The Effect of Health Education based on the Health Belief Model about Changing the Belief Related to Substance use among University Students in
Mosul City-Iraq
Nasir Muwfaq Younis1, Arkan Bahlol. Naji2
1 Assist. Prof ,2Professor
1College of Nursing-University of Mosul-Iraq
2University of Baghdad, College of Nursing, Iraq
E-mail: [email protected]
Abstract
Aim: To identify the Effect of Health Education Based on the Health Belief Model about Changing the Belief Related to Substance use Among University Students in Mosul City-Iraq Methods: A probability (simple random sample) of (N=80) undergraduate student in different specialties would be selected. The study sample will be recruited from (4) colleges in the University of Mosul's Engineering, Sciences, Medicine and Education Colleges. The sample will be randomly assigned into experimental and control groups of (40) undergraduate student for each group..For during from 25of October / 2019 till 1 of February/2021. Data is analyzed using the "Statistical Package for Social Science" (SPSS) software for Windows (V:26).
Results: This finding indicated that before the intervention, mean scores for all concepts of HBM, add to Motivation, Control, and behaviors intensions of students they were almost equal.
However, after the intervention were significantly different in the study group, while it was not significant in the control group.
Conclusion:This study concluded that designing an HBM-based study could affect students' understanding and their behaviors in the field of substance abuse. Considering the positive correlation between construct of HBM, particularly in "perceived benefits and perceived severity" related to students’ beliefs. These beliefs implied a significant correlation with each other and with the attention to the prevention of addiction.
KEYWORDS: Effect, Health Belief Model, Substance use, University student
1.Introduction:
Substance use disorders (SUD) are significant health concern worldwide. Substance use is inveterate trouble which is associated with significant morbidity and mortality. These troubles also account for important health care employment and medical costs (Maqbool et al., 2019).
Substance use disorders and intemperance represent universal public health problem of substantial socioeconomic inclusion (Whiteford, et al.,2015). Many clinical studies signalize that there is an association between substance use and personality troubles with guide that personality pathology may affect both an etiology and course of substance use troubles (Moran, et al., 2015).Substance use problems are associated with capitalize health retro gradation, weakness and death due to impacts and exceed (Mclellan ,2017). There is growing concern about the effects of conflict and wars on substance use in Iraq (Al Hemiery et al., 2017). It emerged that substance abuse can have an effect on society Systems do not only serve as a health concern but also as a social issue. And other opioid addictions, too health issues, coupled with social disadvantage (Silverman et al., 2018).Students are among the groups with higher drug risk abuse because they don't know the illegal drugs' outcomes yet have no right convictions about them (Panahi et al., 2018). Substance use "alcohol, tobacco, hookah and illicit drugs" is a big issue of the world today (Montazeri, et al., 2017). However, preparing college has historically been looked a defensive factor against the development of substance use troubles in new decades substance use has become one of the most diffuse health troubles on university in the United States (Schulenberg et al., 2017). According to the United States study on medicine and criminality the number of alcoholism users was between (155-250 million) in 2013, approximately (5.3- 7.5%) of the people aged 15 to 65 years old. Mousawi,2014, Found in Iraqi studies on secondary school and university students reported smoking use rates spreading from (3.2- 21%).However, to the World Health Organization (WHO), record (3.3 million) deaths in the world are attributable to alcoholism in 2012 (Busse et al., 2014), this statement specified that unintentional injuries comprised the second largest part of alcohol concerning deaths after cardiovascular diseases and that a large plurality of alcohol concerning deaths and injuries in the world are way traffic concerning and happen in developing countries. The most common age ambit of narcotic abusers in the world is (18 -25) years. Some of students are at these ages and narcotic abuse increase has been showed in them, among illegal drugs with consuming of (3.8%) is the most common abused narcotic in the world (Rezahosseini et al, 2014). The country of Iraq expects a population of 39.2 Million, Iraq is one of the West Asian countries bordering the Arabian Gulf. It is bordered by “Turkey in the north, Kuwait and Saudi Arabia in the south, Syria and Jordan in the west, and Iran in the east”. Iraq's geographical position is also another agent that makes Iraq vulnerable to drug use, due to the long and spongy border between Iraq and Iran, as Iran is facing increasing and severe substance use problems (Mahmood et al.,2018). Substance use is expanding particularly among young people who are always in high school and university students (Goreishi and Shajari., 2013). Consequently, the distribution in Iraq of lifetime uses of
