The Effect of an Educational Program based on the Information-Motivation-Behavioral Skill Model on Medication Adherence among Patients with Pulmonary Tuberculosis

The Effect of an Educational Program based on the Information-Motivation-Behavioral Skill Model on Medication Adherence among Patients with Pulmonary Tuberculosis | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article The Effect of an Educational Program based on the Information-Motivation-Behavioral Skill Model on Medication Adherence among Patients with Pulmonary Tuberculosis Ali Mirbalouchzehi, Moradali Zareipour, Abedeh Arzani, Mohammad Saeed Jadgal This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6130200/v1 This work is licensed under a CC BY 4.0 License Status: Under Revision Version 1 posted 10 You are reading this latest preprint version Abstract Background Approximately one-third of the world’s population is infected by tuberculosis bacteria and is at risk of being infected by the tuberculosis disease. The aim is to investigate the effect of an educational program based on the Information-Motivation-Behavioral Skill Model on medication adherence in Pulmonary Tuberculosis patients. Methods The quasi-experimental study examined 140 patients selected by simple randomization. Three educational sessions were held for the intervention group. Finally, the data were analyzed by descriptive and inferential tests run in the SPSS 20 software. Results The mean scores of IMB constructs were significantly higher in the intervention group after the intervention (p 0.05). Likewise, the mean medication adherence score of the intervention group increased significantly in the post-intervention phase (p 0.05). Besides, treatment adherence was significantly higher in the intervention than in the control group after the education (p < 0.05). Conclusion The findings emphasize the effectiveness of the educational intervention in improving treatment adherence among TB patients in the intervention group. Pulmonary Tuberculosis Disease Education Information-Motivation-Behavioral Skills Model Medication adherence Figures Figure 1 Introduction Approximately one-third of the world’s population is infected by tuberculosis bacteria and is at risk of being infected by the tuberculosis disease. Around 9.3 million individuals suffer from active tuberculosis, and virtually 1.8 million people die due to this illness. 1 The disease becomes bold when we find that one out of three individuals on the earth suffers from the TB Bacillus, one person is infected every four seconds, and one dies of this disease every 10 seconds. 2 Among Iran’s various provinces, Sistan and Baluchestan and Golestan report the highest incidence rate in the country (20.01–29.2 among 100,000 individuals). 3 The term medication adherence means the patient’s compliance with medical instructions and includes two axes: Using medications timely and using medications based on the physician’s instructions. 4 Studies reveal that socioeconomic factors like social support and poverty are associated with non-adherence to TB treatment. 5 , 6 In addition, individual behavioral factors such as awareness of the TB disease, recovery feelings several weeks after beginning the treatment, negative attitudes toward the healthcare personnel, missing medications, drinking alcohol, and smoking influence adherence to TB treatment. 7 , 8 The core of health promotion is skillfulness, which mainly incorporates knowledge, motivation, self-efficacy, dexterity, and self-esteem. The present study employs the IMB model due to the similarity of these components to the constructs of the IMB model, the utilization of these constructs in many health education and health promotion models, and the limitations of the present theories of health and social psychology. Proposed by Fisher, the IMB model explains HIV-related behaviors and has been applied for medication adherence, 9 self-care behavior (nutrition and exercises) in diabetic patients, 10 condom use prediction, 11 and risky sexual behaviors among youths. 12 According to this model, information is a primary prerequisite for defining the approval of health behavior. 13 Motivation is composed of two factors: First, personal motivations that include beliefs about intervention outcomes and attitudes toward certain health behaviors (use of medications) and encompass beliefs, attitudes, perceptions, moods, and feelings. The second addresses social motivations that involve the perceived social support and social norms for engaging in a certain behavior. 14 Personal perception or perceived sensitivity is considered the third construct. Behavioral skills also shape a determinant construct in the IMB model and are the necessary skills for facilitating the change of a specific behavior. Behavioral skills in the IMB model are necessary for improving individuals’ skills and perceived self-efficacy. These factors are interrelated and do not function separately. This research is significant since medication adherence, estimated at a minimum value of 85% by the World Health Organization (WHO), 15 , 16 contributes to the recovery of these patients, studies that address this topic using the IMB model are a few, and the present literature is mostly theory-oriented and evidence-based and lacks systematic planning. The aim is to investigate the effect of an educational program based on the IMB model on medication adherence in TB patients. Materials and methods The present quasi-experimental study examined TB patients in Iranshahr and Chabahar cities as its target population. The inclusion criteria were informed consent to participate in the research, Iranian nationality, new TB cases, the outset of the aggressive treatment, and smear-positive and smear-negative pulmonary tuberculosis. Illiterate individuals and patients with extrapulmonary TB were excluded from the research. To determine the sample size with respect to the pre-intervention adherence ratio of 60% reported in similar studies and attain an adherence ratio of 85% after the intervention, considering a test power of 80% and type I error of 5%, the researchers estimated the number of samples at 63 individuals per group and increased the sample size by 10% to compensate for probable attrition; i.e., 70 patients per group and 140 totally. To sample the statistical population, the researchers attended tuberculosis, AIDS, and leprosy units of the health centers in Iranshahr and Chabahar cities and selected patients with smear-positive and smear-negative pulmonary TB using simple randomization. In the case of some patient dissatisfaction, simple randomization was continued for the attainment of the determined sample size (Fig. 1). The present study employed a demographic form, Morisky Medication Adherence Scale (MMAS-8), and a researcher-made IMB questionnaire. The demographic form included questions about age, gender, occupation, marital status, education, and place of residence and was completed by TB patients in a self-report form. Secondly, MMDS-8 was used to measure medication adherence. This scale includes 8 items answered as either yes or no and scored zero or 1, with 8 as the complete score. Scores below 6, 6 to 8, and 8 indicate weak, moderate, and strong adherence, respectively. 17 Ghanei Gheshlagh et al. 18 estimated and confirmed the validity and reliability of the tool. In addition, a researcher-made questionnaire was applied to collect data on the constructs of the IMB model concerning medication adherence. The researchers sent the IMB questionnaire to 10 health education and promotion specialists, pharmacists, and physicians to estimate its validity and Content Validity Index (CVI) and applied the necessary corrections with respect to experts’ viewpoints. The Content Validity Ratio (CVR) and Content Validity Index (CVI) of the questionnaire were above 0.49 and 0.79 and thus acceptable. The Cronbach alpha method was also used to measure reliability. The IMB questionnaire consists of 6 sections, wherein the information, individual motivation, social motivation, and risk perception constructs, in the stage beforeconfirming validity and reliability include 7, 7, 10, and 4 questions, scored on a 5-point Likert scale (strongly disagree, somehow disagree, neutral, somehow agree, and strongly agree). Scores 1 and 5 were allocated to the strongly disagree and strongly agree responses. After confirming the validity and reliability of the questions, the questionnaire is as follows: information construct with 5 items, individual motivation construct with 6 items, social motivation construct with 6 items, and risk perception construct with 4 items. Similarly, the self-efficacy and behavior constructs in the stage before confirming validity and reliability, with 7 and 6 items, were rated on a 5-point scale (always, usually, sometimes, rarely, and never), where scores 5 and 1 were assigned to the always and never responses. Also, after examining the validity and reliability, the number of items from each of these constructs was reduced by one. After the confirmation of their validity and reliability, the questionnaires were filled out by both groups of participants. This questionnaire was designed specifically for this study and has