Evaluates educational interventions for waste separation, applying Value-Belief-Norm Theory and PRECEDE-PROCEED Model in Iran

Evaluates educational interventions for waste separation, applying Value-Belief-Norm Theory and PRECEDE-PROCEED Model in Iran | 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 Evaluates educational interventions for waste separation, applying Value-Belief-Norm Theory and PRECEDE-PROCEED Model in Iran khadijeh jafarpour, Leila ghahremani, masoud karimi, zahra derakhshan This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6506584/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 17 You are reading this latest preprint version Abstract In the face of escalating environmental challenges spurred by industrialization, the management of household waste has emerged as a critical area necessitating attention. This study sought to empower housewives in Shushtar city through a structured educational intervention designed to enhance their knowledge and practices regarding waste separation. Employing a quasi-experimental methodology, 120 housewives were randomly selected and assigned to intervention and control groups, each with 60 participants. The educational program comprised six face-to-face sessions over one month, utilizing a comprehensive questionnaire founded on the Value-Belief-Norm Theory and PRECEDE-PROCEED Model for data collection. Analysis was conducted using established statistical software before the intervention and two and four months after the intervention. Results indicated that while no significant differences were observed in demographic variables between groups, notable improvements were recorded in the intervention group's mean scores across various constructs related to values, beliefs, subjective norms, skills, social support, and intentions towards waste separation. In contrast, the control group exhibited no significant changes over time. These findings underscore the positive impact of targeted educational initiatives on fostering responsible waste management behaviors among urban housewives; thus emphasizing the necessity for further development of policies aimed at enhancing environmental knowledge and instilling a sense of responsibility for ecological stewardship within communities. Household Waste Separation Educational Intervention Value-Belief-Norm theory PRECEDE-PROCEED Model Introduction In recent years, the growth of population and global economic development has caused a notable rise in the municipal solid waste (MSW) generation. This rise has a direct effect on the quality of life, public health, and the environment, making solid waste management an important environmental issue in developing countries ( 1 ). The large-scale production of waste is a worldwide urban challenge, largely driven by the rapid growth of urban populations, especially in major cities, and the absence of comprehensive waste disposal policies( 1 ). Predictions indicate that global solid waste generation, mainly due to population growth, urbanization, and socio-economic issues in low-income (and also middle-income) countries, will have increased from 1.3 billion tons in 1990 to 2.7 billion tons by 2050. This increase is particularly significant for Asia and Africa( 2 ). The mean amount of urban and rural solid waste generated across the country is 0.63 kg per capita daily. In Iran, the composition of solid waste is predominantly organic, accounting for 70%, followed by plastic and paper, which make up 7% of the waste stream ( 4 ). However, 80% of household waste in developed countries is recycled and reintegrated into the consumption cycle. In Australia and the UK, approximately 60% of household waste is recycled ( 5 ). To manage waste effectively, it is essential to predict pollution levels while also developing strategies for waste management. Recycling is a crucial solution, as it reduces MSW. Waste separation plays a vital role in effective recycling management by optimizing incineration processes and improving the quality of recyclables( 3 ). At the household level it involves sorting waste according to its characteristics or intended use at its source. This practice benefits farmers, recycling industries, municipalities, and other stakeholders by lowering disposal and collection costs, providing material for further processing such as composting, reducing issues related to waste pickers, and decreasing carbon emissions. However, it requires active participation from households. Various countries have implemented interventions, voluntary to mandatory, to boost household participation, however, the outcomes have generally been disappointing( 4 ). The World Health Organization (WHO) states that solid waste management covers the whole process, including waste production, treatment, collection, transfer, and disposal. Insufficient waste collection systems and inappropriate disposal practices are problems associated with solid waste management ( 8 ). Waste segregation serves a crucial element of an integrated waste management system ( 9 ). Implementing effective waste separation programs is essential at the household level to decrease the negative effects of waste disposal and increase waste recovery ( 10 ). The urban waste spread in air, soil, and water causes cholera, hydatid cysts, skin illnesses (leishmaniasis), and some cancers( 5 ). Since solid waste control primarily is done at home, married females play a significant role in enhancing waste management through the separation of household waste. Public involvement is crucial for creating comprehensive solutions to waste-related issues. In Iranian cities, the responsibility of sorting waste typically falls on women. Nonetheless, merely 17.7% of Iranian females reported waste separation( 6 ) Models and theories provide direction for trainers and are applicable at various phases of planning, executing, and assessing a program ( 13 ). The PRECEDE-PROCEED model serves as a roadmap, with behavior change theories acting as especial routes to reach a goal. Its primary purpose is to offer a foundation for the structured use of theories and concepts to design and evaluate health behavior change programs( 7 ). In the 3rd phase of PRECEDE-PROCEED model (educational and ecological evaluation), behavior change models and theories are used to identify predisposing, enabling, and reinforcing factors( 8 ). This model focuses on planning that examines the parameters affecting behavior change ( 16 ). We utilized its educational phase. It offers a framework where predisposing parameters (knowledge, attitude, perceptions, and beliefs), reinforcing parameters (the influence of peers, others, family, health workers, etc.), and enabling parameters (skill and resource availability) all contribute to shaping behavior. The model is particularly useful for understanding the factors related to behavior ( 9 ). The review of some studies has shown that social norms, personal norms, knowledge, beliefs, attitudes, and intention effectively play a role in the formation of waste-recycling behavior( 7 , 10 ); since these factors are in the PRECEDE-PROCEED model and are included in the group of predisposing factors, we can use the VBN theory, which is one of the most comprehensive models used to separate waste and includes predisposing factors (value-belief and norm) in the model to combine the procedures so that we can better understand and identify the factors affecting waste recycling behavior at different individual, interpersonal, and organizational levels( 11 ). The value-belief-norm (VBN) model of environmental behavior suggests that pro-environmental actions are driven by a sequence of related factors, with personal norm (PN) directly influencing behavior ( 20 ). Later research has emphasized the significance of this variable in understanding various environmental behaviors( 12 , 13 ). The modeling framework consists of personal norms, beliefs, and values, which are further explained by ascription of responsibility (AR), awareness of consequences (AC), the New Environmental Paradigm (NEP), value orientation, and personal norms (PN). Their influence operates in interconnected chains, creating a logical causal sequence ( 23 ). Values are typically categorized into Egoistic, Altruistic and Biosphere values. They reflect the need for considering not only the human groups’ well-being but also that of nonhuman species while making decisions. These three value types can encourage individuals to focus on environmental issues and engage in pro-environmental behaviors ( 24 ). Values play a crucial role in predicting and explaining pro-environmental behaviors, as they can motivate individuals to make short-term sacrifices for long-term benefits based on certain values( 14 ). To gain a better understanding of household participation in waste segregation programs, various analyses have been done. Demographic factors, like socio-economic status, housing type, and personal characteristics like education, awareness of consequences, and moral norms, all influence waste separation behaviors. Most of these factors are directly linked to internal motivations that drive individuals' decisions to separate waste. A variety of interventions have been tested to encourage and improve household waste segregation. We investigated the impact of educational intervention based on an integration of VBN theory in the PRCEED-PROCCED MODEL of household waste segregation among households in Shushtar city. Materials and methods In this interventional study, the housewives of Shushtar city covered by health centers were randomly selected according to the block classification of the Sib system using the cluster sampling method from 4 areas, two areas of the controls and two of the intervention group; then, from each alley block, those who had at least 20 households were selected and all the households in that alley were included in the study until 120 subjects (60 in the controls and 60in the intervention group) were enrolled; this process lasted from April 2024 to September 2024. After outlining the study objectives to the head of centers, a list containing eligible women was formed based on the inclusion criteria. The research was then explained to the participants, and those who agreed to participate completed the questionnaires in person prior to the intervention. The inclusion criteria included the age group of 18–65 years, the person responsible for separating the waste at home, and consent to participate. In research, mastering the Persian language means having literacy in reading and writing. Exclusion criteria were refusing to continue working as housewife, having physical disabilities that contribute to household chores, moving to another city or region, missing more than one session in training classes, and not completing or incompletely completing the study questionnaire. The sample size of 120 participants for each group was calculated ( 26 ), using a 95% confidence level, 80% test power, and a 40% effect size. The calculation was performed using the standard deviation (SD) formula for two different populations. Intervention Program : After conducting the pre-test and data analysis, the cases requiring intervention were determined; then, by searching in databases, the consensus of the expert panel, the guidance of the supervisor, and the consultant professors, an educational program tailored to the needs and priorities and literacy of the target group was designed for the intervention group. It was performed in person and collaboratively. Also, during the meetings held with the Shushtar municipality, information banners were installed in the neighborhoods of the target group by the municipality. This program was implemented in the intervention group that was selected from four regions in comprehensive urban health service centers during six sessions of 60 to 90 minutes during 6 consecutive weeks. The interventions were prepared and designed according to the PRECEDE-PROCCED model and VBN theory, and no intervention was done for the controls. Face-to-face training was provided to the intervention group with educational aids like pamphlets and slides. The training topics included knowing the components of waste, ways to reduce separation and production at the source; understanding the significance of waste separation; and knowledge about the economic benefits of waste, role of waste separation in reducing infectious diseases, protection of natural resources, the relationship between waste separation and reduction of the heat of the earth. The role of waste separation in reducing greenhouse gases was to teach the role of governments' responsibility in environmental problems, and to familiarize with the role of family members and relatives and their cooperation in the success of waste separation. An expert from the Environment Department was invited and talked about the importance of waste separation to provide social support to housewives; he held an incentive program that included giving cotton bags for waste separation. Also, the municipal expert was invited to train the intervention group for greater cooperation and an enabling role. The trained households were given plastic bags