Volume 29, Issue 2 (Spring 2021)                   Avicenna J Nurs Midwifery Care 2021, 29(2): 102-112 | Back to browse issues page

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Saadatnia S, Soltani F, Saber A, Kazemi F. The Effect of Group Counseling Based on Health Belief Model on Nutritional Behavior of Pregnant Women with Overweight: a Randomized Controlled Trial. Avicenna J Nurs Midwifery Care 2021; 29 (2) :102-112
URL: http://nmj.umsha.ac.ir/article-1-2216-en.html
1- MSc, Department of Midwifery Counseling, School of Nursing and Midwifery, Hamadan University of Medical Sciences, Hamadan, Iran
2- Associate Professor, Department of Reproductive Health, Mother and Child Care Research Center, Hamadan University of Medical Sciences, Hamadan, Iran
3- Assistant Professor, Department of Nutritional Sciences, Department of Nutritional Sciences, School of Nutritional Sciences and Food Technology, Kermanshah University of Medical Sciences, Kermanshah, Iran
4- PhD, Department of Reproductive Health, Mother and Child Care Research Center, Department of Midwifery, School of Nursing and Midwifery, Hamadan University of Medical Sciences, Hamadan, Iran , faridehkazemi21@yahoo.com
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✅ Therefore, the implementation of counseling intervention based on the structures of the health belief model can play an effective role in improving the nutritional behavior patterns of pregnant women.

Extended Abstract:   (547 Views)

Overweight and obesity are a significant challenge in pregnancy care. This study was conducted to investigate the effect of group counseling based on health belief model on nutritional behavior of overweight pregnant women referred to Kermanshah health centers.


Materials and Methods

This clinical trial was performed in 2018 on 90 pregnant women in Kermanshah. Among the comprehensive health centers, 4 centers were randomly selected for intervention and 4 centers for the control group.
The inclusion criteria were: singleton pregnancy, literacy, ability to speak Persian, suffering from underlying diseases (such as diabetes, hypertension, thyroid, liver and heart disease), lack of addiction and pregnancy. Also, the exclusion criteria were the occurrence of any medical and midwifery problems during the study, not attending a counseling session, and the occurrence of adverse events during the study. After making the necessary arrangements and providing the necessary explanations and having the participants signing a consent form, the grouping was performed.
Then 4 sessions of group counseling program prepared for the intervention groups were held for one month. The content of the counseling included nutrition counseling and familiarity with the food pyramid and principles of proper nutrition, increasing sensitivity to obesity and its complications, understanding the severity of the obesity problem, understanding the obstacles and benefits of following a proper diet and increasing self-efficacy and ultimately achieving healthy eating behavior. The data collection tool was a researcher-made questionnaire including demographic and midwifery information, health belief model constructs, knowledge and nutritional behavior questionnaire.
Kolmogorov-Smirnov test was used to check the normality of quantitative data distribution and independent t-test was used to compare the two groups in terms of demographic and contextual variables and Chi-square test was done if it was qualitative. In addition, ANCOVA test was used to examine the differences between the two groups in terms of different constructs of health belief model and nutritional behaviour.
Data were analyzed using SPSS 16 (SPSS Inc., Chicago, IL., USA). Significance level was considered less than 0.05.


Table 1. The content of the sessions

  First Session Second Session Third Session Fourth Session
Goal Introduction to the general principles of nutrition and the food pyramid Familiarity of mothers with overweight and obesity and its complications Familiarity of the mother with healthy eating behavior Review and conclusions
Compliance with GATHER steps Complies with the first, second and third stages of GATHER Complies with the second, third and fourth stages of GATHER Complies with the third, fourth and fifth stages of GATHER Corresponds to the sixth stage of GATHER
Adaptation to model structures Increasing awareness Increased sensitivity and perceived severity Increase perceived benefits and barriers Increase of self-efficacy and improve in nutritional behavior, use the booklet as a guide to action
Consulting actions taken Familiarization of group members with each other, stating the goals of counseling sessions, providing conditions for building relationships and open communication, emphasizing relationships and group dynamics
Introducing and familiarizing counselors and clients and explaining counseling sessions and explaining its goals, familiarity with general principles of nutrition and food pyramid, familiarity with nutrition during pregnancy and the importance of proper weight gain in pregnancy to increase awareness of pregnant women, answering potential questions clients and helping clients In order to express their wants, needs and beliefs about nutrition and weight gain during pregnancy, summarize the counseling session and plan the next session.
Explain the complications and problems of obesity in pregnancy in order to increase the sensitivity and perceived severity, increase the perception of overweight pregnant women about vulnerability to obesity, provide statistics on the complications of obesity, summarize counseling sessions and plan the next session Investigate the benefits and barriers to healthy eating behaviors in order to increase perceived benefits and reduce perceived barriers, identify barriers to engaging in appropriate nutritional behaviors and try to overcome them, correct misconceptions about nutritional behaviors during pregnancy, summarize counseling sessions, and plan the next session. Appropriate weight management strategies in pregnancy and how to implement healthy eating behaviors and increase self-efficacy, use the booklet as a guide for action, evaluate the success of mental and physical skills to improve diet, answer potential questions of clients and their ambiguities and problems in implementation Teaching techniques and methods, summarizing the whole counseling process
Used tools White board, Visual aids, PowerPoint, Educational pamphlet White board, PowerPoint White board, PowerPoint, White board, PowerPoint, Nutrition booklet



