an important factor in the issue of sanitary wastewater disposal in the villages. Ethical Considerations Ethical approval for this study was obtained from the Ethics Committee of the Golestan University of Medical Sciences with the ethics code 14791793061940. Conflict of Interest The authors declare that they have no competing interests. Acknowledgement This study was funded and supported by Golestan University of Medical Sciences (GOUMS); Grant No. 930618124. We thank all our dear colleagues in the Health Management and Social Development Research Center and Deputy of Research and Technology in Golestan University of Medical Sciences for their cooperation in the approval of this research project. We would like to sincerely thank the staff of AqQala health houses (Rural health worker/ Behvarz) and all those who helped us in conducting this study.