and cardboard to separate waste for two months (60 days). Dry waste was collected once a week by two of the municipal forces who had received the necessary training in this regard. The waste collection was done during 60 days so that people's performance in waste separation could be compared well. Two months and four months after the six-week training course (the length of the intervention period), the post-test questionnaire was filled out by the intervention and control groups. Data Collection Method : The researcher-made questionnaire used in this study includes 91 questions, including 5 questions related to demographic characteristics, 15 questions about knowledge, egoistic values(5 questions), altruistic values(4 questions), biosphere values(4 questions), worldview New Environmental Paradigm(5 questions), consequence awareness (6 questions), the responsibility ascription to self(3 questions), personal norm(9 questions), injunctive norm(5 questions), descriptive norm(3 questions), skill(4 questions), affordable service(3 questions), social support(6 questions), intention(8 questions), and behavior (6 questions) . The data from the questionnaires were entered into the SPSS 26 software after coding. Descriptive and inferential statistics were applied for data analysis. Reliability and Validity of the Tool : The tools’ content validity was assessed by calculating the content validity ratio (CVR) and content validity index (CVI) following the feedback from 11 experts in environmental health, health promotion and health education. The average CVI score was 0.81, while the average CVR score was 0.84. The tool’s reliability was evaluated through measures of stability and internal consistency. The internal consistency was assessed by Cronbach’s alpha coefficient, considering the sample size of 30 individuals independent of the primary study group, which was found to be 0.87. Furthermore, the test-retest evaluated stability of the scale. After two weeks, 30 individuals re-completed it, and the correlation coefficient between the two sets of scores was calculated. The tool's correlation coefficients were 0.82 to 0.92 (Table 1 ). Table 1 Characteristics of the Measurement Scales of the Tool Constructs Construct Number of Items, Scoring (Range) Sample of Items CVR CVI Reliability Knowledge: An individual must acquire facts and understanding regarding an action, idea, object, person, or situation( 20 ) 15 items Yes. No. I don't know (15–45) Are disposable paper containers recyclable? 0.63 0.81 0.72 Egoistic values: These values are driven by self-interest, where individuals prioritize maximizing their personal, particularly economic, benefits 5 items from 1 completely disagree to 5 completely agree ( 5 – 25 ) I will separate the waste if I pay for it 0.81 0.81 0.74 altruism humans: People with these values focus on promoting the well-being of other human groups, aiming to enhance the community's interests. However, altruistic values typically overlook the needs of non-human species. 4 items from 1 completely disagree to 5 completely agree( 4 – 20 ) I like to help preserve resources for future generations by separating waste 0.81 0.72 0.87 altruism biosphere: These values emphasize the importance of individuals considering not only the well-being of human groups but also the welfare of nonhuman species when engaging in certain actions 4 items from 1 completely disagree to 5 completely agree( 4 – 20 ) I respect the planet by separating waste. 0.95 0.91 0.81 New Environmental Paradigm(NEP): NEP represents a widely recognized environmental worldview that reflects individuals’ perceptions about humanity's ability to disturb the natural balance, the potential limitations on societal growth, and humans' rights to control nature 5 items from 1 completely disagree to 5 completely agree( 5 – 25 ) I believe that waste separation has an effect on the life and survival of plants and animals. 0.81 0.72 0.67 awareness of consequences(AC): AC refers to an individual's recognition of the harmful effects their actions, particularly anti-social behaviors, may have on others or the environment. 6 items from 1 completely disagree to 5 completely agree(6–30) Failure to separate waste increases the heat of the earth. 0.81 0.90 0.81 ascription of responsibility to self(AR): This refers to the sense of accountability an individual feels for the negative consequences of failing to act in a pro-social manner. 3 items from 1 completely disagree to 5 completely agree( 3 – 15 ) We are all responsible for environmental problems caused by not separating waste 0.81 0.72 0.94 personal norms(PN): This pertains to an individual’s sense of moral duty to either engage in or avoid certain behaviors‟( 16 ) 9 items from 1 completely disagree to 5 completely agree(9–45) I do not feel obliged to separate the waste. 0.63 0.90 0.60 injunctive norms: These are societal expectations regarding how people should behave, representing the standards of acceptable behavior within a community( 21 ) 5 items from 1 completely disagree to 5 completely agree( 5 – 25 ) My family members confirm my concerns about the environment 0.81 0.72 0.88 Descriptive norms: Descriptive norms are influential concepts that help explain how people in a given culture typically behave, complementing the value-based approach in cross-cultural psychology.( 22 ) 3 items from 1 completely disagree to 5 completely agree( 3 – 15 ) Most of my friends separate waste at home. 1 1 0.83 Skills: facility, proficiency, or dexterity that is acquired or developed through training or experience‖( 23 ) 4 items from 1 completely disagree to 5 completely agree( 4 – 20 ) I can properly separate household waste. 095 092 0.90 Affordable service: both on the price of a health intervention and on the financial means of the person or organization paying for it.( 24 ) 3 items from 1 completely disagree to 5 completely agree( 3 – 15 ) In our neighborhood, the municipality provides my family with special containers for waste separation. 0.81 1 086 Social support: This refers to the social resources that individuals perceive as available or that are actually provided by non-professionals, either through formal support groups or informal helping relationships.( 25 ) 6 items from 1 completely disagree to 5 completely agree(6–30) Whenever I have a question about waste separation., there are people to give me information. 0.81 1 0.78 Intention: This reflects the degree to which housewives are motivated to perform and pursue the behavior( 26 ) 8 items from 1 completely disagree to 5 completely agree(8–40) In the near future, I plan to separate plastic waste such as (plastic containers, etc.) from other waste at home. 1 1 0.80 Behavior: behavior refers to the act of participating in household waste separation by housewives, driven by their intention( 26 ) 6 items from 1 completely disagree to 5 completely agree(6–30) Have you separated paper waste in the last two weeks? 0.81 1 0.81 Inclusion and Exclusion Criteria Participants who did not have any problem meeting the inclusion criteria were asked to provide written consent to participate in the research. Proficiency in the Persian language and literacy were also required. Additionally, individuals with no clear physical conditions affecting their ability to complete the questionnaire were included in the study. Participants who did not complete the questionnaire were excluded. Ethical Considerations Ethics approval and consent to participate the study mentioned above received approval from the ethics board committee of Shiraz University of Medical Sciences (IR.SUMS.SCHEANUTREC.1402.119) and was conducted according to the principles of the Declaration of Helsinki. In the first step, the research’s purpose, importance, and necessity were explained to the participants. Both groups were then given questionnaires before the educational intervention. It’s worth noting that the participants signed the informed consent form before the intervention. We obtained informed consent for illiterate participants from their legal guardians. They were also assured that their information would be kept anonymous. The study did not result in any financial, physical, or psychological harm to the participants. Results The study included 120 participants, with 60 individuals in each group. The participants’ mean age was 35.03 ± 8.37 years. As shown in (Table 2 ), the groups showed no significant difference regarding demographic factors ( P < 0.05). Table 2 Frequency distribution of the intervention and control groups based on demographic variable Variable Total Group X 2 P * Percent(%) Intervention Control Marital status Single 11(18.3) 6( 10 ) 5(8.3) 0.100 0.752 Married 109(81.7) 54(90) 55(91.7) education High school 27(22.50) 18(30) 9(15.0) 5.023 0.081 diploma 43(35.83) 22(36.7) 21(35.0) graduate 50(41.67) 20(33.3) 30(50) spouse's education High school 19(15.833) 10(16.7) 9( 15 ) 1.795 0.616 diploma 49(40.833) 27(45.0) 22(36.7) graduate 45(37.50) 19(31.7) 26(43.3) I don't have a wife 7(5.83) 4(6.7) 3(5.0) women's own occupation Unemployed 9(7.50) 4(6.7) 5(8.3) 6.984 0.137 Employed 87(72.50) 42(70.0) 45(75.0) Retired 16(13.33) 10(46.7) 6(5.0) I don't have a wife 8(6.67) 4(6.7) 4(6.7) *Chi-Square Test A Repeated measure ANOVA results of the educational intervention effect household waste separation by the integration of Value-Belief-Norm theory in the PRECEDE-PROCCED MODEL between the control and intervention groups was also conducted. ( Table 3 ) Table 3 Repeated measure ANOVA results of the educational intervention effect household waste separation by the integration of Value-Belief-Norm theory in the PRECEDE-PROCCED MODEL between the control and intervention groups Variable Time Intervention Mean (SD) Control Mean (SD) Time group Time*group η² knowledge Before 18.96 ± 3.93 19.35 ± 3.99 ˂0.001 ˂0.001 ˂0.001 0.43 After (2months) 27.38 ± 5.50 19.51 ± 4.35 After (4months) 26.65 ± 4.97 19.05 ± 3.91 Egoistic values Before 15.75 ± 3.22 15.98 ± 2.34 ˂0.001 ˂0.001 ˂0.001 0.50 After (2months) 21.63 ± 3.35 15.83 ± 2.98 After (4months) 21.58 ± 3.33 15.76 ± 2.94 altruism humans Before 13.13 ± 2.86 12.21 ± 2.94 ˂0.001 ˂0.001 ˂0.001 0. 54 After (2months) 18.20 ± 2.71 12.13 ± 3.86 After (4months) 18.78 ± 2.00 12.15 ± 3.76 altruism biosphere Before 12.13 ± 2.50 11.96 ± 2.66 ˂0.001 ˂0.001 ˂0.001 0. 44 After (2months) 16.75 ± 2.44 11.93 ± 2.66 After (4months) 16.73 ± 2.50 11.76 ± 2.71 New Environmental Paradigm(NEP) Before 13.01 ± 2.89 13.25 ± 2.81 ˂0.001 < 0.001 ˂0.001 0.51 After (2months) 16.05 ± 3.24 13.08 ± 2.79 After (4months) 16.06 ± 3.38 13.21 ± 2.79 awareness of consequences(AC) Before 18.88 ± 3.42 18.63 ± 3.90 ˂0.001 ˂0.001 ˂0.001 0.49 After (2months) 25.53 ± 3.56 18.76 ± 3.78 After (4months) 25.80 ± 3.27 18.71 ± 3.91 ascription of responsibility to self(AR) Before 8.48 ± 1.64 9.75 ± 1.84 ˂0.001 ˂0.001 ˂0.001 0.71 After (2months) 12.90 ± 1.98 9.63 ± 1.93 After (4months) 12.76 ± 1.87 9.50 ± 1.73 personal norms(PN) Before 30.41 ± 4.59 30.08 ± 4.84 ˂0.001 ˂0.001 ˂0.001 0.22 After (2months) 34.86 ± 4.33 30.06 ± 4.99 After (4months) 35.08 ± 4.21 30.21 ± 4.36 Descriptive norms Before 7.33 ± 1.93 7.58 ± 2.43 ˂0.001 ˂0.001 ˂0.001 0.32 After (2months) 10.70 ± 3.11 7.41 ± 2.27 After (4months) 10.76 ± 3.16 7.45 ± 2.28 injunctive norms Before 14.53 ± 2.94 14.90 ± 3.83 ˂0.001 ˂0.001 ˂0.001 0.24 After (2months) 18.76 ± 4.13 14.75 ± 3.78 After (4months) 18.71 ± 4.15 14.78 ± 3.80 skills Before 12.43 ± 1.81 10.90 ± 2.49 ˂0.001 ˂0.001 ˂0.001 0.19 After (2months) 19.43 ± 1.60 10.50 ± 4.64 After (4months) 19.11 ± 3.02 10.33 ± 3.63 Affordable service Before 7.91 ± 2.90 8.71 ± 2.93 ˂0.001 ˂0.001 ˂0.009 0.13 After (2months) 9.16 ± 2.93 8.15 ± 3.34 After (4months) 10.91 ± 3.61 8.20 ± 4.60 Social support Before 17.86 ± 3.36 18.31 ± 3.04 ˂0.001 ˂0.007 ˂0.003 0.15 After (2months) 21.43 ± 3.21 18.35 ± 3.30 After (4months) 24.10 ± 5.27 18.35 ± 3.19 Intention Before 25.25 ± 3.49 25.33 ± 5.10 ˂0.001 ˂0.001 ˂0.001 0.58 After (2months) 34.55 ± 5.99 25.15 ± 5.01 After (4months) 33.63 ± 3.14 25.11 ± 5.00 behavior Before 14.10 ± 4.69 14.33 ± 4.87 ˂0.001 ˂0.001 ˂0.001 0.30 After (2months) 21.90 ± 6.12 14.20 ± 4.80 After (4months) 21.03 ± 5.79 14.25 ± 4.80 Discussion An educational program based on the VBN theory within the PRECEDE-PROCEED model was shown to enhance household waste separation behavior at the source among housewives in the intervention group in Shushtar city in comparison to the controls. Prior to the intervention, both groups had low knowledge, as indicated by their mean scores. However, it significantly improved the average knowledge score in the intervention group (p ˂0.001). These findings align with other reports (27). The findings underscore the critical role of knowledge in behavior change, highlighting the need to offer adequate information regarding health behaviors to support effective behavior alteration programs( 15 ). Environmental knowledge and awareness has a positive impact on environmental behaviors and attitudes (29). Considering this, and understanding that the effectiveness of each waste management program depends on the involvement and commitment of citizens, it is essential to raise public awareness. This includes