The Effect of Education Based on the Health Belief Model on the Promotion of Sanitary Wastewater Disposal Behavior
Authors: Ghezavati Baghan Zahra , Seyedghasemi Navisa Sadat , Heshmati Hashem , Khatirnamani Zahra , Rafiei Narges 
Published: April 2022

Background. Disposal of non-sanitary 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 Aq-Qala, 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 t-test, Wilcoxon, independent samples t-test and Mann-Whitney 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 self-efficacy 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, inter-sectoral cooperation between village councils is recommended. Background Disposal of non-sanitary 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 Aq-Qala. Methods This interventional study was conducted on 72 heads of rural households in Aq-Qala, 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), self-efficacy (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 t-test and Mann-Whitney 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 self-efficacy 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, inter-sectoral 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, inter-sectoral 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 Aq-Qala health houses (Rural health worker/ Behvarz) and all those who helped us in conducting this study.