تأثیر مداخله آموزشی مبتنی بر منافع و موانع درک شده بر قصد انجام تلقیح واکسن ویروس پاپیلومای انسانی در زنان آسیب‌پذیر: کاربرد مدل اعتقاد بهداشتی

نوع مقاله : اصیل پژوهشی

نویسندگان

1 دانشجوی کارشناسی ارشد مامایی، دانشکده پرستاری و مامایی، دانشگاه علوم پزشکی اصفهان، اصفهان، ایران.

2 دانشیار گروه بهداشت باروری ومامایی، مرکز تحقیقات مراقبت‌های پرستاری و مامایی، دانشکده پرستاری و مامایی، دانشگاه علوم پزشکی اصفهان، اصفهان، ایران.

3 متخصص بیماری‌های عفونی، مرکز کنترل بیماری‌ها، وزارت بهداشت درمان و آموزش پژشکی، تهران، ایران.

4 استادیار گروه بهداشت باروری و مامایی، مرکز تحقیقات مراقبت‌های پرستاری و مامایی، دانشکده پرستاری مامایی، دانشگاه علوم پزشکی اصفهان، اصفهان، ایران.

چکیده

مقدمه: ویروس زگیل تناسلی (HPV)، شایع‌ترین بیماری منتقل شونده از طریق رابطه جنسی می‌باشد. لزوم توسعه آموزش پیشگیرانه، جهت عدم ابتلاء به HPV در جوامع مختلف مورد توجه قرار گرفته است. با توجه به لزوم توسعه برنامه‌های جامع ارتقاء سلامت برای زنان آسیب‌پذیر از جمله برنامه‌های پیشگیرانه، تلقیح واکسن و تشخیص به‌موقع، مطالعه‌ حاضر با هدف تعیین تأثیر آموزش مبتنی بر منافع و موانع درک شده بر قصد انجام تلقیح واکسن HPV در زنان آسیب‌پذیر انجام شد.
روش‌کار: این مطالعه‌ کارآزمایی بالینی شاهددار تصادفی شده، به‌صورت پیش آزمون-پس آزمون در سال 1397 بر روی 64 نفر از زنان آسیب‌پذیر در مراکز تحت پوشش بهزیستی شهر اصفهان انجام شد. زنان در دو گروه آزمون و کنترل قرار گرفتند. آموزش سازه‌های منافع و موانع درک شده (با کاربرد مدل اعتقاد بهداشتی) در رابطه با قصد انجام تلقیح واکسن پاپیلومای انسانی، طی 4 جلسه آموزشی در گروه مداخله اجرا گردید. واحد‌های پژوهش قبل، بلافاصله و 6 هفته بعد از آزمون با پرسشنامه محقق‌ساخته، مورد ارزیابی قرار گرفتند. تجزیه و تحلیل داده­ها با استفاده از آزمون تی مستقل، من‌ویتنی، کای دو استفاده شد. آزمون­ها در سطح خطای 5% و با استفاده از نرم­افزار SPSS (نسخه 22) انجام شد.
یافته‌ها: بررسی و تحلیل داده­ها نشان داد که در گروه آزمون اجرای مداخله باعث ایجاد افزایش معنادار در منافع درک شده و کاهش معنادار در موانع درک شده بلافاصله بعد از آزمون شده بود (001/0>p). 6 هفته بعد از آزمون، منافع درک شده پایدار بوده (840/0=p) و موانع درک شده کاهش معنادار یافته بود (017/0=p). همچنین قصد رفتار تلقیح واکسن بلافاصله بعد از آزمون و 6 هفته پس از آزمون به‌طور معناداری افزایش یافته (001/0=p)، در حالی‌که در گروه کنترل تغییرات امتیازات منافع، موانع و قصد رفتار در سه مرحله­ اندازه­گیری معنادار نبود.
نتیجه‌گیری: با توجه به نتایج مطالعه، برنامه آموزشی بر اساس سازه‌های منافع و موانع درک شده زنان بر افزایش قصد آنان در مورد قصد انجام تلقیح واکسن ویروس پاپیلومای انسانی مؤثر است.

