2. Objectives
This study was conducted to evaluate the effect of an intervention based on PRECEDE-PROCEED Model on preventive behaviors of domestic violence among Iranian high school girls.
3. Patients and Methods
This study was interventional, and was conducted during 2010-2011 on 510 12'th grade senior third grade high school girls in district 17 of Tehran municipality. This district has characteristics such as high density populated community and low level of socioeconomic situation. The sample size was calculated with an 80% confidence interval and 5% accuracy. Considering a design effect on sample size, it was determined that the sample size in each of the interventions and the control group to be 255. Cluster sampling method was used. All high schools in this district were selected and each school was identified as a cluster. Schools were divided into two groups, each group included five schools. Then from 12'th grades senior students of each school, a sample size was randomly selected. Study inclusion criteria included being enrolled in the 12'th grade. Informed consent was obtained from each participant included in the study. The study protocol conforms to the ethical guidelines of the 1975 Declaration of Helsinki. At first, through a mixed qualitative and quantitative study, the first four steps' assessment of PRECEDE portion were conducted and then an appropriate intervention based on their results was developed, implemented, and evaluated. Qualitative data were collected through four focus group discussions with the participation of high schools girls, and from five in-depth interviews with key informants related to domestic violence, such as women's health specialists and consultants. Quantitative data were collected through the questionnaire developed by the researcher, that was based on PRECEDE-PROCEED Model and included demographic characteristics, predisposing factors that included knowledge (7 questions) and attitude (26 questions based on Likert scale), enabling factors (4 questions), reinforcing factors (4 questions), and behavior (9 questions) sections. Scores of variables were classified as weak (less than 50 percent), moderate (50-70 percent), and good (> 70 percent) level. Ten health education and health promotion professionals confirmed the face and content validity of the questionnaire. The reliability of the attitude questionnaire was confirmed with a Cronbach alpha reliability coefficient of 0.71, obtained in a pilot study on 30 students other than the two main study groups. Test- Retest method used for determining the reliability of the knowledge, reinforcing, and, enabling questionnaires in the pilot sample, has been achieved with a correlation coefficient of 0.75, 0.80, and 0.77, respectively.
3.1. Ethical Consideration
The study was approved by Tehran University of Medical Sciences. All Ethical issues - informed consent, conflict of interest, plagiarism, misconduct, data fabrication and/or falsification, double publication and/or submission, redundancy, etc.- have been considered carefully by the authors. The respondents were anonymous and participated willingly and voluntarily in this study
3.2. Social Assessment
In this phase, the researchers identified factors affecting health outcomes and quality of life in the target population. We used some methods for data collection such as interviews with key informants and focus group discussions with high school girls. Results showed that domestic violence can be one of the social problems in our country, which can affect girls' and women's health, and respondents partly confirmed the existence of this problem in our society.
3.3. Epidemiological, Behavioral, and Environmental Assessment
In this phase, we collected existing data related to domestic violence such as types, prevalence rates, importance, and factors associated with domestic violence in Iran and other countries, using data sources such as various online databases and national health surveys in other countries. Then, in behavioral and environmental assessments, factors causally associated with domestic violence were systematically identified, and the most important and changeable behavioral and environmental factors associated with domestic violence were found. Finally, behavioral objectives and environmental objectives were constructed for each risk factor. Results of the focus group discussions and interviews were widely applied for this step. Review of the literature and existing data on domestic violence showed that women and girls are a high-risk group for mortality and morbidity related to domestic violence, and the most important factor found in Iranian families is the lack of the preventive behaviors of domestic violence. After identifying and rating the behavioral and environmental determinants in terms of importance and changeability, the determinants were selected. According to the results of qualitative study, in terms of behavioral determinants of the performance of preventive domestic violence behaviors, life skills applications related to prevention of domestic violence were considered as the target behavior. In terms of environmental determinants of the performance of preventive domestic violence behaviors, access to places, people, or informational resources, such as educational material, classes, and electronic databases were considered as the target behavior. Some demographic variables such as parents' occupation and education, family size, birth order, housing, having a specific room, family status, and field of education were also considered as non-health factors related to quality of life in target population.
