The effect of educational intervention based on the self-efficacy theory of high school students in adopting preventive behaviors of COVID-19
Zahra Rezaie1, Vahid Kohpeima Jahromi1, Vahid Rahmanian1, Nader Sharifi2
1 Research Center for Social Determinants of Health, Jahrom University of Medical Sciences, Jahrom, Iran
2 Department of Public Health, Khomein University of Medical Sciences, Khomein, Iran
|Date of Submission||20-Feb-2022|
|Date of Acceptance||28-Mar-2022|
|Date of Web Publication||26-Nov-2022|
Dr. Nader Sharifi
Department of Public Health, Khomein University of Medical Sciences, Postal code/P.O.Box: 38817-43364, Khomein
Source of Support: None, Conflict of Interest: None
BACKGROUND: The COVID-19 pandemic has become a major problem for education systems. This study was conducted to investigate the effect of educational intervention based on the self-efficacy theory of high-school students in adopting preventive behaviors of COVID-19.
MATERIAL AND METHODS: This quasi-experimental study was performed on Hazrat Zahra and Shahed high-school students in Jahrom (southern Iran) in 2021. In total, 160 students (80 each in the intervention group and the control group) were selected by multistage random sampling. Data collection tools included a demographic information questionnaire and self-efficacy in adopting preventive behaviors from COVID-19 researcher-made questionnaire. Questionnaires were completed by all participants before and 3 months after the educational intervention. The educational intervention was performed for 6 weeks by using an educational program based on Bandura self-efficacy theory. The intervention was performed during 12 sessions of face-to-face training in the classroom (two 1-h sessions per week), distributing educational packages and sending educational videos through cyberspace. Data were analyzed using Chi-square test, independent t test, paired t test, and linear regression.
RESULTS: After the educational intervention, a significant difference was observed in the intervention group before and after the educational intervention (P = 0.018) and between the intervention and the control groups (P = 0.001) in the self-efficacy in adopting preventive behaviors from COVID-19 score. Also, the average self-efficacy score of students increased with an increase in parental education level and a history of COVID-19 in family members.
CONCLUSION: Educational intervention based on self-efficacy theory was shown as an effective method to improve students' self-efficacy in adopting preventive behaviors from COVID-19.
Keywords: Behavior, COVID-19, education, self-efficacy, students
|How to cite this article:|
Rezaie Z, Kohpeima Jahromi V, Rahmanian V, Sharifi N. The effect of educational intervention based on the self-efficacy theory of high school students in adopting preventive behaviors of COVID-19. J Edu Health Promot 2022;11:383
|How to cite this URL:|
Rezaie Z, Kohpeima Jahromi V, Rahmanian V, Sharifi N. The effect of educational intervention based on the self-efficacy theory of high school students in adopting preventive behaviors of COVID-19. J Edu Health Promot [serial online] 2022 [cited 2023 Sep 26];11:383. Available from: https://www.jehp.net//text.asp?2022/11/1/383/361929
| Background|| |
The latest threat to world health is the COVID-19 pandemic., This pandemic has become a major problem for education systems. As a result of the pandemic, more than 1.9 billion students from 190 countries were forced to use virtual education instead of face-to-face schooling. In addition to educational problems and potential inequalities due to distance learning practices, school closures can disrupt students' social interaction, mental health, and physical activity., The importance of face-to-face education in schools is very clear. According to Pattison's study, the physical challenges of reopening schools cause school staff to not pay enough attention to the effects of COVID-19 on students' health. Promoting school health and maintaining the health of students and teachers is essential for reopening schools. One study found that high-school students had poor knowledge and preventive behavior about COVID-19.
Theoretical frameworks should be used to make behavior change interventions effective. Fathian-Dastgerdi's study identified self-efficacy as the strongest predictor in explaining preventive behaviors of COVID-19 in adolescents. Self-efficacy is a central construct in many theories of health behavior and refers to an individual's perceived ability to do a task.,,, According to Bandura, self-efficacy can be improved through four principles: mastery experiences (gaining experience by the individual by facing a new challenge and succeeding in it); social role models (modeling by one person by observing the successful performance of a task by similar people); social persuasion (convincing one to have the skills and abilities to succeed through encouragement); and emotional and physiological states (improve individual self-efficacy by learning how to manage anxiety when experiencing challenging situations).,,
With the gradual reopening of schools, we should identify ways to ensure the health of students, school parents, their families, and the community. Adopting correct behaviors and following health protocols by students will be very effective in achieving this goal. So far, most interventions have focused on improving people's knowledge and motivation to adopt preventive behaviors; thus, there is a need to improve adolescents' perception of their ability to take action, leading to success in adopting preventive behaviors from COVID-19. Therefore, this study was conducted to investigate the effect of educational intervention based on the self-efficacy theory of high school students in adopting preventive behaviors of COVID-19.
| Material and Methods|| |
Study design and setting
This quasi-experimental study was performed on high-school students in Jahrom (southern Iran) in 2021.