not been published anywhere before. After the participants completed the pre-intervention questionnaires, the researchers held three educational sessions for the intervention group (each lasting 15 to 20 minutes) and employed the IMB model for medication adherence in the education amphitheater of Iranshahr Health Center. Meanwhile, one educational session was held for the control group for ethical considerations in the research (Table 1 ). Table 1 Empowerment program based on the IMB model for medication adherence Educational sessions Model constructs Teaching devices and aids Teaching content 1 Information Instructions, charts, short educational films, and pamphlets Education on side effect diagnosis (mild and moderate), the significance of medication adherence, the importance of using medications, disease exacerbating and alleviating factors and their treatment, medication adherence, and correct nutrition during medication use 2 Individual motivation, social motivation, and perceived sensitivity (risk perception) SMSs, group discussions, and statistics and figures representing the poor status of medication adherence Identifying and correcting individuals’ negative attitudes toward anti-TB medications, detecting the perceived social norms that are crucial to patients, and teaching the negative outcomes of incorrect adherence to medications 3 The necessary self-efficacy and objective skills for sound behavior Giving medication-reminder boxes to patients and breaking behavior into smaller components In this phase, every patient is given a reminder box and asked to place daily medications into it at the beginning of the week and count the number of remaining pills at the end of the week. This technique enables individuals to use medications properly. Teaching medication dosage, timely use, and the implementation process of the program Three months after the intervention, the same questionnaires were completed by both groups, and the data were inserted into the SPSS 20 software for statistical descriptive and inferential analyses. The independent t-test and paired t-test were used to compare means in independent and dependent groups, respectively. Likewise, the Chi-squared test was employed to investigate the relationship between demographic variables in the intervention and control groups. Results Many of the research participants were above 40 years in the intervention and control groups, and the results of the Chi-squared test revealed no significant difference between the intervention and control groups in their demographic variables (Table 2 ). Table 2 Frequency distribution of participants’ demographics Variable Groups Intervention group Control group p-value Frequency No. % No. % Age ≥ 40 years 24 30 35 43.8 0.07 < 40 years 56 70 45 56.2 Gender Male 41 51 38 47.5 0.63 Female 39 49 42 52.5 Marital status Single 15 18.8 26 33 0.11 Married 57 71.2 45 56 Widowed 8 10 9 11.3 Education Reading and writing 45 56.3 37 46.2 0.2 Junior high school and above 35 43.7 43 53.8 Place of residence City 35 43.8 42 52.5 0.054 Village 20 25 26 32.5 Suburb 25 31.2 12 15 Occupation Housekeeper 29 36 22 27.4 0.084 Employed 28 35 31 38.8 Jobless 23 29 27 33.8 As observed, the post-intervention mean scores of the intervention group in information, social motivation, risk perception, self-efficacy, and behavior are significantly different from their pre-intervention mean scores (p 0.05) (Table 3 ) Table 3 Comparing pre- and post-intervention means and standard deviations of the scores on IMB constructs in the intervention and control groups IMB constructs Group Pre-intervention Post-intervention Paired t-test Mean difference Mean & SD Mean & SD Information Intervention 16.04 ± 5.76 18.6 ± 3.06 Df = 79 t=-5.8 p < 0.001 2.56 ± 3.94 Control 14.96 ± 5.76 15.34 ± 5.46 Df = 79 t=-0.95 p = 0.34 0.3 ± 375.5 Independent t-test - Df = 158 t = 1.41 p < 0.15 Df = 158 t = 4.66 p < 0.001 - - Individual motivation Intervention 13.73 ± 3.1 15.38 ± 2.83 Df = 79 t=-11.4 p < 0.001 1.65 ± 1.29 Control 13.31 ± 5.04 13.3 ± 5.3 Df = 79 t=-0.036 p = 0.97 0.012 ± 3.09 Independent t-test - Df = 158 t = 0.623 p = 0.53 Df = 158 t = 3.08 p = 0.002 - - Social motivation Intervention 12.16 ± 4.32 13.94 ± 3.98 Df = 79 t=-8.82 p < 0.001 1.2 ± 77.72 Control 11.48 ± 3.99 11.08 ± 3.92 Df = 79 t=-1.12 p = 0.26 0.3 ± 4.17 Independent t-test - Df = 158 t = 1.045 p = 0.29 Df = 158 t = 7.77 p < 0.001 - - Risk perception Intervention 8.2 ± 91.27 12.2 ± 63.28 Df = 79 t=-16.14 p < 0.001 3.2 ± 71.05 Control 8.2 ± 68.25 8.2 ± 31.54 Df = 79 t=-1.62 p < 0.1 0.1 ± 363.96 Independent t-test - Df = 158 t = 0.59 p = 0.55 Df = 158 t = 11.27 p < 0.001 - - Self-efficacy Intervention 9.3 ± 45.91 12.3 ± 65.48 Df = 79 t = 28.65 p < 0.001 3.0 ± 2.99 Control 8.3 ± 81.5 8.3 ± 9.99 Df = 79 t=-0.53 p = 0.59 0.1 ± 8.64 Independent t-test - Df = 158 t = 1.08 p = 0.27 Df = 158 t = 6.32 p < 0.001 - - Behavior Intervention 8.2 ± 6.57 10.2 ± 15.39 Df = 79 t = 21.01 p < 0.001 2.0 ± 8.88 Control 7.3 ± 87.24 7.3 ± 69.13 Df = 79 t = 1.01 p = 0.31 0.1 ± 15.32 Independent t-test - Df = 158 t = 0.48 p = 0.62 Df = 158 t = 5.58 p < 0.001 - - As displayed, the post-intervention mean medication adherence score of the intervention group is significantly different from their pre-intervention mean score (p < 0.001), while this difference is not significant in the control group (p = 0.28) (Table 4 ). Table 4 Comparing pre- and post-intervention means and standard deviations of the medication adherence scores in the intervention and control groups Variable Group Pre-intervention Post-intervention Paired t-test Mean difference Medication adherence Mean ± SD Mean ± SD Intervention 6.1 ± 35.61 7.0 ± 67.69 Df = 79 t=-8.14 p < 0.001 1.1 ± 31.43 Control 6.1 ± 37.06 6.1 ± 12.1 Df = 79 t=-1.06 p = 0.28 0.0 ± 8.73 Independent t-test Df = 158 t = 1.46 p = 0.14 Df = 158 t = 10.63 p < 0.001 - - Table 5 displays the medication adherence status in both groups before and after the educational program. Accordingly, 39.2% of the intervention group revealed weak adherence to medications, 36.7% reported moderate adherence, and 24.1% declared high adherence before the intervention. However, weak, moderate, and high adherence were reported by 7.5%, 15%, and 77.5% of the intervention group after the program. Table 5 Medication adherence status among TB patients Medication adherence Low (< 6) Moderate (6–7) High (8) Group - No. % No. % No. % Intervention Pre-intervention 31 39.2 36 36.7 19 24.1 Post-intervention 6 7.5 12 15 62 77.5 Control Pre-intervention 51 63.7 26 32.5 3 3.8 Pot-intervention 49 61.3 27 33.8 4 5 Discussion The results indicated the positive impact of the intervention on treatment adherence and its components in the examined patients. Inadequate adherence to treatment in TB patients can lead to serious complications, disease recurrence, and increased drug resistance. A key factor in treatment adherence is patients’ degree of awareness and motivation. Ma et al. 19 revealed that an educational program based on the IMB model improved treatment adherence in patients with gallstones and raised their satisfaction. In Shanghai, China, Xu et al. 20 found that health education based on the IMB model considerably improved medication adherence in patients with epilepsy. These results are in line with the findings of the present research. In a study in Haiti, Puttkammer 21 displayed that the IMB model could positively influence adherence to antiretroviral HIV therapy and underscored cultural and contextual aspects. The IMB model is a valuable theoretical framework highlighting the significance of information, motivation, and behavioral skills in forming health behaviors. 22 , 23 Educational empowerment programs designed and implemented based on this model can enhance medication adherence in patients efficiently. Studies reveal that IMB-based interventions raise knowledge, self-efficacy, life quality, and psychological well-being in different health situations, e.g., gallstone, Ovarian Hyper-Stimulation syndrome (OHSS), cervical cancer diagnosis, and adherence to HIV treatment. 24 – 26 Thus, employing the IMB model to develop educational empowerment programs commensurate with patients’ special needs can potentially enhance their medication adherence, as well as general health outcomes. Treatment adherence in TB patients is of particular importance since non-adherence can give rise to serious complications and disease progress. 27 This problem also increases the risk of drug resistance, which is cost-effective and more difficult to treat. In addition, uncared patients can easily transmit the disease to others. Thus, treatment adherence helps lower the incidence of the disease and burden of infection in society. 28 Moreover, increased adherence improves patients’ quality of life and gives them more control over their disease. It also positively impacts public health programs, decreases treatment costs, and improves social health. 