offering certain knowledge regarding the social, economic, environmental, and health impacts, and also improving sustainable behaviors like waste recycling, reuse, and reduction at home. These sustainable approaches help ensure participation of the citizens in waste management efforts. Therefore, providing and supporting collection facilities by the municipality represents a valuable investment for society. The PRECEDE-PROCEED model-based intervention and the VBN theory, involved examining relevant constructs. Specifically, the value subscales (egoistic values, human altruism, and biosphere altruism) demonstrated a significant difference between the groups before the intervention and 2 and 4 months afterward (p ˂0.001). These findings align with those of another study. The belief subscales (NEP, AC, and PN) indicated a significant difference between the groups before, 2 months, and 4 months after the educational intervention (p ˂0.001). Individuals with altruistic and biosphere-oriented values often develop positive attitudes and beliefs toward the environment, as such beliefs contribute to the well-being of both others and the environment( 16 ). The educational intervention successfully altered housewives' norms regarding waste recycling at home. The norm subscales (PN, descriptive norms, and injunctive norms) showed a significant difference between the groups before, 2 months, and 4 months after the intervention (p ˂0.001). Sadeghi reported a similar positive effect of the educational intervention on housewives' norms (32). Gkargkavouzi et al. proposed that ascribing responsibility increases personal norms, encouraging European adults to participate in climate mitigation efforts (33). Effective household solid waste management can only be obtained through collective support, fostering a clean environment and encouraging individuals to separate waste and engage in responsible pro-environmental behavior. Social and personal norms are crucial in promoting ecological behaviors( 17 ). The educational intervention effectively improved housewives' skills in recycling waste at home. Research has indicated that perceived skills are affected by motivational factors like social norms, attitudes, and perceived control (p ˂0.001). Thus, it would be valuable to explore whether such parameters also impact actual recycling skills( 18 ). To improve the effectiveness of waste separation, it is essential to implement interventions that utilize a variety of behavior change strategies. These interventions can include informational and educational campaigns, incentive and disincentive programs, feedback mechanisms, and behavior modeling. The research findings revealed that conducting six educational sessions according to the PRECEDE-PROCEED model and VBN theory caused a significant increase in the average score of both source separation behavior and behavioral intention in the intervention group. Zhang et al. (29) in China and Babazadeh et al. ( 9 ) in Iran found that behavioral intention can predict waste separation behavior. Enhancing the intention to separate waste greatly improves actual behavior. Similarly, Liu et al. carried out a planned recycling behavior-based intervention among New York State residents, and their average recycling behavior scores showed a significant increase after the intervention( 19 ). Conclusions We explored the parameters affecting the intention and behaviors of Shushtari housewives regarding source separation to improve household waste separation, by integrating the VBN Theory within the PRECEDE-PROCEED Model. Urban housewives' intentions to separate waste at the source were positively influenced by values, beliefs, and norms. These results highlight the need for more studies and the development of effective strategies and policies to encourage housewives' active participation in waste separation. Such initiatives should focus on promoting environmental awareness, emphasizing moral responsibilities, and fostering a sense of duty toward environmental protection. Strengths and Limitations : The strengths of our research include the face-to-face training provided to housewives and using an integrated model (the PRECEDE-PROCEED model and VBN theory) in the intervention program. However, one limitation was the short duration of the follow-up with participants. We recommend performing longer follow-up measurements to assess the sustainability and consistency of the behavior. Another limitation is that the findings may not be generalizable beyond Shushtar city. Declarations Acknowledgments: This manuscript is based on the PhD thesis of Ms. Khadijeh Jafarpour in health education and promotion (IR.SUMS.SCHEANUT.REC.1402.119). The study was financially supported by " Shiraz University of Medical Sciences." We are thankful to the women who participated in our study. Authors’ Contribution : All authors contributed to the study and provided feedback on the manuscript at each stage. Conflict of Interests : None. Data Availability : The dataset is available upon request from the corresponding author, either during the submission process or after the publication. Ethical Approval : Ethics approval and consent to participate the study mentioned above received approval from the ethics board committee of Shiraz University of Medical Sciences (IR.SUMS.SCHEANUTREC.1402.119) and was conducted according to the principles of the Declaration of Helsinki. Funding/Support : This manuscript was supported by the “Shiraz University of Medical Sciences.” Informed Consent : The subjects were informed about the confidentiality of the study and its objectives, and they provided written informed consent to participate. References Haghighatjoo S, Asgari A, Tahmasebi R, Noroozi A. Predictor Factors of Recycling Behavior in Residents of Bushehr City: Application of Theo-ry of Planned Behavior. ISMJ. 2020;23(2):116-28. Wilson DC, Velis CA. 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Ain Shams Engineering Journal. 2022;13(4):101729. del Carmen Aguilar-Luzón M, García- Martínez JMÁ, Calvo-Salguero A, Salinas JM. Comparative Study Between the Theory of Planned Behavior and the Value–Belief–Norm Model Regarding the Environment, on Spanish Housewives’ Recycling Behavior. Journal of Applied Social Psychology. 2012;42(11):2797-833. Batool N, Wani MD, Shah SA, Dada ZA. Theory of planned behavior and value-belief norm theory as antecedents of pro-environmental behaviour: Evidence from the local community. Journal of Human Behavior in the Social Environment. 2024;34(5):693-709. Nordlund AM, Garvill J. Effects of values, problem awareness, and personal norm on willingness to reduce personal car use. Journal of environmental psychology. 2003;23(4):339-47. Safavi SR, Bakhshi F, Omidi S. Social determinants of health and lifestyle in the elderly. Iranian Journal of Health Education and Health Promotion. 2022;9(4):372-82. Karimi S. Pro-environmental behaviours among agricultural students: An examination of the value-belief-norm theory. Karimi, S(2019) Pro-Environmental Behaviours among Agricultural Students: An Examination of the Value-Belief-Norm Theory Journal of Agricultural Science and Technology. 2019;21(2):249-63. Richter NF, Martin J, Hansen SV, Taras V, Alon I. Motivational configurations of cultural intelligence, social integration, and performance in global virtual teams. Journal of Business Research. 2021;129:351-67. Passafaro P, Bacciu A, Caggianelli I, Castaldi V, Fucci E, Ritondale D, et al. Measuring individual skills in household waste recycling: Implications for citizens' education and communication in six urban contexts. Applied Environmental Education & Communication. 2016;15(3):234-46. Liu Z, Yang JZ, Clark SS, Shelly MA. Recycling as a planned behavior: the moderating role of perceived behavioral control. Environment, Development and Sustainability. 2021:1-16. Sharma M. Theoretical foundations of health education and health promotion: Jones & Bartlett Learning; 2021. Douglas BD, Holley K, Isenberg N, Kennedy KR, Brauer M. Social sanctions in response to injunctive norm violations. Current opinion in psychology. 2024:101850. Gelfand MJ, Harrington JR. The motivational force of descriptive norms: For whom and when are descriptive norms most predictive of behavior? Journal of Cross-Cultural Psychology. 2015;46(10):1273-8. Blake R. Technology and the four skills. 2016. NAJWAN MR. Effect of Service Quality, Product Quality, Store Atmosphere, and Price Affordability on Customer Satisfaction and Loyalty at Coffee Shop Lapak Ngopi: Universitas Gadjah Mada; 2022. Gottlieb BH, Bergen AE. Social support concepts and measures. Journal of psychosomatic research. 2010;69(5):511-20. Moghaddam MC, Zeidi IM, Morshedi H, Hosseini F, Rouhani-Tonekaboni N. The Effect of an Educational Intervention Based on an Integrated Social Cognition Model on Waste Recycling at the Source Among Housewives in Lahijan City: A Quasi-Experimental Study. Health Scope. 2024;13(1). Additional Declarations No competing interests reported. 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This rise has a direct effect on the quality of life, public health, and the environment, making solid waste management an important environmental issue in developing countries (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e). The large-scale production of waste is a worldwide urban challenge, largely driven by the rapid growth of urban populations, especially in major cities, and the absence of comprehensive waste disposal policies(\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e). Predictions indicate that global solid waste generation, mainly due to population growth, urbanization, and socio-economic issues in low-income (and also middle-income) countries, will have increased from 1.3\u0026nbsp;billion tons in 1990 to 2.7\u0026nbsp;billion tons by 2050. This increase is particularly significant for Asia and Africa(\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e). The mean amount of urban and rural solid waste generated across the country is 0.63 kg per capita daily. In Iran, the composition of solid waste is predominantly organic, accounting for 70%, followed by plastic and paper, which make up 7% of the waste stream (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e). However, 80% of household waste in developed countries is recycled and reintegrated into the consumption cycle. In Australia and the UK, approximately 60% of household waste is recycled (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e). To manage waste effectively, it is essential to predict pollution levels while also developing strategies for waste management. Recycling is a crucial solution, as it reduces MSW. Waste separation plays a vital role in effective recycling management by optimizing incineration processes and improving the quality of recyclables(\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e). At the household level it involves sorting waste according to its characteristics or intended use at its source. This practice benefits farmers, recycling industries, municipalities, and other stakeholders by lowering disposal and collection costs, providing material for further processing such as composting, reducing issues related to waste pickers, and decreasing carbon emissions. However, it requires active participation from households. Various countries have implemented interventions, voluntary to mandatory, to boost household participation, however, the outcomes have generally been disappointing(\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThe World Health Organization (WHO) states that solid waste management covers the whole process, including waste production, treatment, collection, transfer, and disposal. Insufficient waste collection systems and inappropriate disposal practices are problems associated with solid waste management (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e). Waste segregation serves a crucial element of an integrated waste management system (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e). Implementing effective waste separation programs is essential at the household level to decrease the negative effects of waste disposal and increase waste recovery (\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e). The urban waste spread in air, soil, and water causes cholera, hydatid cysts, skin illnesses (leishmaniasis), and some cancers(\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eSince solid waste control primarily is done at home, married females play a significant role in enhancing waste management through the separation of household waste. Public involvement is crucial for creating comprehensive solutions to waste-related issues. In Iranian cities, the responsibility of sorting waste typically falls on women. Nonetheless, merely 17.7% of Iranian females reported waste separation(\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e)\u003c/p\u003e \u003cp\u003eModels and theories provide direction for trainers and are applicable at various phases of planning, executing, and assessing a program (\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e). The PRECEDE-PROCEED model serves as a roadmap, with behavior