Health Belief Model-Oriented Training Intervention’s Impact on Prevention of Domestic Violence against Elderly Women: A quasi-experimental study

Health Belief Model-Oriented Training Intervention’s Impact on Prevention of Domestic Violence against Elderly Women: A quasi-experimental study | 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 Health Belief Model-Oriented Training Intervention’s Impact on Prevention of Domestic Violence against Elderly Women: A quasi-experimental study Goli Taravatmanesh, Rohollah Zere, Samira Rahbar, Sheida Nasseri Akbar, and 3 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7018292/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 10 You are reading this latest preprint version Abstract Background The majority of the accessible evidence on violence against women is focused on the group of women of reproductive age (from 15 to 49), and globally speaking, there is inadequate evidence on the patterns and types of violence against elderly women, while a better perception of the patterns and different dynamics of violence experienced by aged women is necessary in order to guarantee appropriate policy making or the implemented program’s outcomes, which can lead to conducting some behaviors in the senior women. Thus, the present study was developed and performed to outline the Impact of Health Belief Model-Oriented Training Intervention on the Prevention of Domestic Violence against Elderly Women referring to comprehensive rural health service centers located in Kharameh City in 2024. Material and Methods The present quasi-experimental study was conducted in 2024 on 140 aged females referring to comprehensive health centers in Kharameh city, Fars province. Cluster sampling method was applied and the subjects were allocated to two groups as experimental and control by simple random method (n = 70 in the experimental group and n = 70 in the control group). The data were collected by standard Health Belief Model (HBM) questionnaire completed by the control and experimental groups before and two months after the intervention. The training intervention consisted of 6 face-to-face HBM-focused sessions for violence prevention, which were held during two months for the experimental group. After entering the data into SPSS-27, they were analyzed by paired t-test, independent t-test, and Chi-squared test. Results The independent t-test results divulged that the pre-training intervention came up with no statistically significant difference between the intervention and control groups in terms of the mean score of knowledge, attitude, perceived susceptibility, perceived severity, perceived benefits, perceived barriers, cues for action, self-efficacy and behavior (P > 0.05), while the post-training intervention revealed a tangible difference between the HBM constructs in the experimental and control groups (P < 0.05). Conclusion The present study results indicated that the HBM-focused training program proved effective in preventing violent behaviors against aged women. Pursuant to this research, the HBM-focused training program promoted the establishment of susceptibility and severity towards violence by creating a connection between knowledge and attitude, and the elderly women identified the potential benefits and barriers and were able to build up their self-efficacy and behavior by adopting cues for action. Elderly Women Violence Training Intervention Preventive Behaviors Health Belief Model (HBM) Introduction Domestic violence against women is a major health problem and the most prevalent form of violence [ 1 , 2 ], which brings about death and disability in women [ 3 , 4 ]. Domestic violence against women encompasses any type of violent behavior that results in physical, sexual, or psychological harm to her, as well as actions that cause suffering to women or forced deprivation of personal or social freedoms [ 5 ]. As reported by the World Health Organization in 2021, one out of three women undergoes domestic violence by their partner [ 6 ]; this rate has been reported as around 37.7% in Asian countries [ 7 ] and the Iranian rate of violence against women is 34.9% [ 8 ]. The reported statistics is on the women of reproductive age (up to 45), while one of the groups at risk of domestic violence is elderly women [ 9 ]. It is tough to estimate the prevalence of violence against aged women, as health professionals might face challenges to identify and report such cases due to denying the extent of the problem in society and neglecting to report the relevant cases of violence [ 10 ]. Despite this matter, in a report published in 2021, the WHO reported the outbreak of violence against the elderly more than 10% [ 11 ], and in a study in Iran, it was reported as 39.8% [ 12 ]. Various factors play a role in the incidence of domestic violence against the aged women, which include individual (age and gender, education and occupation), family (family support, differences between men and women), and social (cultural, occupational, organizational) issues [ 13 , 14 , 15 ], but what matters is that some of these factors are rooted in the violence victim, such as attitudes and beliefs about violence against women [ 16 ], misogyny which can stimulate men's desire to commit violence against women [ 17 ], considering violence committed by men against women as normal in some societies [ 18 ], and gender inequalities [ 19 ]. Taking this issue into account, and now that violence is followed by many consequences such as psychological problems [ 20 ] and physical nuisances [ 