Discussion
Based on the results of the present study, the intervention based on HBM improved the participants' knowledge of cervical cancer significantly, changed their attitudes and motivated them to do Pap test. The results of the previous similar studies confirmed our findings. Sharifi-Rad et al 10 evaluated the educational effect on the performance of the prevention of smoking in first-year highschool students of Boukan City. They indicated that all constructs of the model inproved significanty after intervention. Papa et al 11 studied the effect of education on the knowledge, concern and desire of 50 women who were eligible to do Pap smear. They reported that 77% of the participants were encouraged to do Pap test after intervention.
We found that mean score of knowledge varied across age groups and educational level. This shows that the effect of intervention based on HBM has different effects on different age groups and education level. Tabeshian et al 12 conducted a Knowledge, Attitude and Practice (KAP) study to assess the effect of training on teachers of Isfahan County, but reported no statistically significant relationship between knowledge and both age and educational level.
We indicated that the mean score of all components of HBM increased significantly post-intervention compared to pre-intervention. Our findings are consistent with results of previous investigations. Yakhforoushha et al 9 assessed the effect of training on the voluntary health workers' knowledge and attitude regarding Pap test using HBM. Hazavehei et al 13 performed a training program for girl students in Garmsar City and used HBM to investigate the preventive behavior of the participants regarding osteoporosis. Sharifi-Rad et al 14 assessed the effect of health education using HBM on preventive action against cigarette smoking among high school students on preventive health practices of smoking in high school students has examined the results. All these studies revealed that both knowledge and attitude of the participants improved significantly after training program.
The main finding of the present study was changing in the participants' health behavior so that majority of them (81.4%) proceeded to do Pap test while they had never done Pap test previously. Park 15 planned a curriculum based on HBM and trained the women and found that tendency of do Pap test and practice was higher in intervention group compared to control group. In addition, an investiagtion conducted by Hazavehei et al 13 revealed that safety training based on the HBM can improve behavior of workers practice in using personal protective equipment. These findings indicate that training based on HBM can motivate and improve the preventive health behaviors. On the other hand, Tabeshian et al 12 used KAP design to improve the health behaviors of teachers in Isfahan County to do Pap test but found no significant differences in the participants' behaviors post-intervention compared to pre-intervention.
This study had several limitations including: (a) difficult access to the target group who were eligible to do Pap test but they did not refer to the health center for screening; (b) unwillingness of the participants due to high cost of Pap test; and (c) difficulty in filling out the questionnaire because of low literacy of the participants. Despite its limitations, the results of the current study revealed that education based on HBM could improve the knowledge of general population and change the people's behaviors regarding Pap test even in low educated individuals who had never participated previously in screening programs of the cervical cancer.
Conclusion
We concluded that health education based on HBM can enhance women's knowledge of cervical cancer, change their health beliefs and improve their behaviors regarding screening programs like Pap test even if they had never participated in preventive programs.
Acknowledgments
This article is a part of MSc thesis supported by Tehran University of Medical Sciences. We would like to thank Deputy of Education as well as Deputy of Research and Technology of Tehran University of Medical Sciences for financial support of this study. We also wish to thank Deputy of Health Services of Hamadan University of Medical Sciences for their valuable collaboration with this study.
Conflict of interest statement
The authors declare that they have no conflict of interests.
Funding
This study was funded by the Deputy of Research and Technology of Tehran University of Medical Sciences.
Discussion
Based on the results of the present study, the intervention based on HBM improved the participants' knowledge of cervical cancer significantly, changed their attitudes and motivated them to do Pap test. The results of the previous similar studies confirmed our findings. Sharifi-Rad et al 10 evaluated the educational effect on the performance of the prevention of smoking in first-year highschool students of Boukan City. They indicated that all constructs of the model inproved significanty after intervention. Papa et al 11 studied the effect of education on the knowledge, concern and desire of 50 women who were eligible to do Pap smear. They reported that 77% of the participants were encouraged to do Pap test after intervention.
We found that mean score of knowledge varied across age groups and educational level. This shows that the effect of intervention based on HBM has different effects on different age groups and education level. Tabeshian et al 12 conducted a Knowledge, Attitude and Practice (KAP) study to assess the effect of training on teachers of Isfahan County, but reported no statistically significant relationship between knowledge and both age and educational level.
We indicated that the mean score of all components of HBM increased significantly post-intervention compared to pre-intervention. Our findings are consistent with results of previous investigations. Yakhforoushha et al 9 assessed the effect of training on the voluntary health workers' knowledge and attitude regarding Pap test using HBM. Hazavehei et al 13 performed a training program for girl students in Garmsar City and used HBM to investigate the preventive behavior of the participants regarding osteoporosis. Sharifi-Rad et al 14 assessed the effect of health education using HBM on preventive action against cigarette smoking among high school students on preventive health practices of smoking in high school students has examined the results. All these studies revealed that both knowledge and attitude of the participants improved significantly after training program.
The main finding of the present study was changing in the participants' health behavior so that majority of them (81.4%) proceeded to do Pap test while they had never done Pap test previously. Park 15 planned a curriculum based on HBM and trained the women and found that tendency of do Pap test and practice was higher in intervention group compared to control group. In addition, an investiagtion conducted by Hazavehei et al 13 revealed that safety training based on the HBM can improve behavior of workers practice in using personal protective equipment. These findings indicate that training based on HBM can motivate and improve the preventive health behaviors. On the other hand, Tabeshian et al 12 used KAP design to improve the health behaviors of teachers in Isfahan County to do Pap test but found no significant differences in the participants' behaviors post-intervention compared to pre-intervention.
This study had several limitations including: (a) difficult access to the target group who were eligible to do Pap test but they did not refer to the health center for screening; (b) unwillingness of the participants due to high cost of Pap test; and (c) difficulty in filling out the questionnaire because of low literacy of the participants. Despite its limitations, the results of the current study revealed that education based on HBM could improve the knowledge of general population and change the people's behaviors regarding Pap test even in low educated individuals who had never participated previously in screening programs of the cervical cancer.
Conclusion
We concluded that health education based on HBM can enhance women's knowledge of cervical cancer, change their health beliefs and improve their behaviors regarding screening programs like Pap test even if they had never participated in preventive programs.
Acknowledgments
This article is a part of MSc thesis supported by Tehran University of Medical Sciences. We would like to thank Deputy of Education as well as Deputy of Research and Technology of Tehran University of Medical Sciences for financial support of this study. We also wish to thank Deputy of Health Services of Hamadan University of Medical Sciences for their valuable collaboration with this study.
Conflict of interest statement
The authors declare that they have no conflict of interests.
Funding
This study was funded by the Deputy of Research and Technology of Tehran University of Medical Sciences.
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