29 Hence, teaching treatment adherence to TB patients is imperative and directly influences the success of treatment and control of the disease. Sound training informs patients of the significance of using medications regularly, their probable side effects, and approaches to managing these complications and raises their motivation to continue the treatment. Eventually, providing inclusive education and employing teaching aids can noticeably increase treatment adherence and help control and eradicate TB disease. Conclusion Educational programs based on the IMB model can be utilized as an efficient tool to promote medication adherence in TB patients. Considering the significance of improving treatment adherence in achieving desirable outcomes among these patients, the researchers suggest teaching efficient care models, especially IMB, to healthcare providers, doctors, and other concerned individuals and making the necessary policies for their implementation in healthcare environments. Future studies can investigate the effect of the IMB model on other variables, such as quality of life, self-care, etc., and other patients with similar diseases. Declarations Ethical approval and Informed consent: The present study was approved by the Research Ethics Committees of Iranshahr University of Medical Sciences with the code of ethics IR.IRSHUMS.REC.1401.026. The present study was conducted in accordance with the Declaration of Helsinki. The informed consent was obtained after describing the research objectives and confidentiality of information for participants. Consent for publication Not applicable. Conflicts of interest The author (s) declared no potential conflicts of interest with respect to the research, authorship, and/ or publication of this article. Funding The authors received no financial support for the research, authorship and/or publication of this article. Data availability The datasets analyzed during the current study are available from the corresponding author on reasonable request. Clinical Trial Number Not applicable. References Allwood B, Van der Zalm M, Makanda G, et al. The long shadow post-tuberculosis. Lancet Infect Dis. 2019;9:1170–1. Feleke BE, Alene GD, Feleke TE, et al. Clinical response of tuberculosis patients, a prospective cohort study. PLoS ONE. 2018;13:e0190207. Shirazinia R, Saadati D, Zeinali E, et al. The incidence and epidemiology of tuberculosis in Sistan region of Iran: an update to the past researches. Int J Basic Sci Med. 2017;2:189–93. Lam WY, Fresco P. Medication Adherence Measures: An Overview. Biomed Res Int. 2015; 2015: 217047. 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J Pharm Sci Community. 2023;20:191–200. Additional Declarations No competing interests reported. Supplementary Files Researchermadequestionnaire.pdf Cite Share Download PDF Status: Under Revision Version 1 posted Editorial decision: Revision requested 16 May, 2025 Reviews received at journal 03 May, 2025 Reviewers agreed at journal 03 May, 2025 Reviews received at journal 25 Apr, 2025 Reviewers agreed at journal 20 Apr, 2025 Reviewers invited by journal 15 Apr, 2025 Editor assigned by journal 09 Apr, 2025 Editor invited by journal 19 Mar, 2025 Submission checks completed at journal 18 Mar, 2025 First submitted to journal 18 Mar, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-6130200","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":443193346,"identity":"b1f2c33e-c095-4f22-bfa2-d925ec2405bb","order_by":0,"name":"Ali Mirbalouchzehi","email":"","orcid":"","institution":"Iranshahr university of medical sciences","correspondingAuthor":false,"prefix":"","firstName":"Ali","middleName":"","lastName":"Mirbalouchzehi","suffix":""},{"id":443193347,"identity":"dbf7e7c4-9a52-4a71-b07b-cb9fa4c02a52","order_by":1,"name":"Moradali Zareipour","email":"","orcid":"","institution":"Khoy University of Medical Sciences","correspondingAuthor":false,"prefix":"","firstName":"Moradali","middleName":"","lastName":"Zareipour","suffix":""},{"id":443193348,"identity":"2460621c-46f4-4e13-99f7-dac7b2a1b95b","order_by":2,"name":"Abedeh Arzani","email":"","orcid":"","institution":"Iranshahr university of medical sciences","correspondingAuthor":false,"prefix":"","firstName":"Abedeh","middleName":"","lastName":"Arzani","suffix":""},{"id":443193349,"identity":"68035de2-e689-47b7-afc2-f34d4509729b","order_by":3,"name":"Mohammad Saeed Jadgal","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA3klEQVRIiWNgGAWjYBACxgYGAwaGAol6fhAvoYBoLQYWCZINIC0GxFkE0lKRYHAAyiYImNsPb37xw0Aiz/j86sQPDwwY5PnFDhBwWE9amWWPgUSx2Y23myWADjOcOTuBgJaGHDMDHgMJxm03zm4AaUkwuE1IS/8bM8M/QC2bZ5zd/IM4LTNyjB8DbUncwN+7jUhbZjwrY5YxkDCWuMG7zSLBQIKwXwz7kzd/fFNRJ8fff3bzzR8VNvL80oS0NDCwSYBZEmCVEviVg4A8MGo+gFn8BwirHgWjYBSMgpEJAOY3RSngWoHoAAAAAElFTkSuQmCC","orcid":"","institution":"Iranshahr university of medical sciences","correspondingAuthor":true,"prefix":"","firstName":"Mohammad","middleName":"Saeed","lastName":"Jadgal","suffix":""}],"badges":[],"createdAt":"2025-02-28 16:23:08","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-6130200/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-6130200/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":80807513,"identity":"4db741ce-c70e-4c4b-88f4-3d1abf423b4c","added_by":"auto","created_at":"2025-04-17 09:39:38","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":32241,"visible":true,"origin":"","legend":"\u003cp\u003eCONSORT chart of the stages of the study\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-6130200/v1/eac3c36e6baa2af1f80452ea.png"},{"id":80809365,"identity":"9046cde4-c507-489f-ae8b-cf0fd29c88ba","added_by":"auto","created_at":"2025-04-17 10:03:38","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":917930,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6130200/v1/8bd8a940-96dc-4083-830a-dbd41ae3b193.pdf"},{"id":80808379,"identity":"89ffe53d-629b-442d-b366-ecdd3eba5987","added_by":"auto","created_at":"2025-04-17 09:47:38","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"supplement","size":262167,"visible":true,"origin":"","legend":"","description":"","filename":"Researchermadequestionnaire.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6130200/v1/02f4525d19c7a4c458557ae5.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"The Effect of an Educational Program based on the Information-Motivation-Behavioral Skill Model on Medication Adherence among Patients with Pulmonary Tuberculosis","fulltext":[{"header":"Introduction","content":"\u003cp\u003eApproximately one-third of the world\u0026rsquo;s population is infected by tuberculosis bacteria and is at risk of being infected by the tuberculosis disease. Around 9.3\u0026nbsp;million individuals suffer from active tuberculosis, and virtually 1.8\u0026nbsp;million people die due to this illness.\u003csup\u003e\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u003c/sup\u003e The disease becomes bold when we find that one out of three individuals on the earth suffers from the TB Bacillus, one person is infected every four seconds, and one dies of this disease every 10 seconds.\u003csup\u003e\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u003c/sup\u003e Among Iran\u0026rsquo;s various provinces, Sistan and Baluchestan and Golestan report the highest incidence rate in the country (20.01\u0026ndash;29.2 among 100,000 individuals).\u003csup\u003e\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eThe term medication adherence means the patient\u0026rsquo;s compliance with medical instructions and includes two axes: Using medications timely and using medications based on the physician\u0026rsquo;s instructions.\u003csup\u003e\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e\u003c/sup\u003e Studies reveal that socioeconomic factors like social support and poverty are associated with non-adherence to TB treatment.\u003csup\u003e\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e\u003c/sup\u003e In addition, individual behavioral factors such as awareness of the TB disease, recovery feelings several weeks after beginning the treatment, negative attitudes toward the healthcare personnel, missing medications, drinking alcohol, and smoking influence adherence to TB treatment.\u003csup\u003e\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eThe core of health promotion is skillfulness, which mainly incorporates knowledge, motivation, self-efficacy, dexterity, and self-esteem. The present study employs the IMB model due to the similarity of these components to the constructs of the IMB model, the utilization of these constructs in many health education and health promotion models, and the limitations of the present theories of health and social psychology. Proposed by Fisher, the IMB model explains HIV-related behaviors and has been applied for medication adherence,\u003csup\u003e\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e\u003c/sup\u003e self-care behavior (nutrition and exercises) in diabetic patients,\u003csup\u003e\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e\u003c/sup\u003e condom use prediction,\u003csup\u003e\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e\u003c/sup\u003e and risky sexual behaviors among youths.\u003csup\u003e\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e\u003c/sup\u003e According to this model, information is a primary prerequisite for defining the approval of health behavior.