Academic journal article Iranian Journal of Public Health

Impact of Education Based on Theory of Planned Behavior: An Investigation into Hypertension-Preventive Self-Care Behaviors in Iranian Girl Adolescent

Academic journal article Iranian Journal of Public Health

Impact of Education Based on Theory of Planned Behavior: An Investigation into Hypertension-Preventive Self-Care Behaviors in Iranian Girl Adolescent

Article excerpt


Currently, hypertension is increasingly growing in the most of developing countries due to rapid changes in lifestyle and the increase in urbanization stress (1). As reported by World Health Statistics (2012), 28.1% of men and 25% of women suffer from systolic blood pressure (BP) more than 140 or diastolic one above 90 across the world. Such statistics are estimated 26.1% for males and 22.4% for females in Iran. In this case, a growth of cardiovascular disease for about 3%, from 2002 to 2008, has been reported in Iran (2), while the age of hypertension is decreasing. In Iran, 4.7% of total investigated 13-18 years old students had a BP higher than normal level. Furthermore, hypertension was more in females compared to males (3). In a study, systolic BP of females was significantly higher than males (4).

In line with these findings, new views about the prevention of hypertension emphasize on prevention and treatment of hypertension during the adolescence, since the risk factors for cardio-vascular disease are formed during adolescence period. Hence, it is reasonable to start a healthy lifestyle to improve health level from adolescence period (5). Considering the fact that adolescents usually do not put any limitation for their nutrition and do not consider it, inappropriate nutrition is observed in this age group more than any other group (6).

In order to increase the impact of health education, community health nurses could take advantage of behavioral change theories (7). One is the theory of planned behavior (TPB) which provides a systematic framework for the health education. According to this theory, the intention to conduct a behavior is related to an individual's positive or negative evaluation of self-performance of the particular behavior (attitude), an individual's perception about the particular behavior, which is influenced by the judgment of significant others, such as parents, spouse, friends and, teachers (subjective norms), and an individual's perceived ease or difficulty of performing the particular behavior (perceived behavioral control) (8, 9). This theory presents an appropriate framework to study behaviors associated with nutrition, such behaviors are those activities conducted to confront competitive motivations and twofold attitude, mentioning that they are influenced by social factors. Therefore, the theory that pays attention to the impact of attitudes, subjective norms, and perceived behavioral control is appropriate to conduct nutritional behaviors (10). In a study investigating the application of TPB in healthy nutritional behaviors in American adolescents, the TPB was effective to predict affecting factors of nutritional behaviors (11). All components of the TPB had a positive correlation with behavioral intention where the theory could predict the intention of physical activities accomplishment up to 58% among Australian adolescents (12).

One of the most appropriate strategies for health education is the workshop. Activities of the workshop are based on the process of problem solving, aim to provide a condition for the participants to make decisions on a health problem or behavior, and then provide their own solutions (13). School, as the focal center of education, is a suitable place, making adolescents accessible assumed as a place to acquire health information from health assistants. In this regard, Shi-Chung et al. examined nutrition-based health improvement in schools; leading to the increase of student's attitudes in school using educational intervention (14). Further, applying the education based on TPB led to the increase of attitude, perceived behavioral control and intentional behavior in physical activity dimension (15, 16).

Considering that educational program about risk factors of hypertension rather than reinforcing tendency to improvement of sport and physical activity in schools is emphasized by health experts (17), this study designed an educational program based on TPB to investigate intention to change of nutrition and activity related behaviors among female adolescents of schools. …

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