21 ]. For the elderly; therefore, it is a must to be prevented, and based on scientific documents, training is one of the most basic tools and methods for preventing violence against women [ 22 ]. Out of many models and patterns of health education, the Health Belief Model (HBM) is an efficient one [ 23 ]. The HBM is a psychological model attempting to explain and predict health behaviors. Thus, it focuses on individuals' attitudes and beliefs (change in beliefs) and displays the relationship between beliefs and behavior. In fact, the HBM allows us to examine the potential psychological factors affecting individuals' decisions [ 23 ]. The above model’s constructs include perceived susceptibility, perceived severity, perceived benefits, perceived barriers, cues for action, and self-efficacy [ 23 ]. In this respect, some studies emphasized the critical role of interventions to prevent violence against women [ 24 , 25 , 26 ]. Unfortunately, most studies focused on a specific group of women and, despite the value of the elderly, this group has been neglected, and there is little global evidence on the patterns and types of violence against women aged 60 and older. While it can definitively be stated that it is required to come up with a better understanding of the different patterns and dynamics of violence experienced by older women so that to warranty befitting policy making or the pertinent program-induced outcomes. Therefore, the current research was developed and executed pursuing the goal to weigh up the effect of the Health Belief Model-focused training program on the prevention of domestic violence among the aged women referring to comprehensive rural health service centers in Kharameh City in 2024. Material and Methods Study Design and Participants This quasi-experimental study was done in 2024 in Fars Province, Kharameh City. The study community was composed of the elderly women referring to the comprehensive health centers located in Kharameh City in 2024. The study inclusion criteria were having an active file in the Comprehensive Health Service Center, in the age bracket 60 and above, a history of domestic violence (according to the individual’s statements, clinical examination by a physician and consulting the center's psychologist), cooperation with the experts working in the Comprehensive Health Service Center for face-to-face training, willingness to participate in the study, adequate visual and auditory performance, not participating in violence prevention training course. The study exclusion criteria included withdrawal from further cooperation, and being absent more than two sessions in the training. Sample Size The sample size was calculated as 68 subjects based on a similar study done by Rakhshani et al. (2024), using the formula for the mean difference in two populations and confidence level 0.95%, and test power 80%, which increased to 140 subjects by considering the attrition rate 10% .Then 70 individuals were calculated for each group [ 27 ]. Sampling Method A multi-stage cluster sampling method was employed for the study. Each health center in Kharameh City was viewed a cluster (there are 7 health centers), out of which 2 health houses were randomly selected from these clusters and 1 center (Mozabad -Jaberi Center) was designated as the control group, while 1 center (Tohid Center) was chosen as the experimental group. Then the participants were picked up from the above centers using convenience sampling and divided into 2 groups by simple random method. In case of the participants dropping out of the study, the replacements were made by picking up additional eligible women from the same health centers to maintain the sample size. Data Collection Tool A demographics questionnaire containing the individuals’ information and a standard HBM-oriented questionnaire were utilized to collect the data. Demographics questionnaire : including 7 items: age, age at marriage, education, spouse's education, occupation, spouse's occupation, who you live with, and the history of underlying disease. HBM-focused questionnaire This section measured knowledge, attitude, behavior, and the HBM components on domestic violence. Knowledge : initially, the part on Knowledge about domestic violence was made up of 18 items (like: I am a religious person; the opinions of younger parents are closer to their children; I have gained the necessary training on how to deal with violence from my textbooks ;). These items were designed as three options (True = score 3, I don’t know = score 2, and False = score 1). The range of scores was between 18 and 36, where higher score indicated higher knowledge about domestic violence. Attitude : The part on Attitude was composed of 18 items (such as: My relatives conduct violent behavior; my family problems affect the way I deal with others; my family members understand me). These items were designed as five options (Absolutely Agree = score 5, Agree = score 4, No Opinion = score 3, Disagree = score 2, and absolutely Disagree = score 1). The range of scores was between 18 and 90, and higher scores stood for higher attitude towards domestic violence. Perceived Susceptibility : The part on Perceived Susceptibility involved 7 items (including: I received the required training on how to deal with violence from TV programs; I read novels involving violent characters; I feel uncomfortable when people pock their nose into my private life.) Perceived Intensity : The part about Perceived Intensity had 10 items (such as: My mother regularly visits me to check my life