change theories acting as especial routes to reach a goal. Its primary purpose is to offer a foundation for the structured use of theories and concepts to design and evaluate health behavior change programs(\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e). In the 3rd phase of PRECEDE-PROCEED model (educational and ecological evaluation), behavior change models and theories are used to identify predisposing, enabling, and reinforcing factors(\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThis model focuses on planning that examines the parameters affecting behavior change (\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e). We utilized its educational phase. It offers a framework where predisposing parameters (knowledge, attitude, perceptions, and beliefs), reinforcing parameters (the influence of peers, others, family, health workers, etc.), and enabling parameters (skill and resource availability) all contribute to shaping behavior. The model is particularly useful for understanding the factors related to behavior (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThe review of some studies has shown that social norms, personal norms, knowledge, beliefs, attitudes, and intention effectively play a role in the formation of waste-recycling behavior(\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e); since these factors are in the PRECEDE-PROCEED model and are included in the group of predisposing factors, we can use the VBN theory, which is one of the most comprehensive models used to separate waste and includes predisposing factors (value-belief and norm) in the model to combine the procedures so that we can better understand and identify the factors affecting waste recycling behavior at different individual, interpersonal, and organizational levels(\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThe value-belief-norm (VBN) model of environmental behavior suggests that pro-environmental actions are driven by a sequence of related factors, with personal norm (PN) directly influencing behavior (\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e). Later research has emphasized the significance of this variable in understanding various environmental behaviors(\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThe modeling framework consists of personal norms, beliefs, and values, which are further explained by ascription of responsibility (AR), awareness of consequences (AC), the New Environmental Paradigm (NEP), value orientation, and personal norms (PN). Their influence operates in interconnected chains, creating a logical causal sequence (\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e). Values are typically categorized into Egoistic, Altruistic and Biosphere values. They reflect the need for considering not only the human groups’ well-being but also that of nonhuman species while making decisions. These three value types can encourage individuals to focus on environmental issues and engage in pro-environmental behaviors (\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e). Values play a crucial role in predicting and explaining pro-environmental behaviors, as they can motivate individuals to make short-term sacrifices for long-term benefits based on certain values(\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eTo gain a better understanding of household participation in waste segregation programs, various analyses have been done. Demographic factors, like socio-economic status, housing type, and personal characteristics like education, awareness of consequences, and moral norms, all influence waste separation behaviors. Most of these factors are directly linked to internal motivations that drive individuals' decisions to separate waste. A variety of interventions have been tested to encourage and improve household waste segregation.\u003c/p\u003e \u003cp\u003eWe investigated the impact of educational intervention based on an integration of VBN theory in the PRCEED-PROCCED MODEL of household waste segregation among households in Shushtar city.\u003c/p\u003e "},{"header":"Materials and methods","content":"\u003cp\u003e In this interventional study, the housewives of Shushtar city covered by health centers were randomly selected according to the block classification of the Sib system using the cluster sampling method from 4 areas, two areas of the controls and two of the intervention group; then, from each alley block, those who had at least 20 households were selected and all the households in that alley were included in the study until 120 subjects (60 in the controls and 60in the intervention group) were enrolled; this process lasted from April 2024 to September 2024. After outlining the study objectives to the head of centers, a list containing eligible women was formed based on the inclusion criteria. The research was then explained to the participants, and those who agreed to participate completed the questionnaires in person prior to the intervention. The inclusion criteria included the age group of 18–65 years, the person responsible for separating the waste at home, and consent to participate. In research, mastering the Persian language means having literacy in reading and writing. Exclusion criteria were refusing to continue working as housewife, having physical disabilities that contribute to household chores, moving to another city or region, missing more than one session in training classes, and not completing or incompletely completing the study questionnaire.\u003c/p\u003e\u003cp\u003eThe sample size of 120 participants for each group was calculated (\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e), using a 95% confidence level, 80% test power, and a 40% effect size. The calculation was performed using the standard deviation (SD) formula for two different populations.\u003c/p\u003e\u003cp\u003e \u003cb\u003eIntervention Program\u003c/b\u003e:\u003c/p\u003e\u003cp\u003eAfter conducting the pre-test and data analysis, the cases requiring intervention were determined; then, by searching in databases, the consensus of the expert panel, the guidance of the supervisor, and the consultant professors, an educational program tailored to the needs and priorities and literacy of the target group was designed for the intervention group. It was performed in person and collaboratively. Also, during the meetings held with the Shushtar municipality, information banners were installed in the neighborhoods of the target group by the municipality. This program was implemented in the intervention group that was selected from four regions in comprehensive urban health service centers during six sessions of 60 to 90 minutes during 6 consecutive weeks. The interventions were prepared and designed according to the PRECEDE-PROCCED model and VBN theory, and no intervention was done for the controls. Face-to-face training was provided to the intervention group with educational aids like pamphlets and slides. The training topics included knowing the components of waste, ways to reduce separation and production at the source; understanding the significance of waste separation; and knowledge about the economic benefits of waste, role of waste separation in reducing infectious diseases, protection of natural resources, the relationship between waste separation and reduction of the heat of the earth. The role of waste separation in reducing greenhouse gases was to teach the role of governments' responsibility in environmental problems, and to familiarize with the role of family members and relatives and their cooperation in the success of waste separation. An expert from the Environment Department was invited and talked about the importance of waste separation to provide social support to housewives; he held an incentive program that included giving cotton bags for waste separation. Also, the municipal expert was invited to train the intervention group for greater cooperation and an enabling role. The trained households were given plastic bags and cardboard to separate waste for two months (60 days). Dry waste was collected once a week by two of the municipal forces who had received the necessary training in this regard. The waste collection was done during 60 days so that people's performance in waste separation could be compared well. Two months and four months after the six-week training course (the length of the intervention period), the post-test questionnaire was filled out by the intervention and control groups.\u003c/p\u003e\u003cp\u003e \u003cb\u003eData Collection Method\u003c/b\u003e:\u003c/p\u003e\u003cp\u003eThe researcher-made questionnaire used in this study includes 91 questions, including 5 questions related to demographic characteristics, 15 questions about knowledge, egoistic values(5 questions), altruistic values(4 questions), biosphere values(4 questions), worldview New Environmental Paradigm(5 questions), consequence awareness (6 questions), the responsibility ascription to self(3 questions), personal norm(9 questions), injunctive norm(5 questions), descriptive norm(3 questions), skill(4 questions), affordable service(3 questions), social support(6 questions), intention(8 questions), and behavior (6 questions) .\u003c/p\u003e\u003cp\u003eThe data from the questionnaires were entered into the SPSS 26 software after coding. Descriptive and inferential statistics were applied for data analysis.\u003c/p\u003e\u003cp\u003e \u003cb\u003eReliability and Validity of the Tool\u003c/b\u003e:\u003c/p\u003e\u003cp\u003eThe tools’ content validity was assessed by calculating the content validity ratio (CVR) and content validity index (CVI) following the feedback from 11 experts in environmental health, health promotion and health education. The average CVI score was 0.81, while the average CVR score was 0.84. The tool’s reliability was evaluated through measures of stability and internal consistency.\u003c/p\u003e\u003cp\u003eThe internal consistency was assessed by Cronbach’s alpha coefficient, considering the sample size of 30 individuals independent of the primary study group, which was found to be 0.87. Furthermore, the test-retest evaluated stability of the scale. After two weeks, 30 individuals re-completed it, and the correlation coefficient between the two sets of scores was calculated. The tool's correlation coefficients were 0.82 to 0.92 (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e \u003c/p\u003e\u003cdiv class=\"gridtable\"\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\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\u003eCharacteristics of the Measurement Scales of the Tool Constructs\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e\u003ccolgroup cols=\"6\"\u003e\u003c/colgroup\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eConstruct\u003c/p\u003e \u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNumber of Items, Scoring (Range)\u003c/p\u003e \u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eSample of Items\u003c/p\u003e \u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eCVR\u003c/p\u003e \u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eCVI\u003c/p\u003e \u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eReliability\u003c/p\u003e \u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eKnowledge: An individual must acquire facts and understanding regarding an action, idea, object, person, or situation(\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e15 items Yes. No. I don't know (15–45)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eAre disposable paper containers recyclable?\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.63\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.81\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.72\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEgoistic values: These values are driven by self-interest, where individuals prioritize maximizing their personal, particularly economic, benefits\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5 items from 1 completely disagree to 5 completely agree (\u003cspan additionalcitationids=\"CR6 CR7 CR8 CR9 CR10 CR11 CR12 CR13 CR14 CR15 CR16 CR17 CR18 CR19 CR20 CR21 CR22 CR23 CR24\" citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e–\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eI will separate the waste if I pay for it\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.81\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.81\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.74\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ealtruism humans: People with these values focus on promoting the well-being of other human groups, aiming to enhance the community's interests. However, altruistic values typically overlook the needs of non-human species.