\u003csup\u003e\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e\u003c/sup\u003e Motivation is composed of two factors: First, personal motivations that include beliefs about intervention outcomes and attitudes toward certain health behaviors (use of medications) and encompass beliefs, attitudes, perceptions, moods, and feelings. The second addresses social motivations that involve the perceived social support and social norms for engaging in a certain behavior.\u003csup\u003e\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e\u003c/sup\u003e Personal perception or perceived sensitivity is considered the third construct. Behavioral skills also shape a determinant construct in the IMB model and are the necessary skills for facilitating the change of a specific behavior. Behavioral skills in the IMB model are necessary for improving individuals\u0026rsquo; skills and perceived self-efficacy. These factors are interrelated and do not function separately.\u003c/p\u003e \u003cp\u003eThis research is significant since medication adherence, estimated at a minimum value of 85% by the World Health Organization (WHO),\u003csup\u003e\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e\u003c/sup\u003e contributes to the recovery of these patients, studies that address this topic using the IMB model are a few, and the present literature is mostly theory-oriented and evidence-based and lacks systematic planning. The aim is to investigate the effect of an educational program based on the IMB model on medication adherence in TB patients.\u003c/p\u003e"},{"header":"Materials and methods","content":"\u003cp\u003eThe present quasi-experimental study examined TB patients in Iranshahr and Chabahar cities as its target population. The inclusion criteria were informed consent to participate in the research, Iranian nationality, new TB cases, the outset of the aggressive treatment, and smear-positive and smear-negative pulmonary tuberculosis. Illiterate individuals and patients with extrapulmonary TB were excluded from the research.\u003c/p\u003e \u003cp\u003eTo determine the sample size with respect to the pre-intervention adherence ratio of 60% reported in similar studies and attain an adherence ratio of 85% after the intervention, considering a test power of 80% and type I error of 5%, the researchers estimated the number of samples at 63 individuals per group and increased the sample size by 10% to compensate for probable attrition; i.e., 70 patients per group and 140 totally.\u003c/p\u003e\u003cp\u003e\u003cimg 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\" height=\"279\" width=\"584\"\u003e\u003c/p\u003e \u003cp\u003eTo sample the statistical population, the researchers attended tuberculosis, AIDS, and leprosy units of the health centers in Iranshahr and Chabahar cities and selected patients with smear-positive and smear-negative pulmonary TB using simple randomization. In the case of some patient dissatisfaction, simple randomization was continued for the attainment of the determined sample size (Fig.\u0026nbsp;1).\u003c/p\u003e\u003cp\u003eThe present study employed a demographic form, Morisky Medication Adherence Scale (MMAS-8), and a researcher-made IMB questionnaire. The demographic form included questions about age, gender, occupation, marital status, education, and place of residence and was completed by TB patients in a self-report form. Secondly, MMDS-8 was used to measure medication adherence. This scale includes 8 items answered as either yes or no and scored zero or 1, with 8 as the complete score. Scores below 6, 6 to 8, and 8 indicate weak, moderate, and strong adherence, respectively.\u003csup\u003e\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e\u003c/sup\u003e Ghanei Gheshlagh et al.\u003csup\u003e\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e\u003c/sup\u003e estimated and confirmed the validity and reliability of the tool. In addition, a researcher-made questionnaire was applied to collect data on the constructs of the IMB model concerning medication adherence. The researchers sent the IMB questionnaire to 10 health education and promotion specialists, pharmacists, and physicians to estimate its validity and Content Validity Index (CVI) and applied the necessary corrections with respect to experts\u0026rsquo; viewpoints. The Content Validity Ratio (CVR) and Content Validity Index (CVI) of the questionnaire were above 0.49 and 0.79 and thus acceptable. The Cronbach alpha method was also used to measure reliability. The IMB questionnaire consists of 6 sections, wherein the information, individual motivation, social motivation, and risk perception constructs, in the stage beforeconfirming validity and reliability include 7, 7, 10, and 4 questions, scored on a 5-point Likert scale (strongly disagree, somehow disagree, neutral, somehow agree, and strongly agree). Scores 1 and 5 were allocated to the strongly disagree and strongly agree responses. After confirming the validity and reliability of the questions, the questionnaire is as follows: information construct with 5 items, individual motivation construct with 6 items, social motivation construct with 6 items, and risk perception construct with 4 items. Similarly, the self-efficacy and behavior constructs in the stage before confirming validity and reliability, with 7 and 6 items, were rated on a 5-point scale (always, usually, sometimes, rarely, and never), where scores 5 and 1 were assigned to the always and never responses. Also, after examining the validity and reliability, the number of items from each of these constructs was reduced by one. After the confirmation of their validity and reliability, the questionnaires were filled out by both groups of participants. This questionnaire was designed specifically for this study and has not been published anywhere before.\u003c/p\u003e \u003cp\u003e After the participants completed the pre-intervention questionnaires, the researchers held three educational sessions for the intervention group (each lasting 15 to 20 minutes) and employed the IMB model for medication adherence in the education amphitheater of Iranshahr Health Center. Meanwhile, one educational session was held for the control group for ethical considerations in the research (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eEmpowerment program based on the IMB model for medication adherence\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEducational sessions\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eModel constructs\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eTeaching devices and aids\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eTeaching content\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eInformation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eInstructions, charts, short educational films, and pamphlets\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eEducation on side effect diagnosis (mild and moderate), the significance of medication adherence, the importance of using medications, disease exacerbating and alleviating factors and their treatment, medication adherence, and correct nutrition during medication use\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eIndividual motivation, social motivation, and perceived sensitivity (risk perception)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eSMSs, group discussions, and statistics and figures representing the poor status of medication adherence\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eIdentifying and correcting individuals\u0026rsquo; negative attitudes toward anti-TB medications, detecting the perceived social norms that are crucial to patients, and teaching the negative outcomes of incorrect adherence to medications\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eThe necessary self-efficacy and objective skills for sound behavior\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eGiving medication-reminder boxes to patients and breaking behavior into smaller components\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eIn this phase, every patient is given a reminder box and asked to place daily medications into it at the beginning of the week and count the number of remaining pills at the end of the week. This technique enables individuals to use medications properly. Teaching medication dosage, timely use, and the implementation process of the program\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eThree months after the intervention, the same questionnaires were completed by both groups, and the data were inserted into the SPSS 20 software for statistical descriptive and inferential analyses. The independent t-test and paired t-test were used to compare means in independent and dependent groups, respectively. Likewise, the Chi-squared test was employed to investigate the relationship between demographic variables in the intervention and control groups.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eMany of the research participants were above 40 years in the intervention and control groups, and the results of the Chi-squared test revealed no significant difference between the intervention and control groups in their demographic variables (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eFrequency distribution of participants\u0026rsquo; demographics\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"7\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eVariable\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eGroups\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003eIntervention group\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003eControl group\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003ep-value\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFrequency\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eNo.