The Effect of the Health Belief Model-Based Intervention in Primary School 3rd and 4th Grade Students' Behavior on Safety Precautions for Preventing Accidents at School
Phase: NA
Conditions: Health Behavior
Sponsor: Afyonkarahisar Health Sciences University

The Effect of the Health Belief Model-Based Intervention in Primary School 3rd and 4th 
Grade Students' Behavior on Safety Precautions for Preventing Accidents at School   
 
 
NCT05576987 
 
 
Study Protocol and Statistical Analysis Plan 
 
 
 
June 3, 2022 
 
 
 
 
 
 
 
 
 
 
 

Inroduction 
An accident is defined as an event that ends with an injury or an unexpected event that 
requires emergency medical attention and results in a syndrome that includes events such as 
trauma, fracture, poisoning, and burns (Gambarte et al., 2014). Accidents are an important 
public health problem due to deats, temporary or permanent disability. Injuries are among the 
leading causes of death and lifelong disability between the ages of 5-14 years (WHO). 
Children in this age group spend certain hours of the day at school, and children are also very 
active physically in school. This physical activity can cause accidents and injury to the child. 
It is reported that 15% of child accidents occur at school (Gambarte et al., 2014). In an 
epidemiological study examining school accidents between 2012 and 2016 in our country, 
7042 school injury records were examined. In this study, it was determined that most of the 
school injuries were caused by falling (60.1%) and occurred during break time (38.6%), while 
13.3% of the injuries were caused by environmental reasons and 86.7% by behavioral reasons 
(Şengel et al., 2020). In this direction, changing the behaviors that cause injury and improving 
the behavior towards preventive safety measures can reduce the risk of injury due to 
accidents. It is identified three levels of impact in injury prevention, each of which may be 
appropriate for different prevention approaches. These; the internal level at which 
interventions can target self-efficacy, knowledge, skills and beliefs; the interpersonal level at 
which the intervention can target social/peer influences and norms, and the community level, 
which includes interventions involving the environment or settings and policies. The health 
belief model is among the most widely applied individual-level (internal and interpersonal) 
behavioral change theories in injury prevention (Orton et al., 2016). The Health Belief Model 
(Gözüm and Çapık, 2014), developed by Rosenstock in 1966 and later expanded by Becker et 
al., focuses on individuals' attitudes and beliefs. This model defends that health behavior is 
determined by an individual's personal beliefs or perceptions about a disease/health condition. 
In line with this model, a child perceives injury as a problem, takes it seriously, and as a result 
causes a positive behavioral change to prevent injury. In a study, it was determined that health 
belief model (HBM)-based school health education to high school students can improve 
students' health beliefs about injury (Cao et al., 2014). Another study found that an 
educational intervention based on the Health Belief Model could improve students' practice in 
preventing school injuries (Farhadi et al., 2014). Studies have shown that a HBM-based 
intervention can improve injury-related health beliefs and practices in injury prevention. 
However, sufficient information could not be reached about the effect of HBM-based 

intervention on behavior towards security measures in primary school students. In this 
direction Purpose of this study is to research the impact of the education that has given 
towards the health belief model, for the behavior of children about precautions against school 
accidents. This study will provide scientific data support to the school health nurse on how to 
apply HBM in creating behavior change for safety measures to prevent school accidents. 
Hypothesis 
Education for school accidents, prepared in line with the components of the Health Belief 
Model, affects the safety precautionary behavior of students for school accidents. 
Primary Outcomes 
Behavior of Students for Safety Precautions in School Accidents 
Method 
Study Design 
This research was designed as quasi-experimental. It has a pretest-posttest design with a 
control group. 
Sample 
The behavior score averages and standard deviations of the two groups in a previous study 
(Dilek, 2018) and the effect size were calculated to determine the sample size of the study. 
Power analysis (significance level 0.05 for type 1 error, effect size 0.50, and power 0.95). 
(Gpower 3.1 version) was carried out. In the power analysis, the minimum number of 
participants was 87 in the experimental group and 87 in the control group. In this context, the 
research will be conducted with 100 participants in each group, taking into account the 
possibility that non-parametric statistics may need to be used due to the non-normal 
distribution of the dependent variable, incomplete and erroneous data, and absenteeism. 
Experimental and control groups will be selected from the branches 3rd and 4th grade. 3 
branches will be selected for the experimental group and 3 branches for the control group. 
Branches will be determined by drawing. In order not to interfere with the education of 
students during the training, the groups will be designated as class branches. 
Inclusion Criteria 
Being educated in 3rd and 4th grade 