status; My father visits me regularly to check my living condition; My wife pays enough attention to my children’s education). Perceived Benefits : The part on Perceived Benefits included 6 items (such as: Home cooked food should be as the man desires; the woman’s type of makeup and clothing outside the house should be as the man wishes). Perceived Barriers : The part about Perceived Barriers had 8 items (like: A woman should totally obey her husband; if a woman disobeys her husband, he has the right to beat her; the most important duty of a woman is to take care of her husband). Guide to action : The part on Guide to action involved 5 items (like: The book on the rules of marriage is effective in controlling domestic violence; Seeking help and guidance from a family member has an effect on managing domestic violence; Exercising and relaxing the soul exerts an impact on fending off domestic violence). Self-efficacy : The part on Self-efficacy had 8 items (such as: If a married man has a relationship with another woman, there is no problem in case of a concubine; Where to live is only decided by the husband, and the wife should be subordinate to her husband; The man has the right to have marital relations with his wife even if his wife is not willing to do so). The next items were designed as 5 options (Absolutely Agree = score 5, Agree = score 4, I don’t know = score 3, Disagree = score 2, and absolutely Disagree = score 1). The score range was as follows: Perceived Intensity (10–50), Perceived Susceptibility (7–35), Perceived Barriers (8–40), Perceived Benefits (6–30), and Self-efficacy (8–40). The scores for Cues to Action ranged from 5 to 25. Higher scores indicated a better situation regarding domestic violence against women. Behavior : The part on Behavior was made up of 8 items (like: The definition of physical violence (hitting, slapping, throwing objects at others, pushing) and verbal violence (obscene words, disrespect, insulting, threatening, etc.). These questions were designed as three options (True = score 3, I don’t know = score 2, and False = score 1). The score ranged from 8 to 16, and higher scores indicated higher behavior towards domestic violence prevention. Validity and Reliability of HBM questionnaire The HBM-focused questionnaire has already been used in the research done by Rakhshani et al. and its validity and reliability have been confirmed. Cronbach’s alpha was 0.74 for knowledge, 0.75 for perceived intensity, 0.82 for perceived susceptibility, 0.84 for perceived benefits, 0.76 for perceived barriers, 0.82 for self-efficacy, and 0.81 for behavior [ 27 ]. In this study, the questionnaire’s validity was confirmed by twelve specialists and experts (outside the research team) in the fields of health education and health promotion (8 experts), physicians (2 ones), epidemiology (2 specialists), and statistics (1 expert). For reliability, Cronbach's alpha coefficient was estimated for the model constructs and for the entire questionnaire. Cronbach's alpha for the construct was 0.76 for knowledge, 0.79 for attitude, 0.76 for perceived susceptibility, 0.75 for perceived severity, 0.71 for perceived benefits, 0.81 for perceived barriers, 0.71 for self-efficacy, and 0.81 for behavior. Training Intervention To design the training intervention, a standard Health Belief Model-focused questionnaire was first distributed among the study participants once. Then, the intervention consisting of six 50–60 minute sessions was held in the form of three training methods (lecture, question and answer (Q& A), and group discussion) at the question Health Center for preventive behaviors against domestic violence in the intervention group. Then, two months after the training intervention, the data were completed again and compared with those of the pre-intervention. During the training implementation, a group of experts including a mental health expert was consulted accompanied with the researcher, each of whom gave instructions about the items about preventive behaviors against domestic violence professionally. During the training course, the Ministry of Health training book, and the question and answer and group discussion method were used. The book Healthy Lifestyle according to the Guide to Improving Lifestyle for Senior Adults (compiled by the Ministry of Health of Iran) was employed to prepare the educational content in the training. The routine measures (elderly care) were taken into account for the control group. The explanations about the training intervention are given in Table 1 . Table 1 Details of Training Intervention Session Goal Topic of education Duration (minute) Training method Instructor 1st The goal behind holding training courses and training knowledge & attitude constructs Acquaintance of group members with each other and the psychologist and stating the objectives. Talking about domestic violence & getting familiar with types of home violence like verbal, physical and ,sexual violence in the aged 60 Lecture Question & Answer Specialist group and expert 2nd Training on perceived susceptibility & intensity constructs Creating susceptibility in the aged women about this issue whether they know what sort of violence is domestic violence ,to determine and evaluate domestic violence induced perceived susceptibility 60 Group discussion and Q&A Psychologist and expert 3rd & 4th Training on perceived benefits & barriers constructs Introducing the benefits & barriers existing in the prevention of domestic violence 60 Educational videos & poster Consultant & expert 5th