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eNo.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cb\u003eAge\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026ge;\u0026thinsp;40 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e24\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e30\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e35\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e43.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.07\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;40 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e56\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e70\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e45\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e56.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cb\u003eGender\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e41\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e51\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e38\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e47.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.63\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e39\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e49\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e42\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e52.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e\u003cb\u003eMarital status\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSingle\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e18.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e26\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e33\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e0.11\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMarried\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e57\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e71.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e45\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e56\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eWidowed\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e11.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cb\u003eEducation\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eReading and writing\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e45\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e56.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e37\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e46.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eJunior high school and above\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e35\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e43.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e43\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e53.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e\u003cb\u003ePlace of residence\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCity\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e35\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e43.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e42\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e52.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e0.054\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eVillage\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e26\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e32.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSuburb\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e31.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e15\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e\u003cb\u003eOccupation\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHousekeeper\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e29\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e36\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e22\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e27.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e0.084\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eEmployed\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e28\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e35\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e31\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e38.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eJobless\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e23\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e29\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e27\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e33.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eAs observed, the post-intervention mean scores of the intervention group in information, social motivation, risk perception, self-efficacy, and behavior are significantly different from their pre-intervention mean scores (p\u0026thinsp;\u0026lt;\u0026thinsp;0.05). However, this difference is not significant in the control group (p\u0026thinsp;\u0026gt;\u0026thinsp;0.05) (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e)\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eComparing pre- and post-intervention means and standard deviations of the scores on IMB constructs in the intervention and control groups\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eIMB constructs\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eGroup\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePre-intervention\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003ePost-intervention\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003ePaired t-test\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eMean difference\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMean \u0026amp; SD\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eMean \u0026amp; SD\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cb\u003eInformation\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eIntervention\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e16.04\u0026thinsp;\u0026plusmn;\u0026thinsp;5.76\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e18.6\u0026thinsp;\u0026plusmn;\u0026thinsp;3.06\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eDf\u0026thinsp;=\u0026thinsp;79 t=-5.8 p\u0026thinsp;\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e2.56\u0026thinsp;\u0026plusmn;\u0026thinsp;3.94\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eControl\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e14.96\u0026thinsp;\u0026plusmn;\u0026thinsp;5.76\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e15.34\u0026thinsp;\u0026plusmn;\u0026thinsp;5.46\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eDf\u0026thinsp;=\u0026thinsp;79 t=-0.95 p\u0026thinsp;=\u0026thinsp;0.34\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.3\u0026thinsp;\u0026plusmn;\u0026thinsp;375.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eIndependent t-test\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eDf\u0026thinsp;=\u0026thinsp;158 t\u0026thinsp;=\u0026thinsp;1.41 p\u0026thinsp;\u0026lt;\u0026thinsp;0.15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eDf\u0026thinsp;=\u0026thinsp;158 t\u0026thinsp;=\u0026thinsp;4.66 p\u0026thinsp;\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cb\u003eIndividual motivation\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eIntervention\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e13.73\u0026thinsp;\u0026plusmn;\u0026thinsp;3.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e15.38\u0026thinsp;\u0026plusmn;\u0026thinsp;2.83\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eDf\u0026thinsp;=\u0026thinsp;79 t=-11.4 p\u0026thinsp;\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.65\u0026thinsp;\u0026plusmn;\u0026thinsp;1.29\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eControl\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e13.31\u0026thinsp;\u0026plusmn;\u0026thinsp;5.04\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e13.3\u0026thinsp;\u0026plusmn;\u0026thinsp;5.