The effect of feedback, education, and social media interventions based on the health belief model on protective beliefs in adults exposed to secondhand smoke at home

Objective: To compare the effects of feedback, interactive group education, and social media (HBM FEM) interventions based on the Health Belief Model on protective beliefs in adults at risk of exposure to secondhand smoke (SHS) at home. Method: A single-blind (participant), randomized controlled trial with three parallel active groups was conducted. Each group included 31 participants who received either a one-time 15-minute exposure feedback session; a one-time 50-minute exposure feedback plus interactive group training session; or exposure feedback plus daily twice-a-day social media posts over four weeks. The study was carried out between February and April 2025 in a Family Health Center and two Public Education Centers in Antalya, Turkey. Data were collected at baseline and week five using the Health Belief Model Scale for Preventing SHS Exposure Behaviors, actual and perceived risk levels of exposure, urine cotinine test kits, and the Thirdhand Smoke (THS) Beliefs Scale. Results: All interventions significantly improved beliefs about SHS exposure (p <.001), with significant group differences (F (2, 89) = 17.887, p <.001); the exposure feedback + interactive group education group had the strongest impact. Although cotinine positivity declined, the change was not statistically significant (p> .05). No significant differences were found among groups in the concordance between actual and perceived risk (F (2, 89) = 0.557, p = 0.575). Beliefs about THS also improved significantly (p <.001), again with the greatest effect in the exposure feedback + interactive group education group (F (2, 89) = 30.677, p <.001). Conclusion: Health Belief Model-based interventions were effective in enhancing protective beliefs, with the greatest impact observed in the exposure feedback + interactive group education, followed by exposure feedback + social media and exposure feedback only. While participants' beliefs about SHS and THS changed, there was no change in actual SHS exposure.