\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4 items from 1 completely disagree to 5 completely agree(\u003cspan additionalcitationids=\"CR5 CR6 CR7 CR8 CR9 CR10 CR11 CR12 CR13 CR14 CR15 CR16 CR17 CR18 CR19\" citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e–\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eI like to help preserve resources for future generations by separating waste\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.81\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.72\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.87\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ealtruism biosphere: These values emphasize the importance of individuals considering not only the well-being of human groups but also the welfare of nonhuman species when engaging in certain actions\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4 items from 1 completely disagree to 5 completely agree(\u003cspan additionalcitationids=\"CR5 CR6 CR7 CR8 CR9 CR10 CR11 CR12 CR13 CR14 CR15 CR16 CR17 CR18 CR19\" citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e–\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eI respect the planet by separating waste.\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.95\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.91\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.81\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNew Environmental Paradigm(NEP): NEP represents a widely recognized environmental worldview that reflects individuals’ perceptions about humanity's ability to disturb the natural balance, the potential limitations on societal growth, and humans' rights to control nature\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5 items from 1 completely disagree to 5 completely agree(\u003cspan additionalcitationids=\"CR6 CR7 CR8 CR9 CR10 CR11 CR12 CR13 CR14 CR15 CR16 CR17 CR18 CR19 CR20 CR21 CR22 CR23 CR24\" citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e–\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eI believe that waste separation has an effect on the life and survival of plants and animals.\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.81\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.72\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.67\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eawareness of consequences(AC): AC refers to an individual's recognition of the harmful effects their actions, particularly anti-social behaviors, may have on others or the environment.\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e6 items from 1 completely disagree to 5 completely agree(6–30)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eFailure to separate waste increases the heat of the earth.\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.81\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.90\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.81\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eascription of responsibility to self(AR): This refers to the sense of accountability an individual feels for the negative consequences of failing to act in a pro-social manner.\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3 items from 1 completely disagree to 5 completely agree(\u003cspan additionalcitationids=\"CR4 CR5 CR6 CR7 CR8 CR9 CR10 CR11 CR12 CR13 CR14\" citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e–\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eWe are all responsible for environmental problems caused by not separating waste\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.81\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.72\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.94\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003epersonal norms(PN): This pertains to an individual’s sense of moral duty to either engage in or avoid certain behaviors‟(\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e9\u003c/b\u003e items from 1 completely disagree to 5 completely agree(9–45)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eI do not feel obliged to separate the waste.\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.63\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.90\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.60\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003einjunctive norms: These are societal expectations regarding how people should behave, representing the standards of acceptable behavior within a community(\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e5\u003c/b\u003e items from 1 completely disagree to 5 completely agree(\u003cspan additionalcitationids=\"CR6 CR7 CR8 CR9 CR10 CR11 CR12 CR13 CR14 CR15 CR16 CR17 CR18 CR19 CR20 CR21 CR22 CR23 CR24\" citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e–\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMy family members confirm my concerns about the environment\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.81\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.72\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.88\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDescriptive norms: Descriptive norms are influential concepts that help explain how people in a given culture typically behave, complementing the value-based approach in cross-cultural psychology.(\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e3\u003c/b\u003e items from 1 completely disagree to 5 completely agree(\u003cspan additionalcitationids=\"CR4 CR5 CR6 CR7 CR8 CR9 CR10 CR11 CR12 CR13 CR14\" citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e–\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMost of my friends separate waste at home.\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.83\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSkills: facility, proficiency, or dexterity that is acquired or developed through training or experience‖(\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e4\u003c/b\u003e items from 1 completely disagree to 5 completely agree(\u003cspan additionalcitationids=\"CR5 CR6 CR7 CR8 CR9 CR10 CR11 CR12 CR13 CR14 CR15 CR16 CR17 CR18 CR19\" citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e–\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eI can properly separate household waste.\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e095\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e092\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.90\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAffordable service: both on the price of a health intervention and on the financial means of the person or organization paying for it.(\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e3\u003c/b\u003e items from 1 completely disagree to 5 completely agree(\u003cspan additionalcitationids=\"CR4 CR5 CR6 CR7 CR8 CR9 CR10 CR11 CR12 CR13 CR14\" citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e–\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eIn our neighborhood, the municipality provides my family with special containers for waste separation.\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.81\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e086\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSocial support: This refers to the social resources that individuals perceive as available or that are actually provided by non-professionals, either through formal support groups or informal helping relationships.(\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e6 items from 1 completely disagree to 5 completely agree(6–30)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eWhenever I have a question about waste separation., there are people to give me information.\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.81\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.78\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIntention: This reflects the degree to which housewives are motivated to perform and pursue the behavior(\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e8 items from 1 completely disagree to 5 completely agree(8–40)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eIn the near future, I plan to separate plastic waste such as (plastic containers, etc.) from other waste at home.\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.80\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBehavior: behavior refers to the act of participating in household waste separation by housewives, driven by their intention(\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e6 items from 1 completely disagree to 5 completely agree(6–30)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eHave you separated paper waste in the last two weeks?\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.81\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.81\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/table\u003e\u003c/div\u003e\u003cp\u003e \u003cb\u003eInclusion and Exclusion Criteria\u003c/b\u003e \u003c/p\u003e\u003cp\u003eParticipants who did not have any problem meeting the inclusion criteria were asked to provide written consent to participate in the research. Proficiency in the Persian language and literacy were also required. Additionally, individuals with no clear physical conditions affecting their ability to complete the questionnaire were included in the study. Participants who did not complete the questionnaire were excluded.\u003c/p\u003e\u003cp\u003e \u003cb\u003eEthical Considerations\u003c/b\u003e \u003c/p\u003e\u003cp\u003e \u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e \u003c/p\u003e\u003cp\u003e the study mentioned above received approval from the ethics board committee of Shiraz University of Medical Sciences (IR.SUMS.SCHEANUTREC.1402.119) and was conducted according to the principles of the Declaration of Helsinki. In the first step, the research’s purpose, importance, and necessity were explained to the participants. Both groups were then given questionnaires before the educational intervention. It’s worth noting that the participants signed the informed consent form before the intervention. We obtained informed consent for illiterate participants from their legal guardians. They were also assured that their information would be kept anonymous. The study did not result in any financial, physical, or psychological harm to the participants.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eThe study included 120 participants, with 60 individuals in each group. The participants’ mean age was 35.03 ± 8.37 years. As shown in (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e), the groups showed no significant difference regarding demographic factors (\u003cem\u003eP\u003c/em\u003e \u0026lt; 0.05).\u003c/p\u003e\u003cp\u003e \u003c/p\u003e\u003cdiv class=\"gridtable\"\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=\"char\" char=\".\" 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=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\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 the intervention and control groups based on demographic variable\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e\u003ccolgroup cols=\"7\"\u003e\u003c/colgroup\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eVariable\u003c/p\u003e \u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eTotal\u003c/p\u003e \u003c/th\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003eGroup\u003c/p\u003e \u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eX\u003csup\u003e2\u003c/sup\u003e\u003c/p\u003e \u003c/th\u003e\u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003eP\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e \u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePercent(%)\u003c/p\u003e \u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eIntervention\u003c/p\u003e \u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eControl\u003c/p\u003e \u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eMarital status\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSingle\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e11(18.3)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e6(\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e5(8.3)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.100\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.752\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=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e109(81.7)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e54(90)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e55(91.7)\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eeducation\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHigh school\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e27(22.50)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e18(30)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e9(15.0)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e5.023\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e0.081\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ediploma\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e43(35.83)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e22(36.7)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e21(35.0)\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003egraduate\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e50(41.67)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e20(33.3)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e30(50)\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003espouse's