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

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 six 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. Data analyses were done using analysis of variance, Friedman and Mann-Whitney U Tests. 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 i n t he e xperimental g roup c ompared t o t he c ontrol g roup ( P < 0 . 0 5). T he mean a nd s tandard deviation of adoption of smoking preventive behaviors at the beginning of the study in smoking and non-smoking students in the experimental group were 12.66 1.24 and 8.66 0.16, respectively. Then, after three months they changed to 22.32 3.53 and 9.38 0.33, respectively, which represents a significant increase in the adoption o f behaviors in the experimental group (p < 0.0001), but no significant difference was observed in the adoption of smoking preventive behaviors in smoking and non-smoking students in the control group (p > 0.05). Conclusions: This study showed that educational intervention by Telegram application based on HBM and HL was effective in promoting the adoption of smoking preventive behaviors among university students.