"alcohol, licit or illicit substances" was at least 10.3 percent (Al-Hemiery et al., 2017).According to reports of the Iraqi Ministry of Health in 2017, the number of smokers in Iraq was (31%) male, (4%) female. On the other hand, according to the statistics of the (WHO,2014, Smith&Foster,2014), the number of alcoholics is (6.8%) for men, and (0.6%) for female. While, the number of drug addicts (illegal drug) in Iraq was around (7.2%).University students, aged (18-24) is duration of quick economic, social, and cultural transmission in Iraq which has produced a suitable condition for growing socially upset types of smoking, hookah, narcotic and alcohol use. Substance use is increased trouble in Iraq, as in many developing countries. In Iraq colleges' students are very a substantial class that is susceptible to depend on the drugs. This is a very earnest trouble that worries both the population and government. Addiction among youth in Iraq is associated with public health troubles such as poverty and school truancy. The most recent study in Iraq found that (41.7%) of students are smokers, and this allows the awful statement that smoking is considered an admission to the use of other illegal drugs, which can in turn destroy your life with alcohol and brain effects (Mahmood et al., 2018).
2.Methodology:
2.1. Design of the Study:
True experimental design by using the random controlled trial approach is conducted to determine the efficacy of the HBM in changing the belief related to substance use among university students in Mosul City for during from 25of October / 2019 till 1 of January /2021, 2.2. Setting of the Study:
The study is carried out in Iraq. In University of Mosul is a public university situated in Mosul. It's one of the largest educational and research centers in the Mosul City, and the second largest in Iraq, behind the University of Baghdad. Contain of 22 college in different specialties divided to four colleges in the University of Mosul's Engineering, Sciences, Medicine and Education College. Mosul University is located in the north side of the center of Mosul City at the right braid of the Tigris River.
3.3. Sample of the Study:
A probability (simple random sample) of (N=80) undergraduate student in different specialties would be selected. The study sample will be recruited from (4) colleges in the University of Mosul's Engineering, Sciences, Medicine and Education Colleges. A sampling
pool consisted of 80 students distributed at four college in Mosul University included (Political Science, Engineering, Sciences, and Nursing Colleges). The sample will be randomly assigned into experimental and control groups of (40) undergraduate student for each group and are evenly distributed with esteem to their age and the colleges. Such chosen is employed of pool of topics that have the criteria contain students who have using on (Smoking, Hookah, Drug abuse and Alcohol).
2.4. Instrument of the Study:
The data for this study was collected by using questionnaire contain of two parts; part I, involved, to describe the student's socio-demographic characteristic such as (age, gender, grade, college ,socioeconomic status) the part II, involved the using scale to measure students' beliefs towards of substance use. This instrument developed from more than one source and includes(El-Rahman Mona,et.al,2014; Hall, D. H., & Queener, J. E. ,2007; Manning, K.,et.al,2018; Nobiling, B. D., & Maykrantz, S. A. 2017; Luoma, J. B.,et.al, 2010).this scale to developed on the rule of health belief model and included (6) major subscales and (3) secondary
; (1): "the perceived susceptibility subscale", (2): "the perceived severity subscale", (3): "the perceived benefits subscale", (4): "the perceived barrier subscale", (5): "the perceived cue to action" (6): "the perceived self-efficacy subscale": These secondary components include (7) :"the perceived motivation subscale", (8): "the perceived behavioral control subscale" and (9): "the perceived behavioral intentions subscale" to changes in the student's beliefs about substance use .