Study participants and sampling
A total of 160 students (80 each in the intervention group and control group) were considered for the sample according to Tavafi et al., power 90%, type I error (α) 5%, effect size 0.554, and considering the 15% probability of samples falling. From all high schools in Jahrom, two girls' high schools, Hazrat Zahra and Shahed, were selected by lottery random sampling. Then, Hazrat Zahra High School was randomly selected for the intervention group and Shahed High School was selected for the control group. Four classes were randomly selected from each high school to reach a sample size (at least 80 students). The inclusion criteria were high-school students who are in school for at least the next two semesters, and the exclusion criteria included not completing a written consent form and not attending regular training courses in the intervention group.
Data collection tool and technique
Data collection tools included demographic information questionnaire (age, field of study, degree, family economic status, father's education, mother's education, place of residence, history of personal or family infection with COVID-19, and vaccination status of COVID-19) and self-efficacy in adopting preventive behaviors from COVID-19 questionnaire. This researcher-made questionnaire has been designed based on a careful study of scientific texts and related questionnaires. To design the questionnaire, an extensive search was performed using the keywords “COVID-19 prevention,” “COVID-19 prevention behavior,” and “self-efficacy.” Seven articles were selected from 30 articles published between 2010 and 2021. Various aspects of individual behaviors affecting the prevention of COVID-19 were extracted from the articles, and the questions were designed based on the theory of self-efficacy. Then, the necessary changes were made in writing and arranging the questions and appropriate scoring. To improve the face validity of the questionnaire, by taking into account the opinions of experts, the necessary corrections were made and the questions were designed based on rationality and appropriateness to the characteristics of the respondents and were placed in the questionnaire in an appropriate order. Then, the questionnaire was evaluated by 10 experts in related fields, and the content validity ratio (CVR) and content validity index (CVI) were calculated. The calculated ratios for each item were compared with the table numbers provided by Lawsche, and CVR values above 0.62 were confirmed. Moreover, items with CVI values greater than 0.70 were approved for retention in the questionnaire. To assess the reliability, the questionnaire was randomly completed by 20 high-school students in Jahrom. Sample participants in this phase of the study did not participate in the next phases. The collected data were analyzed using SPSS21, and Cronbach's alpha value of the questionnaire was calculated to be 0.73. Considering that Cronbach's alpha value above 0.7 is acceptable as internal consistency, the reliability of the questionnaire was confirmed.
Participants were reassured about the confidentiality of information and the optionality of participating in the study, and they completed a written consent form. Demographic information and self-efficacy in adopting preventive behaviors from COVID-19 questionnaires were completed by the intervention and control groups.
Educational Intervention Program
The educational intervention was performed for 6 weeks by using an educational program based on Bandura self-efficacy theory. The intervention was performed during 12 sessions of face-to-face training in the classroom (two 1-h sessions per week) by distributing educational packages and sending educational videos through the Internet [Table 1].
Participants were briefed on the objectives of the research and assured that their information would be confidential. Then, the written consent form was completed by all participants. At the end of this study, an educational package to improve self-efficacy in adopting COVID-19 preventive behaviors was provided to the controls. This research was approved by the Research Ethics Committees of Jahrom University of Medical Sciences with code IR.JUMS.REC.1400.046.
Three months after the educational intervention, the questionnaires were completed by intervention and control groups. Data were entered into SPSS 17.0. (SPSS Inc., Chicago, IL, USA), and the normality of data was initially investigated using the Kolmogorov–Smirnov test. Data were then analyzed using Chi-square, independent t test, and paired t test. Also, linear regression (ENTER method) was used to investigate the relationship between variables studied with self-efficacy scores. The significant level for all tests was less than 0.05.
| Results|| |
The mean age of students in the intervention and control groups was 13.84 ± 1.10 and 13.50 + 1.06, respectively (P = 0.051). All subjects in the control group and 68 (85%) of the intervention group had received at least one dose of the COVID-19 vaccine (P = 0.001). On the contrary, the variables of the parents' education, area of residence, self-assessment of the economic situation, and history of COVID-19 in students and their families were not significantly different in the intervention and control groups (P > 0.05) [Table 2].
|Table 2: Comparison of frequency distribution of demographic characteristics of experimental and control groups|
Click here to view
Before the educational intervention, there was no significant difference between the self-efficacy in adopting preventive behaviors from the COVID-19 score in the intervention and the control groups (P = 0.428). However, after the educational intervention, a significant difference was observed in the intervention group before and after the educational intervention (P = 0.018) and between the intervention and the control groups (P = 0.001) [Table 3].