 The mean age of participants in the intervention group was 24.91(6.19) and in the control group was 27.53(5.60). After controlling the effect of pre-test scores on the constructs of knowledge, perceived susceptibility, perceived severity, perceived benefits, perceived barriers, self-efficacy and nutritional behavior, the results showed a significant increase after the intervention, in the mean scores of the intervention group (P=0.001).



Based on the findings of the present study, the knowledge and behavior of pregnant women about nutrition during pregnancy in the experimental group compared to the control group increased significantly after the educational intervention. This confirms the effectiveness of a counseling program designed based on the Health Belief Model in increasing the awareness of pregnant women under intervention. These results are in line with the findings of more or less similar studies conducted on pregnant women in different countries; the results of studies by Anderson et al. (1995) in Scotland (29) and Boyd et al. (2003) in the United States (30) showed that nutrition education improved the level of nutrition awareness during pregnancy.
Regarding the effect of educational interventions on improving the nutritional behaviors of pregnant women, some studies have shown similar results. The results of a study on pregnant women in the United States showed a significant improvement in energy intake, folate, vitamin B6, iron, zinc, and calcium, as well as the number of daily meals consumed by vegetables and bread and cereals after training in the experimental group (31). In addition, the results of a study by Chawla et al. (2004) in India showed a positive effect of education on better intake of energy, protein, milk and dairy products and some minerals in the intervention group (32). The results of some studies also show the positive effect of educational interventions on improving nutritional behavior (29, 34). The reason for the difference in the results of these studies can be related to the way of providing training and educational interventions.
It is worth noting that we must also pay attention to the fact that awareness is necessary to change behavior; but it is not enough and nutritional awareness and behavior are not necessarily positively related (35). The results of studies by Anderson et al. (1995) in Scotland (29) and Burr et al. (2007) in the United Kingdom (34) showed that despite providing the necessary knowledge to pregnant women, no improvement in their eating behaviors was observed. Lack of significant positive effect of nutrition education can be related to factors other than mere information (awareness), such as lifestyle (36), community beliefs (29), economic issues and access to food (34).
 It is also noteworthy to point out to the increase in sensitivity, perceived severity, perceived barriers and perceived benefits in the structures of the health belief model in the intervention group compared to the control group. Significant increases in model component scores have been obtained in several other studies: Sharifirad et al. (2001) on the effectiveness of nutrition education in type 2 diabetic patients (37), the research of Ahmadpoor ​​et al. (2015) (38), the research of Sharifirad et al. (2013) (39) and the study of Khoramabadi et al. (2016) (40) ). In this study, the mean components of the health belief model were significantly increased after training. Also, according to various studies, increased sensitivity and perceived severity are predictive factors in appropriate health adoptions. Therefore, it is a fact that they consider it necessary to provide the necessary education to pregnant women in order to accept the benefits of proper nutrition and to overcome the existing barriers.



The findings of this study showed the effectiveness of counseling based on the health belief model in promoting the nutritional behavior of pregnant women with high body mass index. Researchers in this study recommend counseling interventions based on this model. Therefore, the implementation of counseling intervention based on the structures of the health belief model can play an effective role in improving the nutritional behavior patterns of pregnant women.



This article is taken from the approved dissertation in Hamadan University of Medical Sciences with ethics ID IR.UMSHA.REEC.1397. Researchers thank the respected university authorities and all those who have assisted them in this research project.

Conflicts of Interest

The authors declared no connflict of interest.


Type of Study: Original Research | Subject: Midwifery
Received: 2020/07/29 | Accepted: 2020/08/14 | Published: 2020/11/28

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