3.Results :
Table 1: Demographical Characteristics and Homogeneity Between Experimental and Control Groups
Socio-demographic
Experimental (n=40)
Control (n = 40)
Total (n = 80)
t
M SD M SD M SD
Age 23.37 2.09 23.70 2.04 23.53 2.06 0.230
BMI 20.51 2.64 21.95 2.22 21.23 2.53 0.283
Characteristics F % F % F % χ2
Gender 0.694
Male 36 90 37 92.5 73 91.25
Female 4 10 3 7.5 7 8.75
Marital status 0.856
Married 10 25 11 27.5 21 26.25
Single 29 72.5 27 67.5 56 70
Divorced 1 2.5 2 5 3 3.75
Residential unit 0.433
House owner 29 72.5 32 80 61 76.25
House rent
11 27.5 8 20 19 23.75
Table 1 shows that the study participants were 80 students between 18 - 27 years old, and the overall mean age for the participants was 23.53 (SD = 2.06). Concerning body mass index (BMI) most of participants were normal body weight. The overall mean BMI for participants was 21.23 (SD = 2.53). Regarding other demographic characteristics, most of participants for the experimental group were male (90%) single (72.5%) and house owner (72.5%). For the control group most of participants were male (92.5%) unmarried (67.5%) with house owner (80%).
Table 2: Distribution and Homogeneity of Behavioral Habits Between Experimental and Control Groups
Behavioral habits
Experimental (n=40)
Control (n=40)
Total (n=80) χ2
F % F % F %
Smoking and Hookah 24 0.949
Currently smoking 21 87.5 16 66.66 37 77.08 Smoke intermittent 3 12.5 8 33.34 11 22.92
Alcohol consumption 7 1.810
1-2 drinks/day 1 14.28 2 28.58 3 21.43
3-4 drinks/day 1 14.28 0 0.0 1 7.14
5 drinks or greater /day 0 0.0 0 0.0 0 0.0
1-2 drinks/weekly 2 28.58 1 14.28 3 21.43
1-2 drinks/monthly 3 42.86 4 57.14 7 50
Drug abuse 9 2.476
1-2 drinks/day 3 33.33 3 33.33 6 33.33
3-4 drinks/day 0 0.0 1 11.11 1 5.56
5 drinks or greater /day 4 44.45 2 22.22 6 33.33
1-2 drinks/weekly 1 11.11 3 33.34 4 22.22
1-2 drinks/monthly 1 11.11 0 0.0 1 5.56
According to the (Table 2) most of participant in the experimental group were currently smoker (87.5%), then followed intermittent smokers approximately (12. 5%); As for alcohol consumers, the proportions were distributed between a user (1-2 daily) and (3-4 daily) at a rate of (14.28%), (1-2 a week) at a rate of (28.58%) and the last (1-2 monthly) at a rate of (42.86%);
Likewise, the use of drug shows the highest percentage (44. 45%) taking drugs 5 or more times a day. For the control group, as well the majority of participant were currently smokers (66.66%) then followed intermittent smokers approximately (33. 34%); The most use of alcohol is (1- 2drinks/monthly) approximately (57.14%). Finally, the use of drug shows the high rate (33.34%) take drug (1-2 drinks/weekly). There were no statistically significant differences in the baseline behavioral habits between the groups (Table 2).
Table 3: Baseline Homogeneity in the Health Belief Model Concepts, Motivation, Behavioral Control and Intensions Between Experimental and Control Groups
Beliefs
Groups
Experimental (n=40)
Control (n=40)
M SD M SD t p
Perceived Susceptibility 2.42 0.76 2.39 0.48 0.217 0.829
Perceived Severity
3.12 0.71
3.17 0.67 -0.339 0.736
Perceived Benefit
2.91 0.76
2.96 0.78 -0.288 0.774
Perceived Barrier
2.75 0.59
2.91 0.56 -1.229 0.223
Cue to action
2.31 0.70
2.27 0.61 0.211 0.779
Perceived Self-Efficacy
2.27 0.91
2.41 0.99 -0.643 0.522
Motivation
2.77 0.76
2.69 0.90 0.482 0.631
Behavioral control
2.83 0.99
2.73 0.54 0.573 0.568
Behavioral Intentions 2.81 1.05 2.92 0.86 -0.443 0.604
M: mean; SD: Standard Division; t: t-test; (p): P-value; Minimum value for health belief model constructs= 1; Maximum value for health belief model constructs= 5
The results of this table indicate that there was no statistically significant difference (p > 0.05) in the health beliefs model concepts, motivation, Behavioral control and Behavioral Intensions at baseline (pre-test).
