An Influenza Health Education Intervention Using the Health Belief Model: A Randomized Controlled Trial among Senior High-School Students in Northern Taiwan
Date Issued
2015
Date
2015
Author(s)
Lee, Po-Yi
Abstract
Objectives: In previous influenza research, few randomized controlled trials based on behavior science theory have been conducted. Hence, there is a scarcity of empirical data for the evaluation of the effectiveness of influenza health education interventions. Based on the Health Belief Model (HBM), this health education intervention trial was designed and implemented to assess its effectiveness on hand washing and face mask wearing behaviors. This study also aimed to examine which changes in health beliefs could predict increases in these influenza-related health behaviors and behavioral intentions, and to what extent. Methods: A randomized controlled trial was conducted among senior high-school students in northern Taiwan, with HBM-based health education intervention delivered to 329 participants in the experimental group and regular health education intervention delivered to 327 in the control group. Pretest and follow-up posttest data regarding influenza-related HBM health beliefs, hand washing and face mask wearing behaviors, and behavioral intentions were collected before the intervention and 3 months after the intervention, respectively, using self-administed questionnaires. Results: Multivariate linear autoregression analysis was conducted, controlling for hand washing behavior, intention, and background characteristics at pretest. Participants in the experimental group were found to have significantly higher scores than those in the control group in their hand washing behavior (β=.098) and intention (β=.140) at 3-month follow-up, indicating that the HBM-based intervention was effective in increasing hand washing behavior and intention. However, no significant differences were found between the two groups, after controlling for the changes in HBM health beliefs between pretest and follow-up posttest, suggesting that the significant intervention effects in the experimental group were mediated through changes in HBM health beliefs. Of all the changes in HBM health beliefs, increased self-efficacy was the strongest predictor of hand washing and face mask wearing behaviors (β=.541 and .559, respectively), as well as behavioral intentions (β=.418 and .437, respectively). Elevated levels of perceived benefits significantly increased hand washing behavior (β=.107), but had no significant effect on face mask wearing behavior. Finally, increased perceived susceptibility, severity, and benefits significantly predicted increased behavioral intention of washing hands (β=.153, .181, and .139, respectively) and wearing face masks (β=.117, .168, and .141, respectively). Conclusions: The HBM-based health education intervention significantly increased hand washing behavior and intention, more than the regular health education intervention, at 3-month follow-up. Such intervention effects were mediated through changes in HBM health beliefs. Changes in different health behaviors were driven by changes in different health beliefs. Increased perceived benefits led to significantly increased hand washing behavior, intention, and face mask wearing intention, suggesting that future interventions should emphasize the preventive effects of hand washing and face mask wearing against influenza infection. Above all, increased self-efficacy was the strongest predictor of these influenza-related preventive behaviors. Therefore, future health education interventions should focus on increasing self-efficacy for optimal program effectiveness.
Subjects
influenza
health education intervention
hand washing
face mask wearing
randomized controlled trial
Health Belief Model
senior high-school students
Type
thesis
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