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.

 

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

Results

Discussion

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.

 

Conclusion

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.

 

Acknowledgments

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.