Table 4: Descriptive Statistics Measuring Change in Health Belief Model Concepts, Motivation, Behavioral Control and Behavioral Intensions Across Study Group and Over Times.
HBM Concepts
Groups
M (SD)
(T 0) (T 1) (T 2)
Perceived Susceptibility
Exp 2.42 (0.76) 3.25 (0.41) 3.21 (0.46) Con 2.39 (0.48) 2.44 (0.70) 2.51(0.62) Perceived Severity Exp 3.12 (0.71) 3.89 (0.38) 3.82 (0.33)
Con 3.17 (0.67) 3.28 (0.79) 3.23 (0.64) Perceived Benefits Exp 2.91 (0.76) 3.78 (0.41) 3.63 (0.90) Con 2.96 (0.78) 3.13 (0.72) 3.11 (0.88) Perceived Barriers Exp 2.75 (0.59) 2.69 (0.50) 2.70 (0.56) Con 2.91 (0.56) 2.93 (0.51) 2.87 (0.70) Cue to action Exp 2.31 (0.70) 3.18 (0.78) 3.35 (0.40) Con 2.27 (0.61) 2.61 (0.62) 2.83(0.61) Perceived Self-
Efficacy
Exp 2.27 (0.91) 3.22 (0.60) 3.26 (0.56) Con 2.41 (0.99) 2.56 (1.00) 2.55 (0.95)
Motivation Exp 2.77 (0.76) 3.62 (0.36) 3.58 (0.48)
Con 2.69 (0.90) 2.78 (0.77) 2.72 (0.91) Behavioral Control Exp 2.83 (0.99) 3.38 (0.30) 3.36 (0.45) Con 2.73 (0.54) 2.81(0.51) 2.89 (0.59) Behavioral Intentions
Exp 2.81(1.05) 4.07 (0.70) 3.71 (0.69) Con 2.92(0.86) 3.08 (1.02) 3.04 (0.89)
Table 4: indicated that before the intervention, mean scores for all concepts of HBM, add to Motivation, Control, and behaviors intensions of students they were almost equal. However, after the intervention were significantly different in the study group, while it was not significant in the control
group. The difference was higher among the intervention group than the control group and it was positive for all concepts except for perceived barriers. This issue indicates that education caused significant increase in scores of sensitivities, severity, perceived benefits, cues to action, self-efficiency, motivation, behavioral control and intensions. It further reduced perceived barriers of students in the intervention group.
4. Discussion:
The findings showed a positive influence of health education on the improvement of student beliefs in preventive addiction based on the Health Belief Model. In particular, the participants found post-education that substance use is a serious condition for substance use if they did not participate in preventive substance use behaviors. In addition, the perceived susceptibility, perceived benefits, cues to action, motivation, control, perceived self-efficacy and intentions of participants in modifying perceptions about substance use behaviors in the future were significantly improved after intervention with health belief model-based health intervention. According to the results of (Table 1), the mean ± SD age of the study group and control group was (23.37 ± 2.09) and (23.70 ± 2.04) respectively. In addition, the same table demonstrated that majority of participant were normal body weight, the overall mean (± SD) of the body mass index were (21.23 ± 2.53). Concerning other demographic characteristics, the majority of participant were male (91.25 %), and house owner (76.25 %).Regarding marital status, most of participants were single (70 %). Table (1) this study is consistent with (AL- Hemiery et.al 2017) who found that the male participants reported a significantly higher prevalence of tobacco use, alcohol use, and drug abuse compared to females. On the other hand (Table 2) illustrated that the most of participants were using smoking and hookah (60 %), Alcohol abusers (17.5 %) and drug abusers (22.5 %). Similar to this research (Goings, Hidalgo,
& McGovern, 2018), the use of smoking during adolescence was one of the best predictors of incessant smoking habits (57 percent). This result is consistent with the study in Baghdad 2017 found that lifetime prevalence of alcohol use in Baghdad was 17.8% and drug use prevalence was 7.02% (Al-Hemiary, Al-Diwan, Hashim, & Abdulghani, 2017). These increases in the use of alcohol, prescription drugs, and illicit drugs may indicate an increase in substance use disorders in the country and, therefore, an increased need for treatment interventions. Tables (1, 2) interpretation shows that the sample was homogeneous among themselves because the application of (randomized controlled trials (RCTs) one of its prerequisites must be pool homogeneous, and for this the application of (RCTs) is considered the best way to study efficacy to solve a specific problem through the application of (HBM), so the results of the two groups
(study and control) appeared homogeneous. This study is similar with (Kissal & Kartal,2019), who found the average age of students was (21.21 ± 2.90). About 97.9% were single, 72.9% of them had low family income, and 81.3% lived in a house owner. Table 3 showed that there were no significant differences in participant's beliefs, Motivation, Behavioral Control and Intensions at baseline (pre-test).This implies the homogeneity of beliefs, Motivation, Behavioral Control and intention between experimental and control group. An explanation of this table (3) it is normal in the initial test of the two groups (Experimental & Control) that their knowledge and belief about the substance use is little or weak because they are not exposed to a program, as well as the fact that the two groups are homogeneous among themselves, the results are convergent and logical. This outcome is consistent with the research (Mahmood, et al., 2018) that showed the homogeneity of students awareness participants regarding the harms of substance use.