Training the basics of self-efficacy & behavior constructs Raising women’s self-efficacy ,increasing self-belief ,self-confidence and empowerment for preventing violence ,training anger control methods ,introducing some methods like leaving the location of strife ,keeping silent and settling down the conflicts 60 Educational videos & poster Consultant & expert 6th Summing up & completing the questionnaire for the 2nd phase - - Completing the post-test questionnaire Researcher Data Collection Method In data collection procedure, firstly the ethics code was achieved from the Ethics Committee (IR.SUMS.SCHEANUT.REC.1403.110) of Shiraz University of Medical Sciences. Then, when the necessary permits were gained from Shiraz University of Medical Sciences, the researcher visited the Comprehensive Health Center of Kharameh and once the consent of the eligible elderly was taken, the researcher selected the aged subjects for the study. Then, by visiting the center and coordinating with the elderly, the pre-test questionnaires were handed out among the households and the required information on how to complete the questionnaire, the study objective, and the conditions for quitting the research were supplied. In addition, the elderly women were given the opportunity to fill in the questionnaire, and a week later, the researcher collected the questionnaires by visiting the question centers. Then, when the experimental group was assigned and two months after the training interventions, the post-test questionnaires were collected again from the experimental and control groups. Data Analysis Data analysis was done using SPSS-27. Mean, standard deviation, and frequency indicators were employed to describe the data. For data analysis, the normality of the data was first measured via Kolmogorov-Smirnov test, and then Chi-squared test, independent t-test, and paired t-test tests were used for analyzing the data. The significance level in all tests was considered 0.05. Results The demographics of the experimental and control groups in the study are depicted in Table 2 . The results of the Chi-squared test divulged the two groups being homogeneous in terms of education, spouse's education, occupation, spouse's occupation, underlying disease, and who they currently live with (P > 0.05). Moreover, pursuant to the independent t-test, no tangible difference popped up between the mean age (P = 0.721) and the mean age at marriage (P = 0.842) in the two groups (Table 1 ). Table 1 Comparison of frequency distribution of study participants’ primary variables in two groups Variable Experimental group n.(%) Control group n.(%) Statistics P-value Education Under- diploma 62(88.57) 60(85.71) Chi 2 = 2.15 0.615* Post- diploma 8(11.42) 10(14.25) Spouse’s education Under- diploma 65(92.85) 68(97.14) Chi 2 = 2.36 0.784 Post- diploma 5(7.14) 2(2.85) Occupation Housewife (90)63 65(92.85) Chi 2 = 0.487 0.495** Retired 7(10) 5(7.14) Spouse’s occupation Office holder 6(8.57) 9(12.85) Chi 2 = 2648 0.136* Retired 64(91.42) 61(87.14) Underlying disease Yes 20(28.57) 32(45.71) Chi 2 = 1.954 0.533* No 50(71.42) 38(54.28) Who they live with Spouse 58(82.85) 62(88.57) Chi 2 = 0.945 0.215* Child 10(14.25) 7(10) Close relatives 2(2.85) 1(1.42) Age (Mean ± SD) 72.04 ± 4.89 69.04 ± 4.21 t = 0.086 0.721** Age at marriage (Mean ± SD) 17.04 ± 3.02 16.04 ± 3.99 t = 0.125 0.842** *Chi-squared test ** Independent t-test Table 2 presents the comparison of the mean score of knowledge, attitude and model constructs in the intervention and control groups of pre-and post-intervention. Considering the normality of the mean scores of knowledge and model constructs, independent t-test was applied for intergroup comparison (experimental and control) and paired t-test was used for intragroup comparison. As shown by the results of the independent t-test, the pre-intervention revealed no statistically significant difference between the intervention and control groups concerning the mean score of knowledge, attitude, perceived susceptibility, perceived severity, perceived benefits, perceived barriers, cues to action, self-efficacy and behavior (P > 0.05), while the post-intervention indicated a tangible difference between the health belief model constructs in the experimental and control groups (P < 0.05). Table 2 Comparison of mean and standard deviation of knowledge, attitude and model constructs in two groups of pre- and post-intervention Model Constructs Group Pre-intervention Post-intervention P-value ** Effect size (Cohen’s d) Mean ± SD Mean ± SD Knowledge Experimental 19.84 ± 2.70 24.46 ± 2.18 0.001 0.64 Control 19.98 ± 2.47 19.75 ± 3.94 0.245 - P-value * 0.523 0.001 *Independent t-test ** Paired t-test Effect size(Cohen’s d) - 0.63 Attitude Experimental 42.55 ± 10.21 71.77 ± 11.17 0.001 0.33 Control 42.64 ± 11.76 42.46 ± 10.16 0.942 - P-value* 0.125 0.001 *Independent t-test ** Paired t-test Effect size(Cohen’s d) - 0.60 Perceived susceptibility Experimental 15.33 ± 2.50 21.82 ± 2.36 0.001 0.45 Control 15.03 ± 2.40 15.46 ± 2.47 0.115 - P-value* 0.945 0.001 *Independent t-test **Paired t-test Effect size(Cohen’s d) - 0.45 Perceived intensity Experimental 21.33 ± 9.50 32.64 ± 7.74 0.001 0.41 Control 21.26 ± 9.06 21.94 ± 10.62 0.065 - P-value* 0.972 0.00 *Independent t-test **Paired t-test Effect size(Cohen’s d) - 0.58 Perceived benefits Experimental 15.00 ± 3.12 21.60 ± 3.60 0.001 0.65 Control 15.06 ± 3.89 15.02 ± 3.64 0.945 - P-value* 0.341 0.001 *Independent t-test **Paired t-test Effect size(Cohen’s d) - 0.61 Perceived barriers Experimental 22.23 ± 5.50 19.21 ± 5.02 0.001 0.45 Control 22.96 ± 4.55 22.96 ± 4.60 0.078 - P-value* 0.123 0.001 *Independent t-test **Paired t-test Effect size(Cohen’s d) - 0.70 Guide to action Experimental 13.00 ± 1.72 17.00 ± 1.52 0.001 0.64 Control 13.50 ± 1.79 13.50 ± 1.45 0.065 - P-value* 0.161 0.001 *Independent t-test **Paired t-test Effect size(Cohen’s d) - 0.42 Self-efficacy Experimental 21.46 ± 2.30 26.44 ± 1.69 0.001 Control 21.42 ± 2.90 21.38 ± 1.45 0.51 P-value* 0.845 0.001 *Independent t-test ** Paired t-test Effect size(Cohen’s d) - 0.58 Behavior Experimental 8.75 ± 1.95 13.22 ± 3.30 0.001 0.67 Control 8.98 ± 1.09 8.30 ± 1.73 0.060 - P-value* 0.512 0.001 *Independent t-test ** Paired t-test Effect size(Cohen’s d) - 0.51 Discussion The present study targeted to outline the HBM intervention-induced effect on the prevention of domestic violence among the elderly women, and the results suggested that the above intervention worked out effectively for the HBM variables. The HBM-focused education was able to familiarize the elderly women with violent behavior (raising knowledge), to misunderstand the violence being natural (promoted attitude), to point out the psychological and physical consequences of violence (established susceptibility and perceived severity), to state the reasons for violence (perceived barriers), and ultimately, to result in violence prevention (self-efficacy and behavior). As reported, the training intervention significantly increased the mean knowledge score regarding violent behaviors in the experimental group compared to the control group, which is in accord with the results of the previous studies, including the research done by Craig et al. (2025) [ 28 ], Saudah et al. (2025) [ 29 ], and Ullman et al. (2025) [ 30 ]. Interpreting the results illustrates that the HBM-focused and face-to-face intervention was influential in raising the knowledge of the aged women about violence. During the training process, the researcher initially tried to define violence for the study elderly women, and the researcher's definition was in agreement with the native language and the prevailing culture in the county. This helped the elderly recognize some dimensions of violence after ages and to get familiar with the aspects of violence including verbal violence that they had not known about until then. On the other hand, during the training process, the researcher realized that the dynamics of aging has changed the elderly women’s experience of violence, and now they no longer consider every issue as violence as they used to do in their youth, and this could be one of the hidden reasons for lack of real prevalence of violence against the aged, while elderly women experience different types of violence such as psychological violence and verbal abuse, compared to younger women who undergo the experiences of physical and sexual violence. The results demonstrated that the training intervention led to a meaningful increase in the mean score of attitude towards violent behaviors in the experimental group compared to that of the control group. Comparison with the existing literature displays that most of the prior research cases have verified the positive impact of the interventions on attitudes towards violence; although these studies did not target the elderly, they addressed violence in women. For example, the results of the previous studies, including those by Fisher et al. (2025) [ 31 ], Mohd et al. (2024) [ 32 ], Kumari et al. (2024) [ 33 ], Sutherland et al. (2024) [ 34 ], demonstrated the tangible impact induced by the training intervention on attitudes, which is congruent with the findings of the present study. In the study elderly women, the noticeable point was that some of these women considered violence as natural, which originates from the individual's beliefs. In traditional societies such as Iranian society, this is true about some women to some extent, and since the study group was elderly women being raised in very traditional families in terms of culture and not considering many cases of violence, like verbal violence, as substantial, the stance which might have caused the study aged women not to have a negative attitude towards violence. In this respect, despite the researcher’s efforts to change the women’s attitude and based on the comparison of the mean scores of the pre-and post-test, the researcher was somewhat successful, perhaps this higher mean is merely related to answering the questions and in reality, not much variation was felt towards violence in the elderly women. In accordance with the results, the training intervention critically increased the mean score of perceived susceptibility and severity towards violent behaviors in the experimental group compared to that of the control group. This finding was consistent with the results of the previous studies, including those performed by Villardón-Gallego et al. (2023) [ 35 ], Bacchus et al. (2023) [ 36 ], Elbelassy et al. (2023) [ 37 ], Leight et al. (2023) [ 38 ],and Akram et al. (2023) [ 39 ]. In the training program on perceived susceptibility and severity, the researcher made efforts to elaborate on the psychological and physical dimensions of violence to the senior women and the psychological consequences of violence such as stress, depression and anxiety for the elderly, resulting in upgrading the susceptibility towards violence and the severity of the consequences of violence for women, it was also successful as the results reported. Pursuant to the results, the training intervention meaningfully raised