Adding Health Literacy to the Health Belief Model: Effectiveness of an Educational Intervention on Smoking Preventive Behaviors Among University Students

Abstract

Background: It is believed that smoking is the gateway to use substances and illicit drugs. Due to an increase in smoking among students, we thought there is a need for more efficient ways to prevent smoking among the young and adolescents. Objectives: This study aimed to develop an extended version of the Health Belief Model (HBM) with elements of Health Literacy (HL) to assess whether an educational intervention could be effective in smoking prevention based on this new development in 2016. Methods: This was a quasi-experimental study performed on 130 students living in dormitories of Shahid Beheshti University of Medical Sciences in Tehran, Iran, who were recruited and assigned to experimental and control groups (each containing 65 students). The experimental group received 6 electronic educational sessions via telegram application while the control group received no intervention. The data were collected using a questionnaire containing items on HBM, smoking preventive behaviors, and a measure of HL (the HL inventory for adults-HELIA). The questionnaire was completed at three time-points: before, immediately and three months after the intervention. The significance level was set at 0.05. Results: Before the intervention, there was no significant difference in the demographic and background variables, the underlying level of knowledge, preventive behaviors, HL, and all the constructs of the model between the groups (P > 0.05). After the intervention, comparing two groups showed that the mean scores of knowledge, preventive behaviors, HL, and all components of the model changed significantly in the experimental group compared to the control group (P < 0.05). The mean and standard deviation of adoption of smoking preventive behaviors at the beginning of the study in smoking and non-smoking students in the

Establishing the efficacy of interventions to improve health literacy and health behaviours: a systematic review

“…Of the 22 included studies, the earliest study was from 2014 [30], the latest from 2020 [35][36][37] with the majority (fourteen) being published since 2018 [32-37, 44, 45, 47-52]. Eighteen studies were randomised and included 1 cross over design [50], 5 cluster randomised [39,41,44,47,51] and 12 individually randomised trials [30-32, 34, 36-38, 40, 43, 45, 49, 52]. The remaining four were quasi-experimental pre-post controlled trials [33,35,42,48].…”

“…The remaining four were quasi-experimental pre-post controlled trials [33,35,42,48]. Studies took place in nine countries -USA [30,31,37,39,40,42,43,45], Australia [35,51,52], Iran [32,34,47], China [41,44], Japan [36,49], Taiwan [48], Niger [38], Germany [50] and Demark [33].…”

“…Two studies focused on the domain of disease prevention (cancer screening [39] and malaria health literacy [38]), eight focused on healthcare (diabetes [30,37], gestational diabetes [32], breast cancer [36], cardiac conditions [33,34], one or more chronic conditions [35] and people taking two or more medications daily [31]). The remaining 12 studies focused on health promotion with eight focusing on general health promotion [41,42,44,45,48,[50][51][52], two focusing on nutrition [40,43], one on nutrition and physical activity [49] and one on smoking prevention [47]. Studies are summarised in Table 1.…”

“…There was considerable variation in how health literacy was defined and measured (see Table 2). Six studies [36,40,42,43,45,47] did not provide a definition, two [31,34] gave a definition but no clear reference to identify it, and the remaining 14 studies referenced 10 different definitions (three studies [30,35,48] gave multiple definitions) with Ratzan and Parker [54] used in five studies [30,35,37,39,51] and Sorensen [6] cited in four studies [33,[48][49][50].…”

“…A variety of health literacy measures were used across the 22 studies. Four studies used condition specific measures [30,[37][38][39], four used culture specific measures [32,44,47,50], and three created measures for use in the studies [30,41,48]. The rest used validated general instruments such as newest vital sign -NVS [37,40,43], test of functional health literacy in adults / short test of functional health literacy in adults -TOFHLA/STOFHLA [31,34,37,42,45], Health Literacy Questionnaire -HLQ [33,35,51,52], HLS-EU-Q16 [49], and HLS14 [49].…”