کلیدواژه‌ها


عنوان مقاله [English]

Effect of educational intervention based on perceived benefits and barriers on human papillomavirus inoculation in vulnerable women: Application of health belief model

نویسندگان [English]

  • Leila Ab Ab 1
  • Shahnaz Kohan 2
  • Katayoun Taeri 3
  • Zahra boroumandfar 4
1 M.Sc. student in Midwifery, School of Nursing and Midwifery, Isfahan University of Medical Sciences, Isfahan, Iran.
2 Associate professor, Department of Midwifery and Reproductive Health, Nursing and Midwifery Care Research Center, School of Nursing and Midwifery, Isfahan University of Medical Sciences, Isfahan, Iran.
3 Special of infectious diseases, Center for Communicable Diseases Control (CDC), Ministry of Health and Medical Education (MOHME), Tehran, Iran.
4 Assistant professor, Department of Midwifery and Reproductive Health, Nursing and Midwifery Care Research Center, School of Nursing and Midwifery, Isfahan University of Medical Sciences, Isfahan, Iran.
چکیده [English]

Introduction: Genital wart virus (HPV) is the most common sexually transmitted disease. The need to develop preventive education to avoid HPV in different communities has been considered. Due to the need to develop comprehensive health promotion programs for vulnerable women, including prevention programs, vaccination inoculation and early diagnosis, the present study was conducted to determine the effect of perceived benefits and barriers to HPV vaccination in vulnerable women.
Methods: This randomized controlled clinical trial study was performed as a pretest-posttest in 1397 on 64 vulnerable women in welfare centers in Isfahan. Women were divided into intervention and control groups. Training on perceived benefit structures and barriers (using the Health Belief Model) regarding the intention to inoculate human papilloma vaccine was performed during 4 training sessions in the intervention group. Research units were evaluated before, immediately and 6 weeks after the test with a researcher-made questionnaire. Data analysis was performed using independent t-test, Mann-Whitney and Chi-square. The tests were performed at an error level of 5% using SPSS software (version 22).
Results: The analysis of data showed that in the intervention group, the implementation of the intervention caused a significant increase in perceived benefits and a significant decrease in perceived barriers immediately after the test (p <0.001). 6 weeks after the test, perceived benefits were stable (p = 0.840) and perceived barriers were significantly reduced (p = 0.017). Also, the intention of vaccine inoculation behavior immediately after the test and 6 weeks after the test increased significantly (p = 0.001), while in the control group, changes in benefit scores, barriers and intention to behave in three stages of measurement were not significant.
Conclusion: According to the results of the study, the educational program based on the constructs of benefits and perceived barriers of women is effective in increasing their intention to inoculate human papillomavirus vaccine.

کلیدواژه‌ها [English]