the mean score of perceived benefits towards violent behaviors in the experimental group compared to that of the control group, which is in line with the results of the formerly conducted studies, including those done by Ezenwosu et al. (2025) [ 40 ], and Cerdán-Torregrosa et al. (2025) [ 41 ]. In this stage of the training, the researcher tried to make women aware of the benefits they expressed regarding their response to violence. One of the methods recommended by the researcher was to leave the place of strife and not to react quickly. The researcher reminded the elderly women about not being able to react abruptly due to being old, so it is better to leave the place during physical conflicts and entertain themselves with other activities such as praying and cooking, or during verbal violence, it is better to remain silent and take action against the violence at another proper occasion. The results exposed that the training intervention significantly reduced the mean score of perceived barriers to violent behavior in the experimental group compared to that of the control group. This finding was consistent with the results of the prior studies, including the research cases by Höppner et al. (2025) [ 43 ], and Şat SÖ et al. (2025) [ 43 ]. In the process of educating the elderly on barriers, the researcher verified that regardless of age, some barriers only affect women, which include hesitation about abandoning a violent partner and lack of accurate knowledge about what support expert assistance can provide. Thus, by recognizing such barriers, they would try to get them resolved by finding logical reasons. For instance, if the obstacle is giving up your partner, it is better to talk to him logically and ask him to stop being violent, or if violence is age-related, it is better to consider that biologically age cannot be changed, so it is better to cope with this barrier. Based on the results, the training intervention tangibly increased the mean self-efficacy score towards violent behaviors in the experimental group compared to that of the control group, which is congruent with the results of the prior studies, including those by Simmons et al. (2022) [ 44 ] and Turan et al. (2022), [ 45 ] and Stark et al. (2022) [ 46 ]. These researchers added some points that employing health interventions in building self-efficacy in women is effective in preventing violence. The results indicated that the training intervention meaningfully promoted the mean score of violence-preventing behaviors in the experimental group compared to that of the control group, which is in agreement with the results of the prior studies, like the ones by Airaoje et al. (2025) [ 47 ] and Nishan et al. (2025), [ 48 ], Sousa et al. (2025) [ 49 ], and Yosep et al. (2024) [ 50 ]. When behavior is concerned in elderly women, we are largely faced with lack of justification or infeasibility of certain behaviors because such women are in the aging process and therefore, do not have the ability to do certain reactions. On the other hand, elderly women are less likely to abandon their partners compared to young ladies. Consequently, the researcher tried to recommend leaving the place of violence, keeping silent, and going to their children's house during the face-to-face training interventions. In addition, the researcher begged the elderly women that it would be better to spend their time on walking, attending Quran recitation classes, and praying to prevent some unwanted reactions instead of engaging in behaviors that could provoke their partner to violence. Eventually, it can be stated that due to the population’s aging, the need for help and support to perform various activities in the elderly goes up. Dependence on daily life activities creates tough nuisances for old people and their caregivers. Such problems may lead to long-term care and pertinent costs, which may lead to abusing old individuals, so it is better to take measures to protect the elderly and prevent some types of violence. Strengths The current study strong points encompass designing a Health Belief Model-focused training intervention; applying face-to-face training, conducting a study in an at-risk group, and providing useful educational materials. Limitations Of the present study limitations, we can point out the self-reporting of the individual, and due to the presence of the researcher when completing the questionnaire, it was possible for the respondent not to answer the questions accurately, and short follow-up period was another drawback here; thus, it is recommended for future studies to benefit from longer intervention studies. Conducting similar studies with aged population and focusing exclusively on this group made the justification of the results somewhat ambiguous. And not being able to generalize the results of this project to other areas because of the prevailing cultural differences. Consequently, it is proposed to develop and execute this project in other provinces as well. Concluding Remarks Regarding the current study drawn results, the Health Belief Mode-focused training program managed to prevent violent behaviors against elderly women. The HBM-oriented training program was able to make the study aged women acquainted with violent behavior (building up knowledge), misunderstanding violence as natural (altering attitude), reminding the psychological and physical consequences of violence (creating susceptibility and perceived severity), counting the reasons for violence (perceived barriers), and ultimately, leading to violence prevention (self-efficacy and behavior). The results of the current study can be potentially employed first by the elderly women themselves and then by comprehensive health centers, Fars University of Medical Sciences, Shiraz, and the Ministry of Health, and also provide information for designing and planning future interventions to affiliated organizations such as the Ministry of Health, the universities of medical sciences, and municipalities. Declarations Acknowledgement The authors appreciates the Deputy of Research, Shiraz University of Medical Sciences, as well as to all individuals, such as the fellows from the Comprehensive Health Center in Kharameh, Health Education at Shiraz University of Medical Sciences, and the elderly women who collaborated in implementing this project. Clinical trial number Not applicable. Authors’ contributions GT, LT, RZ and SR conceived and designed the study. ST and LT Collected and analyzed the data. SH A, interpreted the data. GT, LT, RZ, LGH and SR wrote the manuscript and prepared the tables. ST, SHA and LG revised the manuscript. All authors reviewed and approved the final manuscript. Funding This study received no external funding. Data availability The datasets generated and/or analyzed during the current study are not publicly available due to privacy and ethical restrictions but are available from the corresponding author on reasonable request. Ethics approval and consent to participate The protocol for this study was approved by the ethics committee of Shiraz University of Medical Sciences with the code of ethics (IR.SUMS.SCHEANUT.REC.1403.110). Moreover, the study adhered to the Declaration of Helsinki and informed consent was obtained from the participants before collecting the data. Consent for publication Not applicable. Competing interests The authors declare no competing interests. References Stöckl H, Sorenson SB. Violence against women as a global public health issue. Annual review of public health. 2024 May 20;45(1):277-94. https://doi.org/10.1146/annurev-publhealth-060722-025138 Guaita-Fernández P, Martín JM, Ribeiro-Navarrete S, Puertas R. Analysing the efficiency of public policies on gender-based violence: A literature review. 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Lifetime Abuse and the Barriers to Women Aged 50 and Over Using Domestic Violence Services in Germany. Violence Against Women. 2025 Jan 28:10778012241313481. t https://doi.org/10.1177/10778012241313481 Şat SÖ, Aktaş N, Akbaş P. The impact of escape room game and role-playing on nursing students’ violence against women assessment skills and attitudes toward violence against women: A randomised controlled trial. Nurse Education in Practice. 2025 Mar 1;84:104346. https://doi.org/10.1016/j.nepr.2025.104346 Simmons J, Motamedi A, Ludvigsson M, Swahnberg K. Testing an educational intervention to improve health care providers’ preparedness to care for victims of elder abuse: a mixed method pilot study. BMC medical education. 2022 Aug 3;22(1):597.https://doi.org/10.1186/s12909-022-03653-8 Turan FD. Effects of a structured online educational program course on nursing students' attitudes toward gender roles and women and children's violence abuse reports: a quasi-experimental evaluation. Nurse education today. 2022 Jan 1;108:105191. https://doi.org/10.1016/j.nedt.2021.105191 Stark L, Robinson MV, Seff I, Gillespie A, Colarelli J, Landis D. The effectiveness of women and girls safe spaces: a systematic review of evidence to address violence against women and girls in humanitarian contexts. Trauma, Violence, & Abuse. 2022 Oct;23(4):1249-61. https://doi.org/10.1177/1524838021991306 Airaoje OK, Uchendu CE, Akin-Odukoya OO, Aondover EM, Obada AA. Gender-Based Violence as a Public Health Crisis: Consequences for Nigerian Women and Society. Britain International of Humanities and Social Sciences (BIoHS) Journal. 2025 Jan 17;7(1):75-92.DOI: https://doi.org/10.33258/biohs.v7i1.1243 Nishan MN, Ahmed MN, Mashreky SR, Dalal K. Influence of spousal educational disparities on intimate partner violence (IPV) against pregnant women: a study of 30 countries. Scientific Reports. 2025 Jan 15;15(1):2022.https://doi.org/10.1038/s41598-024-84867-2 Sousa M, Gouveia C, Freitas B, Caridade S, Cunha O. The effectiveness of psychological intervention for women who committed child sexual abuse: an empty systematic review. Trauma, Violence, & Abuse. 2025 Jan;26(1):156-66. https://doi.org/10.1177/15248380241277274 Yosep I, Mardhiyah A, Hazmi H, Fitria N, Lukman M, Yamin A, Pahria T. A scoping review of nursing interventions for reducing the negative impacts of domestic violence among women. BMC nursing. 2024 Nov 14;23(1):834.https://doi.org/10.1186/s12912-024-02453-3 Additional Declarations No competing interests reported. 