education\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHigh school\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e19(15.833)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e10(16.7)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e9(\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003e1.795\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003e0.616\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ediploma\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e49(40.833)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e27(45.0)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e22(36.7)\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003egraduate\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e45(37.50)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e19(31.7)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e26(43.3)\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eI don't have a wife\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e7(5.83)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4(6.7)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e3(5.0)\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003ewomen's own occupation\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eUnemployed\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e9(7.50)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4(6.7)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e5(8.3)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003e6.984\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003e0.137\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=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e87(72.50)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e42(70.0)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e45(75.0)\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRetired\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e16(13.33)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e10(46.7)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e6(5.0)\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eI don't have a wife\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e8(6.67)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4(6.7)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e4(6.7)\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"7\"\u003e*Chi-Square Test\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003eA Repeated measure ANOVA results of the educational intervention effect household waste separation by the integration of Value-Belief-Norm theory in the PRECEDE-PROCCED MODEL between the control and intervention groups was also conducted. \u003cb\u003e(\u003c/b\u003eTable\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e\u003cb\u003e)\u003c/b\u003e\u003c/p\u003e\u003cp\u003e \u003c/p\u003e\u003cdiv class=\"gridtable\"\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=\"char\" char=\"±\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\"±\" 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\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\u003eRepeated measure ANOVA results of the educational intervention effect household waste separation by the integration of Value-Belief-Norm theory in the PRECEDE-PROCCED MODEL between the control and intervention groups\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e\u003ccolgroup cols=\"8\"\u003e\u003c/colgroup\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariable\u003c/p\u003e \u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTime\u003c/p\u003e \u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eIntervention\u003c/p\u003e \u003cp\u003eMean (SD)\u003c/p\u003e \u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eControl\u003c/p\u003e \u003cp\u003eMean (SD)\u003c/p\u003e \u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eTime\u003c/p\u003e \u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003egroup\u003c/p\u003e \u003c/th\u003e\u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003eTime*group\u003c/p\u003e \u003c/th\u003e\u003cth align=\"left\" colname=\"c8\"\u003e \u003cp\u003eη²\u003c/p\u003e \u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eknowledge\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eBefore\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\"±\" colname=\"c3\"\u003e \u003cp\u003e18.96 ± 3.93\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\"±\" colname=\"c4\"\u003e \u003cp\u003e19.35 ± 3.99\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e˂0.001\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e˂0.001\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e˂0.001\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e0.43\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAfter (2months)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\"±\" colname=\"c3\"\u003e \u003cp\u003e27.38 ± 5.50\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\"±\" colname=\"c4\"\u003e \u003cp\u003e19.51 ± 4.35\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAfter (4months)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\"±\" colname=\"c3\"\u003e \u003cp\u003e26.65 ± 4.97\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\"±\" colname=\"c4\"\u003e \u003cp\u003e19.05 ± 3.91\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eEgoistic values\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eBefore\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\"±\" colname=\"c3\"\u003e \u003cp\u003e15.75 ± 3.22\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\"±\" colname=\"c4\"\u003e \u003cp\u003e15.98 ± 2.34\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e˂0.001\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e˂0.001\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e˂0.001\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e0.50\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAfter (2months)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\"±\" colname=\"c3\"\u003e \u003cp\u003e21.63 ± 3.35\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\"±\" colname=\"c4\"\u003e \u003cp\u003e15.83 ± 2.98\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAfter (4months)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\"±\" colname=\"c3\"\u003e \u003cp\u003e21.58 ± 3.33\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\"±\" colname=\"c4\"\u003e \u003cp\u003e15.76 ± 2.94\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003ealtruism humans\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eBefore\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\"±\" colname=\"c3\"\u003e \u003cp\u003e13.13 ± 2.86\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\"±\" colname=\"c4\"\u003e \u003cp\u003e12.21 ± 2.94\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e˂0.001\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e˂0.001\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e˂0.001\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e0. 54\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAfter (2months)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\"±\" colname=\"c3\"\u003e \u003cp\u003e18.20 ± 2.71\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\"±\" colname=\"c4\"\u003e \u003cp\u003e12.13 ± 3.86\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAfter (4months)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\"±\" colname=\"c3\"\u003e \u003cp\u003e18.78 ± 2.00\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\"±\" colname=\"c4\"\u003e \u003cp\u003e12.15 ± 3.76\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003ealtruism biosphere\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eBefore\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\"±\" colname=\"c3\"\u003e \u003cp\u003e12.13 ± 2.50\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\"±\" colname=\"c4\"\u003e \u003cp\u003e11.96 ± 2.66\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e˂0.001\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e˂0.001\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e˂0.001\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e0. 44\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAfter (2months)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\"±\" colname=\"c3\"\u003e \u003cp\u003e16.75 ± 2.44\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\"±\" colname=\"c4\"\u003e \u003cp\u003e11.93 ± 2.66\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAfter (4months)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\"±\" colname=\"c3\"\u003e \u003cp\u003e16.73 ± 2.50\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\"±\" colname=\"c4\"\u003e \u003cp\u003e11.76 ± 2.71\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eNew Environmental Paradigm(NEP)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eBefore\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\"±\" colname=\"c3\"\u003e \u003cp\u003e13.01 ± 2.89\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\"±\" colname=\"c4\"\u003e \u003cp\u003e13.25 ± 2.81\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e˂0.001\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e\u0026lt; 0.001\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e˂0.001\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e0.51\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAfter (2months)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\"±\" colname=\"c3\"\u003e \u003cp\u003e16.05 ± 3.24\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\"±\" colname=\"c4\"\u003e \u003cp\u003e13.08 ± 2.79\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAfter (4months)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\"±\" colname=\"c3\"\u003e \u003cp\u003e16.06 ± 3.38\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\"±\" colname=\"c4\"\u003e \u003cp\u003e13.21 ± 2.79\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eawareness of consequences(AC)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eBefore\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\"±\" colname=\"c3\"\u003e \u003cp\u003e18.88 ± 3.42\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\"±\" colname=\"c4\"\u003e \u003cp\u003e18.63 ± 3.90\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e˂0.001\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e˂0.001\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e˂0.001\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e0.49\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAfter (2months)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\"±\" colname=\"c3\"\u003e \u003cp\u003e25.53 ± 3.56\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\"±\" colname=\"c4\"\u003e \u003cp\u003e18.76 ± 3.78\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAfter (4months)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\"±\" colname=\"c3\"\u003e \u003cp\u003e25.80 ± 3.27\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\"±\" colname=\"c4\"\u003e \u003cp\u003e18.71 ± 3.91\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eascription of responsibility to self(AR)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eBefore\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\"±\" colname=\"c3\"\u003e \u003cp\u003e8.48 ± 1.64\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\"±\" colname=\"c4\"\u003e \u003cp\u003e9.75 ± 1.84\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e˂0.001\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e˂0.001\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e˂0.001\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e0.71\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAfter (2months)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\"±\" colname=\"c3\"\u003e \u003cp\u003e12.90 ± 1.98\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\"±\" colname=\"c4\"\u003e \u003cp\u003e9.63 ± 1.93\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAfter (4months)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\"±\" colname=\"c3\"\u003e \u003cp\u003e12.76 ± 1.87\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\"±\" colname=\"c4\"\u003e \u003cp\u003e9.50 ± 1.73\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003epersonal norms(PN)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eBefore\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\"±\" colname=\"c3\"\u003e \u003cp\u003e30.41 ± 4.59\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\"±\" colname=\"c4\"\u003e \u003cp\u003e30.08 ± 4.84\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e˂0.001\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e˂0.001\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e˂0.001\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e0.22\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAfter (2months)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\"±\" colname=\"c3\"\u003e \u003cp\u003e34.86 ± 4.33\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\"±\" colname=\"c4\"\u003e \u003cp\u003e30.06 ± 4.99\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAfter (4months)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\"±\" colname=\"c3\"\u003e \u003cp\u003e35.08 ± 4.21\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\"±\" colname=\"c4\"\u003e \u003cp\u003e30.21 ± 4.36\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eDescriptive norms\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eBefore\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\"±\" colname=\"c3\"\u003e \u003cp\u003e7.33 ± 1.93\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\"±\" colname=\"c4\"\u003e \u003cp\u003e7.58 ± 2.43\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e˂0.001\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e˂0.001\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e˂0.001\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e0.32\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAfter (2months)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\"±\" colname=\"c3\"\u003e \u003cp\u003e10.70 ± 3.11\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\"±\" colname=\"c4\"\u003e \u003cp\u003e7.41 ± 2.27\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAfter (4months)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\"±\" colname=\"c3\"\u003e \u003cp\u003e10.76 ± 3.16\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\"±\" colname=\"c4\"\u003e \u003cp\u003e7.45 ± 2.28\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003einjunctive norms\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eBefore\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\"±\" colname=\"c3\"\u003e \u003cp\u003e14.53 ± 2.94\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\"±\" colname=\"c4\"\u003e \u003cp\u003e14.90 ± 3.83\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e˂0.001\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e˂0.001\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e˂0.001\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e0.24\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAfter (2months)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\"±\" colname=\"c3\"\u003e \u003cp\u003e18.76 ± 4.13\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\"±\" colname=\"c4\"\u003e \u003cp\u003e14.75 ± 3.78\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAfter (4months)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\"±\" colname=\"c3\"\u003e \u003cp\u003e18.71 ± 4.15\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\"±\" colname=\"c4\"\u003e \u003cp\u003e14.78 ± 3.80\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eskills\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eBefore\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\"±\" colname=\"c3\"\u003e \u003cp\u003e12.43 ± 1.81\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\"±\" colname=\"c4\"\u003e \u003cp\u003e10.90 ± 2.49\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e˂0.001\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e˂0.001\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e˂0.001\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e0.19\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAfter (2months)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\"±\" colname=\"c3\"\u003e \u003cp\u003e19.43 ± 1.60\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\"±\" colname=\"c4\"\u003e \u003cp\u003e10.50 ± 4.64\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAfter (4months)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\"±\" colname=\"c3\"\u003e \u003cp\u003e19.11 ± 3.02\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\"±\" colname=\"c4\"\u003e \u003cp\u003e10.33 ± 3.63\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eAffordable service\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eBefore\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\"±\" colname=\"c3\"\u003e \u003cp\u003e7.91 ± 2.90\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\"±\" colname=\"c4\"\u003e \u003cp\u003e8.71 ± 2.93\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e˂0.001\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e˂0.001\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e˂0.009\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e0.13\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAfter (2months)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\"±\" colname=\"c3\"\u003e \u003cp\u003e9.16 ± 2.93\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\"±\" colname=\"c4\"\u003e \u003cp\u003e8.15 ± 3.34\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAfter (4months)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\"±\" colname=\"c3\"\u003e \u003cp\u003e10.91 ± 3.61\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\"±\" colname=\"c4\"\u003e \u003cp\u003e8.20 ± 4.60\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eSocial support\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eBefore\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\"±\" colname=\"c3\"\u003e \u003cp\u003e17.86 ± 3.36\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\"±\" colname=\"c4\"\u003e \u003cp\u003e18.31 ± 3.04\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e˂0.001\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e˂0.007\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e˂0.003\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e0.15\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAfter (2months)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\"±\" colname=\"c3\"\u003e \u003cp\u003e21.43 ± 3.21\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\"±\" colname=\"c4\"\u003e \u003cp\u003e18.35 ± 3.30\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAfter (4months)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\"±\" colname=\"c3\"\u003e \u003cp\u003e24.10 ± 5.27\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\"±\" colname=\"c4\"\u003e \u003cp\u003e18.35 ± 3.19\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eIntention\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eBefore\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\"±\" colname=\"c3\"\u003e \u003cp\u003e25.25 ± 3.49\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\"±\" colname=\"c4\"\u003e \u003cp\u003e25.33 ± 5.10\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e˂0.001\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e˂0.001\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e˂0.001\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e0.58\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAfter (2months)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\"±\" colname=\"c3\"\u003e \u003cp\u003e34.55 ± 5.99\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\"±\" colname=\"c4\"\u003e \u003cp\u003e25.15 ± 5.01\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAfter (4months)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\"±\" colname=\"c3\"\u003e \u003cp\u003e33.63 ± 3.14\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\"±\" colname=\"c4\"\u003e \u003cp\u003e25.11 ± 5.00\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003ebehavior\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eBefore\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\"±\" colname=\"c3\"\u003e \u003cp\u003e14.10 ± 4.69\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\"±\" colname=\"c4\"\u003e \u003cp\u003e14.33 ± 4.87\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e˂0.001\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e˂0.001\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e˂0.001\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e0.30\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAfter (2months)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\"±\" colname=\"c3\"\u003e \u003cp\u003e21.90 ± 6.12\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\"±\" colname=\"c4\"\u003e \u003cp\u003e14.20 ± 4.80\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAfter (4months)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\"±\" colname=\"c3\"\u003e \u003cp\u003e21.03 ± 5.79\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\"±\" colname=\"c4\"\u003e \u003cp\u003e14.25 ± 4.80\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/table\u003e\u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eAn educational program based on the VBN theory within the PRECEDE-PROCEED model was shown to enhance household waste separation behavior at the source among housewives in the intervention group in Shushtar city in comparison to the controls. Prior to the intervention, both groups had low knowledge, as indicated by their mean scores. However, it significantly improved the average knowledge score in the intervention group (p ˂0.001). These findings align with other reports (27). The findings underscore the critical role of knowledge in behavior change, highlighting the need to offer adequate information regarding health behaviors to support effective behavior alteration programs(\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e). Environmental knowledge and awareness has a positive impact on environmental behaviors and attitudes (29). Considering this, and understanding that the effectiveness of each waste management program depends on the involvement and commitment of citizens, it is essential to raise public awareness. This includes offering certain knowledge regarding the social, economic, environmental, and health impacts, and also improving sustainable behaviors like waste recycling, reuse, and reduction at home. These sustainable approaches help ensure participation of the citizens in waste management efforts. Therefore, providing and supporting collection facilities by the municipality represents a valuable investment for society.\u003c/p\u003e\u003cp\u003eThe PRECEDE-PROCEED model-based intervention and the VBN theory, involved examining relevant constructs. Specifically, the value subscales (egoistic values, human altruism, and biosphere altruism) demonstrated a significant difference between the groups before the intervention and 2 and 4 months afterward (p ˂0.001). These findings align with those of another study.\u003c/p\u003e\u003cp\u003eThe belief subscales (NEP, AC, and PN) indicated a significant difference between the groups before, 2 months, and 4 months after the educational intervention (p ˂0.001). Individuals with altruistic and biosphere-oriented values often develop positive attitudes and beliefs toward the environment, as such beliefs contribute to the well-being of both others and the environment(\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eThe educational intervention successfully altered housewives' norms regarding waste recycling at home. The norm subscales (PN, descriptive norms, and injunctive norms) showed a significant difference between the groups before, 2 months, and 4 months after the intervention (p ˂0.001). Sadeghi reported a similar positive effect of the educational intervention on housewives' norms (32). Gkargkavouzi et al. proposed that ascribing responsibility increases personal norms, encouraging European adults to participate in climate mitigation efforts (33). Effective household solid waste management can only be obtained through collective support, fostering a clean environment and encouraging individuals to separate waste and engage in responsible pro-environmental behavior. Social and personal norms are crucial in promoting ecological behaviors(\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eThe educational intervention effectively improved housewives' skills in recycling waste at home. Research has indicated that perceived skills are affected by motivational factors like social norms, attitudes, and perceived control (p ˂0.001). Thus, it would be valuable to explore whether such parameters also impact actual recycling skills(\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eTo improve the effectiveness of waste separation, it is essential to implement interventions that utilize a variety of behavior change strategies. These interventions can include informational and educational campaigns, incentive and disincentive programs, feedback mechanisms, and behavior modeling.\u003c/p\u003e\u003cp\u003eThe research findings revealed that conducting six educational sessions according to the PRECEDE-PROCEED model and VBN theory caused a significant increase in the average score of both source separation behavior and behavioral intention in the intervention group. Zhang et al. (29) in China and Babazadeh et al. (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e) in Iran found that behavioral intention can predict waste separation behavior. Enhancing the intention to separate waste greatly improves actual behavior. Similarly, Liu et al. carried out a planned recycling behavior-based intervention among New York State residents, and their average recycling behavior scores showed a significant increase after the intervention(\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e).