  • Vulnerable Women
  • Behavior intent
  • Health belief model
  • Perceived Benefits
  • Perceived barriers
  • Human Papillomavirus Vaccine
  1. Menon S, van den Broeck D, Rossi R, Ogbe E, Mabeya H. Multiple HPV infections in female sex workers in Western Kenya: implications for prophylactic vaccines within this sub population [published correction appears in Infect Agent Cancer. 2019 Jan 21;14:1]. Infect Agent Cancer 2017; 12:2.
  2. Muñoz-Ramírez A, López-Monteon A, Ramos-Ligonio A, Méndez-Bolaina E, Guapillo-Vargas MRB. Prevalence of Trichomonas vaginalis and Human papillomavirus in female sex workers in Central Veracruz, Mexico. Rev Argent Microbiol 2018; 50(4):351-358.
  3. Toh ZQ, Licciardi PV, Russell FM, Garland SM, Batmunkh T, Mulholland EK. Cervical Cancer Prevention Through HPV Vaccination in Low- and Middle-Income Countries in Asia. Asian Pac J Cancer Prev 2017; 18(9):2339-2343.
  4. Brown B, Carcamo C, Blas MM, Valderrama M, Halsey N. Peruvian FSWs: understanding HPV and barriers to vaccination. Vaccine 2010; 28(49):7743-7747.
  5. Brown B, Cabral A. Letter to the editor: female sex workers and HPV vaccine. Hum Vaccin Immunother 2020; 16(1):124-125.
  6. Kalan-Farmanfarma Kh, Zareban I, Jalili Z, ShahrakiPour M. Effectiveness of Education Based on the Health Belief Model on Performing Preventive Measures for Breast Cancer Among Female Teachers in Zahedan. J Educ Community Health 2014; 1(1):11-18.
  7. Larson HJ, Jarrett C, Eckersberger E, Smith DM, Paterson P. Understanding vaccine hesitancy around vaccines and vaccination from a global perspective: a systematic review of published literature, 2007-2012. Vaccine 2014; 32(19):2150-2159.
  8. MacDonald NE; SAGE Working Group on Vaccine Hesitancy. Vaccine hesitancy: Definition, scope and determinants. Vaccine 2015; 33(34):4161-4164.
  9. Thompson D. Improving Human Papillomavirus Vaccination Rates Through Evidence-Based Interventions. 2018.
  10. Jadgal KM, Alizadeh Siuki H, Shamaian Razavi N. The using of health belief model on AIDS preventive behaviors among health volunteers. Journal of Research and Health 2015; 5(1):58-64.
  11. Rambout L, Tashkandi M, Hopkins L, Tricco AC. Self-reported barriers and facilitators to preventive human papillomavirus vaccination among adolescent girls and young women: a systematic review. Prev Med 2014; 58:22-32.
  12. Sharma M, Romas JA. Theoretical Foundations of Health Education and Health Promotion. 2nd ed. Canada: Jones & Barlett Learning; 2012. p. 31-44.
  13. Sundstrom B, Brandt HM, Gray L, Pierce JY. It’s my time: applying the health belief model to prevent cervical cancer among college-age women. Journal of Communication Management 2018.
  14. Strecher VJ, Rosenstock IM. The health belief model. Cambridge handbook of psychology, health and medicine 1997; 113:117.
  15. Kasting ML. Human papillomavirus vaccination status association with subsequent health behaviors 2016.
  16. James AS, Campbell MK, Hudson MA. Perceived barriers and benefits to colon cancer screening among African Americans in North Carolina: how does perception relate to screening behavior? Cancer Epidemiol Biomarkers Prev 2002; 11(6):529-34.
  17. Ghahramani M, Alami A,  Mohammad zade moghaddam H,  Moodi  M. Screening for Cervical Cancer: An Educational Intervention Based on Transtheoretical Models and Health Belief in Women of Gonabad, Iran. Iran J Obstet Gynecol Infertil 2018; 21( 5):22-32.
  18. Shobeiri F, Javad MT, Parsa P, Roshanaei G. Effects of Group Training Based on the Health Belief Model on Knowledge and Behavior Regarding the Pap Smear Test in Iranian Women: a Quasi-Experimental Study. Asian Pac J Cancer Prev 2016; 17(6):2871-2876.
  19. Saffari M, Shojaei Zadeh D. Principles and Foundations of Health Promotion and Education. 1nd ed. Tehran: Samat; 2016.
  20. Montazeri A, Fallahi H. Effect of educational interventions on sexual high risk behavior between drug addicts ex-users based on the Health Belief Model. Journal of School of Public Health and Institute of Public Health Research 2014; 12(2):93-104.
  21. Lawshe CH. A quantitative approach to content validity. Personnel Psychology 1975; 28:563-75.
  22. Waltz CF, Bausell RB. Nursing research: Design, statistics, and computer analysis. FA Davis Co; 1981.
  23. Novak JS. Berek & Novak's gynecology. 15nd ed. Lippincott Williams & Wilkins; 2012. P. 1058-1063.
  24. Juntasopeepun P, Thana K. Parental acceptance of HPV vaccines in Chiang Mai, Thailand. Int J Gynaecol Obstet 2018; 142(3):343-348.
  25. Restivo V, Costantino C, Fazio TF, Casuccio N, D'Angelo C, Vitale F, et al. Factors Associated with HPV Vaccine Refusal among Young Adult Women after Ten Years of Vaccine Implementation. Int J Environ Res Public Health 2018; 15(4):770.
  26. Didarlu A, Shojaeizadeh D, Mohammadian H. Plan health promotion based on behavioral change models. 2nd ed. Tehran: Asare Sobhan; 2014. P. 74-99.
  27. Karimy M, Gallali M, Niknami Sh, Aminshokravi F, Tavafian SS. The effect of health education program based on Health Belief Model on the performance of Pap smear test among women referring to health care centers in Zarandieh. Journal of Jahrom University of Medical Sciences 2012; 10(1):53-59.
  28. Zareban I, Faryabi R, Rafie M, AizadehSIUKI H. The investigation of the impact of health belief model based training on brest self-exam in women referred to health centers. Journal of Health Literacy 2016; 1(3):172-81.
  29. Skinner CS, Tiro J, Champion VL. Background on the health belief model. Health behavior: Theory, research, and practice 2015; 75.
  30. 30Dayo K, Aluko J, Ojo. Perceptions and Beliefs about Cervical Cancer and Screening Services: A Qualitative Analysis among Female Sex Workers in Abuja, Nigeria. 2020/04/24.
  31. Marra E, van Dam L, Kroone N, Craanen M, Zimet GD, Heijman T, et al. Determinants of Human Papillomavirus Vaccination Intention Among Female Sex Workers in Amsterdam, the Netherlands. Sex Transm Dis 2017; 44(12):756-762.
  32. Brown B, Blas MM, Heidari O, Carcamo C, Halsey NA. Reported changes in sexual behaviour and human papillomavirus knowledge in Peruvian female sex workers following participation in a human papillomavirus vaccine trial. Int J STD AIDS 2013; 24(7):531-535.
  33. Boroumandfar Z, Kianpour M, Zargham A, Abdoli S, Tayeri K, Salehi M, et al. Changing Beliefs and Behaviors Related to Sexually Transmitted Diseases in Vulnerable Women: A Qualitative Study. Iran J Nurs Midwifery Res 2017; 22(4):303-307.