The Effect of Education Based on the Health Belief Model on the Promotion of Sanitary Wastewater Disposal Behavior

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Extended Abstract
Background
Disposal of non-sanitary wastewater in rural areas results in 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, this study aimed 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 involved 72 heads of households from two villages in Aq-Qala, Iran. The villages were divided into the experimental and control groups using simple random allocation. Then, 36 heads of households were selected from each village. The intervention for the experimental group included three training sessions about sanitary wastewater disposal. The classes were held in the rural health centers in the villages. Each training session lasted one hour and included lectures followed by questions and answers. The control group did not participate in the training sessions. We collected data before and after the intervention using a researcher-designed questionnaire based on HBM. The questionnaire consisted of 4 sections: demographic characteristics (6 questions); knowledge (5 questions); 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), cues to action (2 questions); and behavior (3 questions). The questionnaires were completed through participant interviews conducted by the health center staff who were familiar with the local dialect of the villages. The data were analyzed through conducting paired t- test, Wilcoxon, independent t-test, and Mann-Whitney test using Statistical Package for the Social Sciences (SPSS) version 17.
Results
The mean age of the participants in the experimental and control groups was 40.4 (±15.5) and 42.8 (±14.1) years, respectively. In both groups, 80.6% of the participants were male. Rural health worker's opinion was important for 86% and 100% of participants in the intervention and control groups, respectively. Rural health center staff provided information on sanitary sewage disposal to 75% of the participants in the experimental group and 100% of the control group. Prior to the intervention, no significant difference was found between the two groups in the mean score of knowledge, HBM constructs, behavior, and demographic characteristics (P>0.05). The experimental group’s mean score for knowledge, perceived susceptibility, perceived severity, perceived benefits, and self-efficacy significantly increased after the intervention, while the mean score for perceived barriers decreased significantly (P<0.05). However, there was no significant difference in the mean score for behavior (P>0.05).
Conclusion
The results of the present study showed that the training sessions had a positive and significant effect on the knowledge and HBM constructs, but did not affect the domain of behavior in the experimental group. Considering that the construction of absorption wells is costly, inter-sectoral cooperation between village councils is recommended in addition to increasing the number of training sessions.
Practical Implications of Research
Since absorption well construction is expensive, health education specialists and instructors should acknowledge that, in addition to 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 GOUMS 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.