|Table 3: Comparison of self-efficacy in adopting preventive behaviors from COVID-19 score in intervention and control groups (before and after intervention)|
Click here to view
After analyzing the results by using linear regression, only the education of the parents and a history of family members with COVID-19 showed a significant relationship with the self-efficacy in adopting preventive behaviors from COVID-19 score in students. In fact, the average self-efficacy score of students increased with an increase in parental education level and a history of COVID-19 in family members [Table 4].
|Table 4: Factors affecting of self-efficacy using linear regression model|
Click here to view
| Discussion|| |
This study was conducted to investigate the effect of educational intervention on the self-efficacy of high-school students in adopting preventive behaviors of COVID-19. The results showed that the educational intervention based on the theory of self-efficacy was effective in improving students' behaviors to prevent the spread of COVID-19. In Elgzar's study of nursing students, the educational intervention increased their self-efficacy in overcoming perceived barriers to COVID-19 preventive behaviors. The Solhi study showed that educational intervention improves students' self-esteem and self-efficacy in adopting smoking prevention behavior. Rakhshani's study also showed the effect of educational intervention on improving self-efficacy and health-promoting behaviors in high-school students. Karimy study showed self-efficacy as an important predictor of preventive behaviors. However, in Evenson's study to modify dietary behaviors in young adults, educational intervention was not successful in improving self-efficacy. Self-efficacy can affect people's motivation to adopt health-oriented behaviors. People with high self-efficacy are more responsible for their own health and of others and are more willing to adopt health-oriented behaviors. Therefore, in the present study, the implementation of an educational intervention based on the theory of self-efficacy improved the readiness of individuals to adopt COVID-19 preventive behaviors. Of course, it seems that the success of educational interventions in improving people's self-efficacy depends on the time allotted for training, its quality, and repetition.
According to the findings of the present study, parental education and the history of other family members with COVID-19 were associated with self-efficacy in adopting COVID-19 preventive behaviors in students. The findings of Hatef's study showed variables of age, level of education, and level of income as predictors of self-efficacy in patients with chronic diseases. Reisi's findings identified health literacy as an important predictor of self-efficacy for self-care behaviors in diabetics. Based on these results, more attention should be paid to students belonging to the lower socioeconomic strata, marginal and rural schools, and whose parents do not have a high level of education and literacy. Self-efficacy and behavior improvement programs in the context of the COVID-19 crisis should pay special attention to these groups. Furthermore, higher self-efficacy in students who have a history of exposure to the disease in the family emphasizes the need to the perceived susceptibility and severity of COVID-19. Therefore, purposeful and theory-based educational interventions can provide safer conditions for students to attend schools.
Limitation and recommendation
One of the limitations of the study was the problems of access to students and the possibility of closing schools due to the prevalence of a new variant of the coronavirus. In addition, due to the novelty of the research and the lack of similar interventions, it was difficult to compare our results with other scientific evidence.
It is suggested that future studies investigate the application of other models of health education and health promotion in adopting preventive behaviors of COVID-19.
| Conclusion|| |
Educational intervention based on self-efficacy theory was shown as an effective method to improve students' self-efficacy in adopting preventive behaviors against COVID-19. The reopening of schools poses a serious challenge to the health of students, teachers, and their families in the context of the COVID-19 pandemic. Effective educational programs are essential to engage students in self-care along with other protective measures. Improving students' perceived self-efficacy in adopting disease-preventing behaviors will be very useful and effective. In addition, the results can be used as a useful guide for all people who are at high risk of transmitting the disease, such as university students, residents of dormitories, and other gathering places.
This research is taken from a research project approved by Jahrom University of Medical Sciences with code IR.JUMS.REC.1400.046. Jahrom Education Department is appreciated for cooperating in this research project.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Fauci AS, Lane HC, Redfield RR. Covid-19 — Navigating the Uncharted. N Engl J Med 2020;382:1268–9.
Shanbehzadeh M, Kazemi-Arpanahi H, Mazhab-Jafari K, Haghiri H. Coronavirus disease 2019 (COVID-19) surveillance system: Development of COVID-19 minimum data set and interoperable reporting framework. J Educ Health Promot 2020;9:203.
Daniel SJ. Education and the COVID-19 pandemic. Prospects 2020;49:91–6.
Khlaif ZN, Salha S, Kouraichi B. Emergency remote learning during COVID-19 crisis: Students' engagement. Educ Inf Technol 2021;26:7033–55.
Wang G, Zhang Y, Zhao J, Zhang J, Jiang F. Mitigate the effects of home confinement on children during the COVID-19 outbreak. Lancet 2020;395:945–7.