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eDf\u0026thinsp;=\u0026thinsp;79 t=-0.036 p\u0026thinsp;=\u0026thinsp;0.97\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.012\u0026thinsp;\u0026plusmn;\u0026thinsp;3.09\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eIndependent t-test\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eDf\u0026thinsp;=\u0026thinsp;158 t\u0026thinsp;=\u0026thinsp;0.623 p\u0026thinsp;=\u0026thinsp;0.53\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eDf\u0026thinsp;=\u0026thinsp;158 t\u0026thinsp;=\u0026thinsp;3.08 p\u0026thinsp;=\u0026thinsp;0.002\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cb\u003eSocial motivation\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eIntervention\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e12.16\u0026thinsp;\u0026plusmn;\u0026thinsp;4.32\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e13.94\u0026thinsp;\u0026plusmn;\u0026thinsp;3.98\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eDf\u0026thinsp;=\u0026thinsp;79 t=-8.82 p\u0026thinsp;\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.2\u0026thinsp;\u0026plusmn;\u0026thinsp;77.72\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eControl\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e11.48\u0026thinsp;\u0026plusmn;\u0026thinsp;3.99\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e11.08\u0026thinsp;\u0026plusmn;\u0026thinsp;3.92\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eDf\u0026thinsp;=\u0026thinsp;79 t=-1.12 p\u0026thinsp;=\u0026thinsp;0.26\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.3\u0026thinsp;\u0026plusmn;\u0026thinsp;4.17\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eIndependent t-test\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eDf\u0026thinsp;=\u0026thinsp;158 t\u0026thinsp;=\u0026thinsp;1.045 p\u0026thinsp;=\u0026thinsp;0.29\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eDf\u0026thinsp;=\u0026thinsp;158 t\u0026thinsp;=\u0026thinsp;7.77 p\u0026thinsp;\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cb\u003eRisk perception\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eIntervention\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e8.2\u0026thinsp;\u0026plusmn;\u0026thinsp;91.27\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e12.2\u0026thinsp;\u0026plusmn;\u0026thinsp;63.28\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eDf\u0026thinsp;=\u0026thinsp;79 t=-16.14 p\u0026thinsp;\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e3.2\u0026thinsp;\u0026plusmn;\u0026thinsp;71.05\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eControl\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e8.2\u0026thinsp;\u0026plusmn;\u0026thinsp;68.25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e8.2\u0026thinsp;\u0026plusmn;\u0026thinsp;31.54\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eDf\u0026thinsp;=\u0026thinsp;79 t=-1.62 p\u0026thinsp;\u0026lt;\u0026thinsp;0.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.1\u0026thinsp;\u0026plusmn;\u0026thinsp;363.96\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eIndependent t-test\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eDf\u0026thinsp;=\u0026thinsp;158 t\u0026thinsp;=\u0026thinsp;0.59 p\u0026thinsp;=\u0026thinsp;0.55\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eDf\u0026thinsp;=\u0026thinsp;158 t\u0026thinsp;=\u0026thinsp;11.27 p\u0026thinsp;\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eSelf-efficacy\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eIntervention\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e9.3\u0026thinsp;\u0026plusmn;\u0026thinsp;45.91\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e12.3\u0026thinsp;\u0026plusmn;\u0026thinsp;65.48\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eDf\u0026thinsp;=\u0026thinsp;79 t\u0026thinsp;=\u0026thinsp;28.65 p\u0026thinsp;\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e3.0\u0026thinsp;\u0026plusmn;\u0026thinsp;2.99\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eControl\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e8.3\u0026thinsp;\u0026plusmn;\u0026thinsp;81.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e8.3\u0026thinsp;\u0026plusmn;\u0026thinsp;9.99\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eDf\u0026thinsp;=\u0026thinsp;79 t=-0.53 p\u0026thinsp;=\u0026thinsp;0.59\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.1\u0026thinsp;\u0026plusmn;\u0026thinsp;8.64\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eIndependent t-test\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eDf\u0026thinsp;=\u0026thinsp;158 t\u0026thinsp;=\u0026thinsp;1.08 p\u0026thinsp;=\u0026thinsp;0.27\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eDf\u0026thinsp;=\u0026thinsp;158 t\u0026thinsp;=\u0026thinsp;6.32 p\u0026thinsp;\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cb\u003eBehavior\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eIntervention\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e8.2\u0026thinsp;\u0026plusmn;\u0026thinsp;6.57\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e10.2\u0026thinsp;\u0026plusmn;\u0026thinsp;15.39\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eDf\u0026thinsp;=\u0026thinsp;79 t\u0026thinsp;=\u0026thinsp;21.01 p\u0026thinsp;\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e2.0\u0026thinsp;\u0026plusmn;\u0026thinsp;8.88\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eControl\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e7.3\u0026thinsp;\u0026plusmn;\u0026thinsp;87.24\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e7.3\u0026thinsp;\u0026plusmn;\u0026thinsp;69.13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eDf\u0026thinsp;=\u0026thinsp;79 t\u0026thinsp;=\u0026thinsp;1.01 p\u0026thinsp;=\u0026thinsp;0.31\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.1\u0026thinsp;\u0026plusmn;\u0026thinsp;15.32\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eIndependent t-test\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eDf\u0026thinsp;=\u0026thinsp;158 t\u0026thinsp;=\u0026thinsp;0.48 p\u0026thinsp;=\u0026thinsp;0.62\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eDf\u0026thinsp;=\u0026thinsp;158 t\u0026thinsp;=\u0026thinsp;5.58 p\u0026thinsp;\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eAs displayed, the post-intervention mean medication adherence score of the intervention group is significantly different from their pre-intervention mean score (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), while this difference is not significant in the control group (p\u0026thinsp;=\u0026thinsp;0.28) (Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eComparing pre- and post-intervention means and standard deviations of the medication adherence scores in the intervention and control groups\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariable\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eGroup\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePre-intervention\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003ePost-intervention\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003ePaired t-test\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eMean difference\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003eMedication adherence\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eMean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eIntervention\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6.1\u0026thinsp;\u0026plusmn;\u0026thinsp;35.61\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e7.0\u0026thinsp;\u0026plusmn;\u0026thinsp;67.69\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eDf\u0026thinsp;=\u0026thinsp;79 t=-8.14 p\u0026thinsp;\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.1\u0026thinsp;\u0026plusmn;\u0026thinsp;31.43\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eControl\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6.1\u0026thinsp;\u0026plusmn;\u0026thinsp;37.06\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e6.1\u0026thinsp;\u0026plusmn;\u0026thinsp;12.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eDf\u0026thinsp;=\u0026thinsp;79 t=-1.06 p\u0026thinsp;=\u0026thinsp;0.28\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.0\u0026thinsp;\u0026plusmn;\u0026thinsp;8.73\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eIndependent t-test\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eDf\u0026thinsp;=\u0026thinsp;158 t\u0026thinsp;=\u0026thinsp;1.46 p\u0026thinsp;=\u0026thinsp;0.14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eDf\u0026thinsp;=\u0026thinsp;158 t\u0026thinsp;=\u0026thinsp;10.63 p\u0026thinsp;\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e5\u003c/span\u003e displays the medication adherence status in both groups before and after the educational program. Accordingly, 39.2% of the intervention group revealed weak adherence to medications, 36.7% reported moderate adherence, and 24.1% declared high adherence before the intervention. However, weak, moderate, and high adherence were reported by 7.5%, 15%, and 77.5% of the intervention group after the program.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab5\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 5\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eMedication adherence status among TB patients\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"8\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eMedication adherence\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003eLow (\u0026lt;\u0026thinsp;6)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003eModerate (6\u0026ndash;7)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e \u003cp\u003eHigh (8)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eGroup\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eNo.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eNo.