Volunteer to participate in the research 
Consent of the student's parent 
Speak and understand Turkish 
Exclusion Criteria 
Being visually and hearing impaired 
Using a language other than Turkish 
Not willing to participate in the study 
Research Groups 
Intervention arm 
Experimental group will be selected from the branches 3rd and 4th grade. 3 branches will be 
selected for the experimental group. Branches will be determined by drawing. In order not to 
interfere with the education of students during the training, the groups will be designated as 
class branches. Students selected for the experimental group will be trained by the researcher 
for school accidents prepared in line with the components of the Health Belief Model.The 
training program will be planned as 30 minutes per week for 4 weeks. Before the training and 
at the end of the training (at the end of the 4th week), the students will be applied personal 
information form and a behavior scale for safety precautions in school accidents. 
Control Arm 
Control group will be selected from the branches 3rd and 4th grade. 3 branches for the control 
group. Branches will be determined by drawing. In order not to interfere with the education of 
students during the training, the groups will be designated as class branches. After the training 
of the experimental group is completed and the final data are obtained, a 40-minute training 
will be given to the control group about prevention from school accidents. This training was 
planned so that the control group would not be devoided of the intervention. 
 
Data Collection Tools 
The data will be obtained with the personal information form and the behavior scale for safety 
measures in school accidents. 
Personal Information form 

In this form prepared by the researchers, there are questions that determine personal 
characteristics such as age, gender, educational status of parents, school accident status. 
The Scale of Behavior of Students towards Safety Measures in School Accidents 
This scale, developed by Gür and Yıldız (2009), consists of 4 factors. Factor 1 is Unsafe 
Behaviors, Factor 2 is Safe Behaviors, Factor 3 is Safe Behaviors Towards Outside, and 
Factor 4 is Behaviors in the Service Vehicle. The questions are scored in the opposite 
direction. The scale consists of 40 items and is a 5-point Likert type scale. For each item, it is 
required to tick one of the options “Always”, “Often”, “Sometimes”, “Rarely”, “Never”.For 
each question, “Always” receives 5 points, “Often” receives 4 points, “Sometimes” 3 points, 
“Rarely” 2 points, and “Never” receives 1 point.2nd, 3rd, 4th, 5th, 7th, 10th, 12th, 20th, 21st, 
22nd, 26th, 32nd, 34th, 36th, 37th, 38th, 39th. Questions are scored in the opposite 
direction.The lowest score that can be obtained from the scale is 40, and the highest is 
200.The highest score obtained from the scale shows that the student takes the security 
measures for school accidents at the highest level. 
Ethical Considerations 
Ethical permission was obtained from the Ethics Committee of Afyonkarahisar Sağlık 
Bilimleri Üniversitesi (Afyonkarahisar Health Sciences University) (date: 03.June 2022; 
Number: 2022/340) 
Statistical Analysis 
In the evaluation of the data, percentage, arithmetic mean, t-test for independent samples and 
t-test for dependent samples will be used. Significance level will be taken as p<0.05. 
References 
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education programme for injury prevention among high school students in the community 
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Farhadi, Z., Roshanaei, G., Bashirian, S., Rezapur-Shahkolai, F.(2014). The Effect of an 
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and-young-adolescent-mortality-(5-to-14-years). Date of Access: 15.05.2022