\u003c/p\u003e"},{"header":"Conclusions","content":"\u003cp\u003eWe explored the parameters affecting the intention and behaviors of Shushtari housewives regarding source separation to improve household waste separation, by integrating the VBN Theory within the PRECEDE-PROCEED Model. Urban housewives' intentions to separate waste at the source were positively influenced by values, beliefs, and norms. These results highlight the need for more studies and the development of effective strategies and policies to encourage housewives' active participation in waste separation. Such initiatives should focus on promoting environmental awareness, emphasizing moral responsibilities, and fostering a sense of duty toward environmental protection.\u003c/p\u003e\u003cp\u003e \u003cb\u003eStrengths and Limitations\u003c/b\u003e:\u003c/p\u003e\u003cp\u003eThe strengths of our research include the face-to-face training provided to housewives and using an integrated model (the PRECEDE-PROCEED model and VBN theory) in the intervention program. However, one limitation was the short duration of the follow-up with participants. We recommend performing longer follow-up measurements to assess the sustainability and consistency of the behavior. Another limitation is that the findings may not be generalizable beyond Shushtar city.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAcknowledgments:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis manuscript is based on the PhD thesis of Ms. Khadijeh Jafarpour in health education and promotion (IR.SUMS.SCHEANUT.REC.1402.119). The study was financially supported by \u0026quot;\u0026nbsp;Shiraz University of Medical Sciences.\u0026quot; We are thankful to the women who participated in our study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026rsquo; Contribution\u003c/strong\u003e: All authors contributed to the study and provided feedback on the manuscript at each stage.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConflict of Interests\u003c/strong\u003e: None.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData Availability\u003c/strong\u003e: The dataset is available upon request from the corresponding author, either during the submission process or after the publication.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthical Approval\u003c/strong\u003e: Ethics approval and consent to participate the study mentioned above received approval from the ethics board committee of Shiraz University of Medical Sciences (IR.SUMS.SCHEANUTREC.1402.119) and was conducted according to the principles of the Declaration of Helsinki.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp;Funding/Support\u003c/strong\u003e: This manuscript was supported by the \u0026ldquo;Shiraz University of Medical Sciences.\u0026rdquo;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eInformed Consent\u003c/strong\u003e: The subjects were informed about the confidentiality of the study and its objectives, and they provided written informed consent to participate.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eHaghighatjoo S, Asgari A, Tahmasebi R, Noroozi A. Predictor Factors of Recycling Behavior in Residents of Bushehr City: Application of Theo-ry of Planned Behavior. ISMJ. 2020;23(2):116-28.\u003c/span\u003e\u003c/li\u003e\n\u003cli\u003eWilson DC, Velis CA. Waste management\u0026ndash;still a global challenge in the 21st century: An evidence-based call for action. SAGE Publications Sage UK: London, England; 2015. p. 1049-51.\u003c/span\u003e\u003c/li\u003e\n\u003cli\u003eChen B, Lee J. Household waste separation intention and the importance of public policy. International Trade, Politics and Development. 2020;4(1):61-79.\u003c/span\u003e\u003c/li\u003e\n\u003cli\u003eKushwah S, Gokarn S, Ahmad E, Pant KK. An empirical investigation of household\u0026apos;s waste separation intention: A dual-factor theory perspective. Journal of Environmental Management. 2023;329:117109.\u003c/span\u003e\u003c/li\u003e\n\u003cli\u003eKarimi J, Sadeghi M, Fadaie E, \u003c/span\u003eMehdinejad M. 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Medical waste management among healthcare workers: the use of educational diagnosis phase in the precede planning model among healthcare workers in south of Iran. International Journal of Environment and Waste Management. 2021;27(2):201-10.\u003c/span\u003e\u003c/li\u003e\n\u003cli\u003eConti A, Viottini E, Comoretto RI, Piovan C, Martin B, Albanesi B, et al. The Effectiveness of Educational Interventions in Improving Waste Management Knowledge, Attitudes, and Practices among Healthcare Workers: A Systematic Review and Meta-Analysis. Sustainability. 2024;16(9):3513.\u003c/span\u003e\u003c/li\u003e\n\u003cli\u003eAlmulhim AI. Household\u0026apos;s awareness and participation in sustainable electronic waste management practices in Saudi Arabia. Ain Shams Engineering Journal. 2022;13(4):101729.\u003c/span\u003e\u003c/li\u003e\n\u003cli\u003edel Carmen Aguilar-Luz\u0026oacute;n M, Garc\u0026iacute;a-\u003c/span\u003eMart\u0026iacute;nez JM\u0026Aacute;, Calvo-Salguero A, Salinas JM. Comparative Study Between the Theory of Planned Behavior and the Value\u0026ndash;Belief\u0026ndash;Norm Model Regarding the Environment, on Spanish Housewives\u0026rsquo; Recycling Behavior. Journal of Applied Social Psychology. 2012;42(11):2797-833.\u003c/span\u003e\u003c/li\u003e\n\u003cli\u003eBatool N, Wani MD, Shah SA, Dada ZA. Theory of planned behavior and value-belief norm theory as antecedents of pro-environmental behaviour: Evidence from the local community. Journal of Human Behavior in the Social Environment. 2024;34(5):693-709.\u003c/span\u003e\u003c/li\u003e\n\u003cli\u003eNordlund AM, Garvill J. Effects of values, problem awareness, and personal norm on willingness to reduce personal car use. Journal of environmental psychology. 2003;23(4):339-47.\u003c/span\u003e\u003c/li\u003e\n\u003cli\u003eSafavi SR, Bakhshi F, Omidi S. Social determinants of health and lifestyle in the elderly. Iranian Journal of Health Education and Health Promotion. 2022;9(4):372-82.\u003c/span\u003e\u003c/li\u003e\n\u003cli\u003eKarimi S. Pro-environmental behaviours among agricultural students: An examination of the value-belief-norm theory. Karimi, S(2019) Pro-Environmental Behaviours among Agricultural Students: An Examination of the Value-Belief-Norm Theory Journal of Agricultural Science and Technology. 2019;21(2):249-63.\u003c/span\u003e\u003c/li\u003e\n\u003cli\u003eRichter NF, Martin J, Hansen SV, Taras V, Alon I. Motivational configurations of cultural intelligence, social integration, and performance in global virtual teams. Journal of Business Research. 2021;129:351-67.\u003c/span\u003e\u003c/li\u003e\n\u003cli\u003ePassafaro P, Bacciu A, Caggianelli I, Castaldi V, Fucci E, Ritondale D, et al. Measuring individual skills in household waste recycling: Implications for citizens\u0026apos; education and communication in six urban contexts. Applied Environmental Education \u0026amp; Communication. 2016;15(3):234-46.\u003c/span\u003e\u003c/li\u003e\n\u003cli\u003eLiu Z, Yang JZ, Clark SS, Shelly MA. Recycling as a planned behavior: the moderating role of perceived behavioral control. Environment, Development and Sustainability. 2021:1-16.\u003c/span\u003e\u003c/li\u003e\n\u003cli\u003eSharma M. Theoretical foundations of health education and health promotion: Jones \u0026amp; Bartlett Learning; 2021.\u003c/span\u003e\u003c/li\u003e\n\u003cli\u003eDouglas BD, Holley K, Isenberg N, Kennedy KR, Brauer M. Social sanctions in response to injunctive norm violations. Current opinion in psychology. 2024:101850.\u003c/span\u003e\u003c/li\u003e\n\u003cli\u003eGelfand MJ, Harrington JR. The motivational force of descriptive norms: For whom and when are descriptive norms most predictive of behavior? Journal of Cross-Cultural Psychology. 2015;46(10):1273-8.\u003c/span\u003e\u003c/li\u003e\n\u003cli\u003eBlake R. Technology and the four skills. 2016.\u003c/span\u003e\u003c/li\u003e\n\u003cli\u003eNAJWAN MR. Effect of Service Quality, Product Quality, Store Atmosphere, and Price Affordability on Customer Satisfaction and Loyalty at Coffee Shop Lapak Ngopi: Universitas Gadjah Mada; 2022.\u003c/span\u003e\u003c/li\u003e\n\u003cli\u003eGottlieb BH, Bergen AE. Social support concepts and measures. Journal of psychosomatic research. 2010;69(5):511-20.\u003c/span\u003e\u003c/li\u003e\n\u003cli\u003eMoghaddam MC, Zeidi IM, Morshedi H, Hosseini F, Rouhani-Tonekaboni N. The Effect of an Educational Intervention Based on an Integrated Social Cognition Model on Waste Recycling at the Source Among Housewives in Lahijan City: A Quasi-Experimental Study. Health Scope. 2024;13(1).\u003c/span\u003e\u003c/li\u003e\n\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-public-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"pubh","sideBox":"Learn more about [BMC Public Health](http://bmcpublichealth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/pubh/default.aspx","title":"BMC Public Health","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Household Waste, Separation, Educational Intervention, Value-Belief-Norm, theory, PRECEDE-PROCEED Model","lastPublishedDoi":"10.21203/rs.3.rs-6506584/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6506584/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eIn the face of escalating environmental challenges spurred by industrialization, the management of household waste has emerged as a critical area necessitating attention. This study sought to empower housewives in Shushtar city through a structured educational intervention designed to enhance their knowledge and practices regarding waste separation. Employing a quasi-experimental methodology, 120 housewives were randomly selected and assigned to intervention and control groups, each with 60 participants. The educational program comprised six face-to-face sessions over one month, utilizing a comprehensive questionnaire founded on the Value-Belief-Norm Theory and PRECEDE-PROCEED Model for data collection. Analysis was conducted using established statistical software before the intervention and two and four months after the intervention. Results indicated that while no significant differences were observed in demographic variables between groups, notable improvements were recorded in the intervention group's mean scores across various constructs related to values, beliefs, subjective norms, skills, social support, and intentions towards waste separation. In contrast, the control group exhibited no significant changes over time. These findings underscore the positive impact of targeted educational initiatives on fostering responsible waste management behaviors among urban housewives; thus emphasizing the necessity for further development of policies aimed at enhancing environmental knowledge and instilling a sense of responsibility for ecological stewardship within communities.\u003c/p\u003e","manuscriptTitle":"Evaluates educational interventions for waste separation, applying Value-Belief-Norm Theory and PRECEDE-PROCEED Model in Iran","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-06-06 16:05:55","doi":"10.21203/rs.3.rs-6506584/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-10-09T08:06:00+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-06-29T09:59:33+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-06-29T03:51:39+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-06-23T20:18:22+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"248425162744536881269326067801066007392","date":"2025-06-21T07:52:40+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-06-20T08:13:53+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"324863441608206728431334356049190892189","date":"2025-06-18T05:56:14+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"52058037456628853783914820297100983539","date":"2025-06-18T04:46:03+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"43699263649343397700279881399762593909","date":"2025-06-14T14:08:22+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-06-13T07:42:00+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"74128282586189179749111485015916307308","date":"2025-06-11T21:38:09+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"142102352330542911459366363667580762010","date":"2025-06-06T10:59:39+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-06-04T15:01:56+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-05-09T11:52:24+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-05-07T16:37:17+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-05-07T16:32:45+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Public Health","date":"2025-04-22T17:49:10+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-public-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"pubh","sideBox":"Learn more about [BMC Public Health](http://bmcpublichealth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/pubh/default.aspx","title":"BMC Public Health","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"d772f771-14d7-4b56-8a5a-6f594d7787c5","owner":[],"postedDate":"June 6th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-01-25T13:40:19+00:00","versionOfRecord":[],"versionCreatedAt":"2025-06-06 16:05:55","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-6506584","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6506584","identity":"rs-6506584","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}