Tang S, Xiang M, Cheung T, Xiang Y-T. Mental health and its correlates among children and adolescents during COVID-19 school closure: The importance of parent-child discussion. J Affect Disord 2021;279:353–60.
Sharfstein JM, Morphew CC. The urgency and challenge of opening k-12 schools in the fall of 2020. JAMA [2020;324:133.
Pattison KL, Hoke AM, Schaefer EW, Alter J, Sekhar DL. National Survey of School Employees: COVID-19, school reopening, and student wellness. J Sch Health 2021;91:376–83.
Viner RM, Bonell C, Drake L, Jourdan D, Davies N, Baltag V, et al
. Reopening schools during the COVID-19 pandemic: Governments must balance the uncertainty and risks of reopening schools against the clear harms associated with prolonged closure. Arch Dis Child 2021;106:111–3.
Handebo S, Adugna A, Kassie A, Shitu K. Determinants of COVID-19-related knowledge and preventive behaviours among students in reopened secondary schools: Cross-sectional study. BMJ Open 2021;11:e050189.
Jahromi V, Ghashghaei S, Sharifi N. Improvement of osteoporosis-related behaviors in female students based on trans theoretical model. J Educ Health Promot 2020;9:221.
Fathian-Dastgerdi Z, Khoshgoftar M, Tavakoli B, Jaleh M. Factors associated with preventive behaviors of COVID-19 among adolescents: Applying the health belief model. Res Soc Adm Pharm 2021;17:1786–90.
Selzler A-M, Habash R, Robson L, Lenton E, Goldstein R, Brooks D. Self-efficacy and health-related quality of life in chronic obstructive pulmonary disease: A meta-analysis. Patient Educ Couns 2020;103:682–92.
Rafiola R, Setyosari P, Radjah C, Ramli M. The effect of learning motivation, self-efficacy, and blended learning on students' achievement in the industrial revolution 4.0. Int J Emerg Technol Learn 2020;15:71–82.
Tang MY, Smith DM, Mc Sharry J, Hann M, French DP. Behavior change techniques associated with changes in postintervention and maintained changes in self-efficacy for physical activity: A systematic review with meta-analysis. Ann Behav Med 2019;53:801–15.
Ramezani T, Sharifirad G, Rajati F, Rajati M, Mohebi S. Effect of educational intervention on promoting self-care in hemodialysis patients: Applying the self-efficacy theory. J Educ Health Promot 2019;8:65.
Alimohammadi L, Mirghafourvand M, Zarei F, Pirzeh R. The effectiveness of group counseling based on Bandura's self-efficacy theory on sexual function and sexual satisfaction in Iranian newlywed women: A randomized controlled trial. Appl Nurs Res 2018;42:62–9.
Kardong-Edgren S. Bandura's self-efficacy theory… Something is missing. Clin Simul Nurs 2013;9:e327–8.
Schunk DH, Pajares F. Self-efficacy theory. Handb Motiv Sch 2009;35:54.
Tavafi M, Baghaei R. The effect of health habit-based intervention program on self-care and self-efficacy of nursing students. J Heal Promot Manag 2019;7:53–61.
Elgzar WT, Al-Qahtani AM, Elfeki NK, Ibrahim HA. COVID-19 outbreak: Effect of an educational intervention based on health belief model on nursing students' awareness and health beliefs at Najran University, Kingdom of Saudi Arabia. Afr J Reprod Health 2020;24:78–86.
Solhi M, Abasi H, Hazavehei MM, Roshanaei G. Effect of educational intervention on empowerment of high school student in prevention of smoking. Razi J Med Sci 2014;21:52–63.
Rakhshani T, Kashfi SM, Motlagh Z, Kohan N. Effect of educational intervention based on self-efficacy on health-promoting behaviors in high-school girl students: A quasi-experimental study. Int J Pediatr 2020;8:12461–70.
Karimy M, Koohestani HR, Araban M. The association between attitude, self-efficacy, and social support and adherence to diabetes self-care behavior. Diabetol Metab Syndr 2018;10:86.
Evenson AL, Sanders GF. Educational intervention impact on osteoporosis knowledge, health beliefs, self-efficacy, dietary calcium, and Vitamin D intakes in young adults. Orthop Nurs 2016;35:30–6.
Hatef M, Sharif Nia H, Mousavinasab N, Esmaeili R, Shafipour V. Self-efficacy and prediction of associated factors in patients with chronic diseases. J Maz Univ Med Sci 2018;28:86–94.
Reisi M, Mostafavi F, Javadzade SH, Mahaki B, Sharifirad G. Assessment of some predicting factors of self-efficacy in patients with type 2 diabetes. Iran J Endocrinol Metab 2015;17:44–52.
[Table 1], [Table 2], [Table 3], [Table 4]