2. วัตถุประสงค์การศึกษานี้ได้ดำเนินการประเมินผลของการแทรกแซงตามแบบจำลอง PRECEDE ดำเนินพฤติกรรมป้องกันของความรุนแรงในครอบครัวในหมู่เด็กนักเรียนชาวอิหร่าน3. ผู้ป่วยและวิธีการThis study was interventional, and was conducted during 2010-2011 on 510 12'th grade senior third grade high school girls in district 17 of Tehran municipality. This district has characteristics such as high density populated community and low level of socioeconomic situation. The sample size was calculated with an 80% confidence interval and 5% accuracy. Considering a design effect on sample size, it was determined that the sample size in each of the interventions and the control group to be 255. Cluster sampling method was used. All high schools in this district were selected and each school was identified as a cluster. Schools were divided into two groups, each group included five schools. Then from 12'th grades senior students of each school, a sample size was randomly selected. Study inclusion criteria included being enrolled in the 12'th grade. Informed consent was obtained from each participant included in the study. The study protocol conforms to the ethical guidelines of the 1975 Declaration of Helsinki. At first, through a mixed qualitative and quantitative study, the first four steps' assessment of PRECEDE portion were conducted and then an appropriate intervention based on their results was developed, implemented, and evaluated. Qualitative data were collected through four focus group discussions with the participation of high schools girls, and from five in-depth interviews with key informants related to domestic violence, such as women's health specialists and consultants. Quantitative data were collected through the questionnaire developed by the researcher, that was based on PRECEDE-PROCEED Model and included demographic characteristics, predisposing factors that included knowledge (7 questions) and attitude (26 questions based on Likert scale), enabling factors (4 questions), reinforcing factors (4 questions), and behavior (9 questions) sections. Scores of variables were classified as weak (less than 50 percent), moderate (50-70 percent), and good (> 70 percent) level. Ten health education and health promotion professionals confirmed the face and content validity of the questionnaire. The reliability of the attitude questionnaire was confirmed with a Cronbach alpha reliability coefficient of 0.71, obtained in a pilot study on 30 students other than the two main study groups. Test- Retest method used for determining the reliability of the knowledge, reinforcing, and, enabling questionnaires in the pilot sample, has been achieved with a correlation coefficient of 0.75, 0.80, and 0.77, respectively.3.1. Ethical ConsiderationThe study was approved by Tehran University of Medical Sciences. All Ethical issues - informed consent, conflict of interest, plagiarism, misconduct, data fabrication and/or falsification, double publication and/or submission, redundancy, etc.- have been considered carefully by the authors. The respondents were anonymous and participated willingly and voluntarily in this study3.2. Social AssessmentIn this phase, the researchers identified factors affecting health outcomes and quality of life in the target population. We used some methods for data collection such as interviews with key informants and focus group discussions with high school girls. Results showed that domestic violence can be one of the social problems in our country, which can affect girls' and women's health, and respondents partly confirmed the existence of this problem in our society.3.3. Epidemiological, Behavioral, and Environmental AssessmentIn this phase, we collected existing data related to domestic violence such as types, prevalence rates, importance, and factors associated with domestic violence in Iran and other countries, using data sources such as various online databases and national health surveys in other countries. Then, in behavioral and environmental assessments, factors causally associated with domestic violence were systematically identified, and the most important and changeable behavioral and environmental factors associated with domestic violence were found. Finally, behavioral objectives and environmental objectives were constructed for each risk factor. Results of the focus group discussions and interviews were widely applied for this step. Review of the literature and existing data on domestic violence showed that women and girls are a high-risk group for mortality and morbidity related to domestic violence, and the most important factor found in Iranian families is the lack of the preventive behaviors of domestic violence. After identifying and rating the behavioral and environmental determinants in terms of importance and changeability, the determinants were selected. According to the results of qualitative study, in terms of behavioral determinants of the performance of preventive domestic violence behaviors, life skills applications related to prevention of domestic violence were considered as the target behavior. In terms of environmental determinants of the performance of preventive domestic violence behaviors, access to places, people, or informational resources, such as educational material, classes, and electronic databases were considered as the target behavior. Some demographic variables such as parents' occupation and education, family size, birth order, housing, having a specific room, family status, and field of education were also considered as non-health factors related to quality of life in target population.
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