According to the results of (Table 4), there was an increase in the value of the (perceived susceptibility, perceived severity, perceived benefits, cues to action, self-efficacy, motivation, behavioral control and intensions) over time, and there was decrease in the value of perceived barriers over time. Based on the findings, there was no substantial difference between the mean score of beliefs before the intervention of the research and control groups, but the difference was substantial after the experiment and indicates the positive effect of the health education in changing students’ health beliefs about substance use and minimizing students’ perceived barriers of substance use. Table (4) as we mentioned earlier in this chapter, a pre-test was administered for both (study and control groups) prior to implementation of the intervention. The study (experimental) group participants were exposed to the interventions only. The pretest results revealed that the mean of participants in study and control groups is unaccepted (table 4).
This means that the students' belief was low prior to implementation the intervention at pretest. It was also found that there were no statistically significant differences between study and control groups (p > 0.05) in the score of the students' beliefs towards all concepts of Health Belief Model related to substance use at pretest (table 4). This means that all students who participated in the study (study and control groups) were homogeneous and they had the same information and knowledge about substance use at baseline. After that, all sessions of the intervention had been given for study group participants only. After completion the intervention, a posttest-1 was carried out for both groups (study and control) .The results showed that there was a clear change in mean except for perceived barriers. This indicates that the interference has become positively affected .The main purpose of this step was to evaluate the outcomes of the educational program.
And then after (2) months, a posttest-2 was also performed for both groups to investigate the efficacy of the education program. The main purpose of this step was to identify the efficacy of
the educational program in retaining adequate information and knowledge by the study group participants. This research is consistent with the findings of studies performed on target group on substance use and the impact of education on the health belief model (Solhi &Abolfathi, 2013;
Shojaei et al., 2014).This result is consistent with the study of (Bronchia , et al., 2012) showed that there is a significant correlation between the health belief model parts and preventive behaviors of addiction and drug abuse and also a significant correlation between the variables of students and (HBM) in preventive behaviors of drug abuse (P=0.002).This outcome is consistent with the (Fadaei et al., 2020) study that showed that there is a post-test level, the mean intervention and control groups scored substantially different; the preventive substance abuse in the intervention group, behaviors and their dimensions changed ( p value < 0.001and t = 14.57).In line with this study (Mahmood et al., 2018) who found after the introduction of a health education program, the awareness of drug use by students has increased significantly and this reflects the effectiveness of health education program to enhance the awareness of substance use amongst students.
5. Conclusion:
This study concluded that the health education through a health belief model demonstrates the importance of substance use prevention and has a positive impact on student perceptions of perceived susceptibility, perceived severity, perceived benefits of advised substance use stopping interventions in the prevention of addiction and reduction of different health hazards, Cues to action for activate "readiness" to quit within substance user and self- efficacy for confidence in their ability to terminate use of substance.
Acknowledgements:
We thank all the students for their participation in the study Conflict of interest:
The authors declare that they have no competing interests
Data availability statement:
The data that support the findings of this study are available on request from the corresponding author
ORCID:
Nasir Muwfaq Younis http://orcid.org/0000-0002-7987-0484
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