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eNo.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cb\u003eIntervention\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePre-intervention\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e31\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e39.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e36\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e36.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e19\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e24.1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePost-intervention\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e7.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e62\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e77.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cb\u003eControl\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePre-intervention\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e51\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e63.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e26\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e32.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e3.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePot-intervention\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e49\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e61.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e27\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e33.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThe results indicated the positive impact of the intervention on treatment adherence and its components in the examined patients. Inadequate adherence to treatment in TB patients can lead to serious complications, disease recurrence, and increased drug resistance. A key factor in treatment adherence is patients\u0026rsquo; degree of awareness and motivation. Ma et al.\u003csup\u003e\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e\u003c/sup\u003e revealed that an educational program based on the IMB model improved treatment adherence in patients with gallstones and raised their satisfaction. In Shanghai, China, Xu et al.\u003csup\u003e\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e\u003c/sup\u003e found that health education based on the IMB model considerably improved medication adherence in patients with epilepsy. These results are in line with the findings of the present research. In a study in Haiti, Puttkammer\u003csup\u003e\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e\u003c/sup\u003e displayed that the IMB model could positively influence adherence to antiretroviral HIV therapy and underscored cultural and contextual aspects.\u003c/p\u003e \u003cp\u003eThe IMB model is a valuable theoretical framework highlighting the significance of information, motivation, and behavioral skills in forming health behaviors.\u003csup\u003e\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e, \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e\u003c/sup\u003e Educational empowerment programs designed and implemented based on this model can enhance medication adherence in patients efficiently. Studies reveal that IMB-based interventions raise knowledge, self-efficacy, life quality, and psychological well-being in different health situations, e.g., gallstone, Ovarian Hyper-Stimulation syndrome (OHSS), cervical cancer diagnosis, and adherence to HIV treatment.\u003csup\u003e\u003cspan additionalcitationids=\"CR25\" citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e\u003c/sup\u003e Thus, employing the IMB model to develop educational empowerment programs commensurate with patients\u0026rsquo; special needs can potentially enhance their medication adherence, as well as general health outcomes.\u003c/p\u003e \u003cp\u003eTreatment adherence in TB patients is of particular importance since non-adherence can give rise to serious complications and disease progress.\u003csup\u003e\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e\u003c/sup\u003e This problem also increases the risk of drug resistance, which is cost-effective and more difficult to treat. In addition, uncared patients can easily transmit the disease to others. Thus, treatment adherence helps lower the incidence of the disease and burden of infection in society.\u003csup\u003e\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e\u003c/sup\u003e Moreover, increased adherence improves patients\u0026rsquo; quality of life and gives them more control over their disease. It also positively impacts public health programs, decreases treatment costs, and improves social health.\u003csup\u003e\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e\u003c/sup\u003e Hence, teaching treatment adherence to TB patients is imperative and directly influences the success of treatment and control of the disease. Sound training informs patients of the significance of using medications regularly, their probable side effects, and approaches to managing these complications and raises their motivation to continue the treatment. Eventually, providing inclusive education and employing teaching aids can noticeably increase treatment adherence and help control and eradicate TB disease.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eEducational programs based on the IMB model can be utilized as an efficient tool to promote medication adherence in TB patients. Considering the significance of improving treatment adherence in achieving desirable outcomes among these patients, the researchers suggest teaching efficient care models, especially IMB, to healthcare providers, doctors, and other concerned individuals and making the necessary policies for their implementation in healthcare environments. Future studies can investigate the effect of the IMB model on other variables, such as quality of life, self-care, etc., and other patients with similar diseases.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthical approval and Informed consent:\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe present study was approved by the Research Ethics Committees of Iranshahr University of Medical Sciences with the code of ethics IR.IRSHUMS.REC.1401.026. The present study was conducted in accordance with the Declaration of Helsinki. The informed consent was obtained after describing the research objectives and confidentiality of information for participants.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConflicts of interest\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe author (s) declared no potential conflicts of interest with respect to the research, authorship, and/ or publication of this article.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors received no financial support for the research, authorship and/or publication of this article.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData availability\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets analyzed during the current study are available from the corresponding author on reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eClinical Trial Number\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u0026nbsp;\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eAllwood B, Van der Zalm M, Makanda G, et al. The long shadow post-tuberculosis. Lancet Infect Dis. 2019;9:1170\u0026ndash;1.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eFeleke BE, Alene GD, Feleke TE, et al. Clinical response of tuberculosis patients, a prospective cohort study. PLoS ONE. 2018;13:e0190207.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eShirazinia R, Saadati D, Zeinali E, et al. The incidence and epidemiology of tuberculosis in Sistan region of Iran: an update to the past researches. Int J Basic Sci Med. 2017;2:189\u0026ndash;93.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLam WY, Fresco P. Medication Adherence Measures: An Overview. Biomed Res Int. 2015; 2015: 217047.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eNaidoo P, Peltzer K, Louw J, et al. Predictors of tuberculosis (TB) and antiretroviral (ARV) medication non-adherence in public primary care patients in South Africa: a cross sectional study. BMC Public Health. 2013;13:396.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eChoi H, Chung H, Muntaner C, et al. The impact of social conditions on patient adherence to pulmonary tuberculosis treatment. Int J Tuberc Lung Dis. 2016;20:948\u0026ndash;54.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eM\u0026eacute;da ZC, Lin YT, Sombi\u0026eacute; I, et al. Medication-adherence predictors among patients with tuberculosis or human immunodeficiency virus infection in Burkina Faso. J Microbiol Immunol Infect. 2014;47:222\u0026ndash;32.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMekonnen HS, Azagew AW. Non-adherence to anti-tuberculosis treatment, reasons and associated factors among TB patients attending at Gondar town health centers, Northwest Ethiopia. BMC Res Notes. 2018;11:691.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAlexander DS, Hogan SL, Jordan JM, et al. examining whether the information\u0026ndash;motivation\u0026ndash;behavioral skills model predicts medication adherence for patients with a rare disease. Patient Prefer Adherence. 