The effect of education program based on the health belief model on elementary school students' behaviors of prevention from playground accidents

Introduction: In the elementary education period, when children are more likely at risk of injury, playground accidents pose serious threats to children. Moreover, they potentially cause severe injuries. The purpose of the present study is to investigate the effect of education program based on health belief model on elementary school students' behaviors of prevention from playground accidents. Material and Method This research is an experimental follow-up study with a pretest - posttest design including a control group. The research was conducted at Rıza Özmenoğlu Elementary School in Konak - İzmir between September 2016 and June 2017. The sample consists of an experimental group of 62 participants and a control group of 62 participants. Three criteria, namely age, gender, and risk-of-injury score, were considered in the randomization of experimental and control group. A Student Description Form, Injury Behavior Checklist (IBC) and Injury Attitude Scale (IAS) were used as data collection tools. The data were collected with face-to-face interviews and by sending out the tools to the parents as enclosed in envelops. Following the assessment of the pretest, the students in the experimental group were present 40-minute education classes in four sessions to improve their attitudes and behaviors to avoid playground accidents in line with the principal concepts of the health belief model. Two weeks after the training program, a posttest was administered to both groups and the follow-ups were conducted in March and June 2017. In the post-training follow-ups, the students were given an educational booklet entitled "Let's Play Safe". The control group was provided with no training. The data were analyzed in consideration of number-percentage distribution, mean-standard deviation and by employing chi-square analysis, repeated measures ANOVA, Bonferroni test, a significance test for the difference between two means, Pearson's correlation analysis, while the prediction rates concerning the changes in the experimental scale and sub-dimension were obtained with linear regression analysis. The experimental and control groups' statuses pertaining to accidents chi-square test and injuries in the school playground in the last 6 months were compared with Yates' correction chi-square test. Findings: The mean ages of experimental and control group are 9.41±0.69 and 9.48±0.62, respectively. 53.2% of the participants in the experimental group is 10 years old and 59.7% are male, while 54.8% of the students in the control group is 10 years old and 56.5% are females. A homogeneous distribution was observed within the experimental and control group (p>.05). After the training program, the mean scores of experimental group concerning the "fate" sub-domain significantly decreased in comparison with the control group. In the "fate" sub-domain, a highly significant difference was observed between the mean scores in terms of time, group*time and group interaction (p<.05). The mean scores related to susceptibility/severity and preventability sub-domains significantly increased in comparison with the control group. A highly significant difference was observed between the mean scores pertaining to the scores of susceptibility/severity and preventability sub-domains in terms of time, group*time and group interaction (p<.05). The overall mean scores of the experimental group from IBC significantly decreased in comparison to the control group. The comparison of the overall mean scores from IBC in terms of groups and time revealed a statistically significant difference between the mean scores by time, group*time and group interaction (p<.05). It was figured out that the education program had a moderate level of effect on fate (d=0.65), susceptibility/severity (d=0.56), preventability (d=0.42), and risk of injury (d=0.54). In all the sub-domains and "risk of injury", the level of "labor force" was found to be high. The scores from the "fate" and "risk of injury" were found to have decreased by .664 and .645 times respectively while the scores related to susceptibility/severity and preventability sub-domains increased by .581 and 530 times respectively. Conclusion: The eduation program based on the principal concepts of the health belief model intended for the prevention of elementary school students from playground accidents was indicated to be capable of providing scientific guidance to produce behavioral changes by allowing for a grounded evaluation of students' attitudes. Keywords: Elementary school, accidents, health belief model, nursing, school health care