2017;11:75\u0026ndash;83.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGavgani RM, Poursharifi H, Aliasgarzadeh A. Effectiveness of Information-Motivation and Behavioral skill (IMB) model in improving self-care behaviors \u0026amp; Hba1c measure in adults with type2 diabetes in Iran-Tabriz. Procedia-Social Behav Sci. 2010;5:1868\u0026ndash;73.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKalichman S, Stein JA, Malow R, et al. Predicting protected sexual behaviour using the Information-Motivation-Behaviour skills model among adolescent substance abusers in court-ordered treatment. Psychol health Med. 2002;8:207\u0026ndash;13.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBahrami Z, Zarani F. Application of the Information-Motivation and Behavioral Skills (IMB) model in risky sexual behaviors amongst male students. J Infect Public Health. 2015;8:207\u0026ndash;13.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMisovich SJ, Martinez T, Fisher JD, et al. Predicting breast self-examination: A test of the information-motivation-behavioral skills model. J Appl Soc Psychol. 2003;33:90\u0026ndash;775.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eFisher JD, Fisher WA, Amico KR, et al. An Information-Motivation- Behavioral Skills Model of adherence to antiretroviral therapy. Health Psychol. 2006;25:462\u0026ndash;73.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHashemi Bonjar ZS, Mirshekari L, Imankhah R, et al. Quality of Life and Related Factors in Patients with Pulmonary Tuberculosis. J Mazandaran Univ Med Sci. 2016;25:0235\u0026ndash;247.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eJahani S, Elahi N, Shahinzade A, et al. Relation of knowledge and attitude with control of medication in tuberculosis patients in Ahvaz-Iran. J Gorgan Univ Med Sci. 2011;12:80\u0026ndash;4.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMorisky DE, Ang A, Krousel-Wood M, et al. Predictive validity of a medication adherence measure in an outpatient setting. J Clin Hypertens. 2008;10:348\u0026ndash;54.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGhanei Gheshlagh R, Ebadi A, Veisi Raygani AK, et al. Determining concurrent validity of the morisky medication adherence scale in patients with type 2 diabetes. Iran J Rehabilit Res. 2015;1:24\u0026ndash;32.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMa L, Yu Y, Zhao B-J, et al. Effect of information-motivation-behavioral skills model based perioperative nursing on pain in patients with gallstones. World J Gastrointest Surg. 2024;16:2232.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eXu H, Wang J. An information-motivation-behavioral skills model-based intervention for patients with epilepsy. Epilepsy Behav. 2023;147:109408.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePuttkammer N, Demes JAE, Dervis W, et al. The situated information, motivation, and behavioral skills model of HIV antiretroviral therapy adherence among persons living with HIV in Haiti: A qualitative study incorporating culture and context. J Assoc Nurses AIDS Care. 2022;33:448\u0026ndash;58.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eFisher JD, Fisher WA. An information-motivation-behavioral skills (IMB) model of pandemic risk and prevention. Adv Psychol. 2023;1:1\u0026ndash;26.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eShi Q, Wu RJ, Liu J. Effect of health education based on information-motivation-behavioral skills model on patients with unilateral vestibular dysfunction. World J Clin Cases. 2024;12:903.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eYousif AM, Ibrahim WK, Ahmed AFM. Information Motivation Behavior Skill Model: It\u0026rsquo;s Effect on Knowledge and self-Efficacy of Women with Ovarian Hyperstimulation Syndrome. Int Egypt J Nurs Sci Res. 2024;5:91\u0026ndash;107.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHonez FE, Rachmawati IN. Pengaruh Model Information, Motivation, and Behavioral Skills (IMB) dalam Meningkatkan Deteksi Dini Kanker Serviks. J Telenursing. 2023;5:2611\u0026ndash;22.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eZareipour M, Morowatisharifabad MA, Movahed E et al. Application of information-motivation-behavioral skills model in adherence to diet and reduction of depression among HIV-positive patients: health promotion strategy 90-90-90. HIV \u0026amp; AIDS Review. 2021; 20: 187\u0026thinsp;\u0026ndash;\u0026thinsp;94.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHossain MM, Flora MS, Rahman MS, et al. Treatment Related Factors Associated with Non-adherence to Anti-Tuberculosis Treatment. Delta Med Coll J. 2021;9:96\u0026ndash;100.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBoutilier JJ, J\u0026oacute;nasson JO, Yoeli E. Improving tuberculosis treatment adherence support: the case for targeted behavioral interventions. Manuf service operation Manage. 2022;24:2925\u0026ndash;43.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMau MY, Hartayu TS. Success Factors in Improving Patients\u0026rsquo; Adherence to Tuberculosis Treatment Program: Case Study in Sleman, Yogyakarta, Indonesia. J Pharm Sci Community. 2023;20:191\u0026ndash;200.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-pulmonary-medicine","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"pulm","sideBox":"Learn more about [BMC Pulmonary Medicine](http://bmcpulmmed.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/pulm/default.aspx","title":"BMC Pulmonary Medicine","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Pulmonary Tuberculosis Disease, Education, Information-Motivation-Behavioral Skills Model, Medication adherence","lastPublishedDoi":"10.21203/rs.3.rs-6130200/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6130200/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eApproximately one-third of the world’s population is infected by tuberculosis bacteria and is at risk of being infected by the tuberculosis disease. The aim is to investigate the effect of an educational program based on the Information-Motivation-Behavioral Skill Model on medication adherence in Pulmonary Tuberculosis patients.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe quasi-experimental study examined 140 patients selected by simple randomization. Three educational sessions were held for the intervention group. Finally, the data were analyzed by descriptive and inferential tests run in the SPSS 20 software.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe mean scores of IMB constructs were significantly higher in the intervention group after the intervention (p \u0026lt; 0.05), while this surge was not significant in the control group (p \u0026gt; 0.05). Likewise, the mean medication adherence score of the intervention group increased significantly in the post-intervention phase (p \u0026lt; 0.05), while the control group displayed no significant difference (p \u0026gt; 0.05). Besides, treatment adherence was significantly higher in the intervention than in the control group after the education (p \u0026lt; 0.05).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe findings emphasize the effectiveness of the educational intervention in improving treatment adherence among TB patients in the intervention group.\u003c/p\u003e","manuscriptTitle":"The Effect of an Educational Program based on the Information-Motivation-Behavioral Skill Model on Medication Adherence among Patients with Pulmonary Tuberculosis","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-04-17 09:39:34","doi":"10.21203/rs.3.rs-6130200/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-05-16T18:08:44+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-05-03T20:39:13+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"274787980301497396809782184563469183063","date":"2025-05-03T19:59:59+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-04-25T16:17:11+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"25283060512998619682603021250649707418","date":"2025-04-20T12:53:17+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-04-15T09:44:09+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-04-09T15:47:44+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-03-19T09:23:06+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-03-18T19:18:38+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Pulmonary Medicine","date":"2025-03-18T19:17:36+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-pulmonary-medicine","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"pulm","sideBox":"Learn more about [BMC Pulmonary Medicine](http://bmcpulmmed.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/pulm/default.aspx","title":"BMC Pulmonary Medicine","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"4b2cde0e-185d-4944-bf67-696f7b137c55","owner":[],"postedDate":"April 17th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"in-revision","subjectAreas":[],"tags":[],"updatedAt":"2026-02-25T12:55:10+00:00","versionOfRecord":[],"versionCreatedAt":"2025-04-17 09:39:34","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-6130200","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6130200","identity":"rs-6130200","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}