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citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. Domestic violence against women encompasses any type of violent behavior that results in physical, sexual, or psychological harm to her, as well as actions that cause suffering to women or forced deprivation of personal or social freedoms [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. As reported by the World Health Organization in 2021, one out of three women undergoes domestic violence by their partner [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]; this rate has been reported as around 37.7% in Asian countries [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e] and the Iranian rate of violence against women is 34.9% [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. The reported statistics is on the women of reproductive age (up to 45), while one of the groups at risk of domestic violence is elderly women [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. It is tough to estimate the prevalence of violence against aged women, as health professionals might face challenges to identify and report such cases due to denying the extent of the problem in society and neglecting to report the relevant cases of violence [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. Despite this matter, in a report published in 2021, the WHO reported the outbreak of violence against the elderly more than 10% [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e], and in a study in Iran, it was reported as 39.8% [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. Various factors play a role in the incidence of domestic violence against the aged women, which include individual (age and gender, education and occupation), family (family support, differences between men and women), and social (cultural, occupational, organizational) issues [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e], but what matters is that some of these factors are rooted in the violence victim, such as attitudes and beliefs about violence against women [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e], misogyny which can stimulate men's desire to commit violence against women [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e], considering violence committed by men against women as normal in some societies [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e], and gender inequalities [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. Taking this issue into account, and now that violence is followed by many consequences such as psychological problems [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e] and physical nuisances [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]. For the elderly; therefore, it is a must to be prevented, and based on scientific documents, training is one of the most basic tools and methods for preventing violence against women [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]. Out of many models and patterns of health education, the Health Belief Model (HBM) is an efficient one [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]. The HBM is a psychological model attempting to explain and predict health behaviors. Thus, it focuses on individuals' attitudes and beliefs (change in beliefs) and displays the relationship between beliefs and behavior. In fact, the HBM allows us to examine the potential psychological factors affecting individuals' decisions [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]. The above model\u0026rsquo;s constructs include perceived susceptibility, perceived severity, perceived benefits, perceived barriers, cues for action, and self-efficacy [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]. In this respect, some studies emphasized the critical role of interventions to prevent violence against women [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e, \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e, \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e]. Unfortunately, most studies focused on a specific group of women and, despite the value of the elderly, this group has been neglected, and there is little global evidence on the patterns and types of violence against women aged 60 and older. While it can definitively be stated that it is required to come up with a better understanding of the different patterns and dynamics of violence experienced by older women so that to warranty befitting policy making or the pertinent program-induced outcomes. Therefore, the current research was developed and executed pursuing the goal to weigh up the effect of the Health Belief Model-focused training program on the prevention of domestic violence among the aged women referring to comprehensive rural health service centers in Kharameh City in 2024.\u003c/p\u003e"},{"header":"Material and Methods","content":"\u003cp\u003e\u003cstrong\u003eStudy Design and Participants\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis quasi-experimental study was done in 2024 in Fars Province, Kharameh City. The study community was composed of the elderly women referring to the comprehensive health centers located in Kharameh City in 2024. The study inclusion criteria were having an active file in the Comprehensive Health Service Center, in the age bracket 60 and above, a history of domestic violence (according to the individual\u0026rsquo;s statements, clinical examination by a physician and consulting the center\u0026apos;s psychologist), cooperation with the experts working in the Comprehensive Health Service Center for face-to-face training, willingness to participate in the study, adequate visual and auditory performance, not participating in violence prevention training course. The study exclusion criteria included withdrawal from further cooperation, and being absent more than two sessions in the training.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSample Size\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe sample size was calculated as 68 subjects based on a similar study done by Rakhshani et al. (2024), using the formula for the mean difference in two populations and confidence level 0.95%, and test power 80%, which increased to 140 subjects by considering the attrition rate 10% .Then 70 individuals were calculated for each group [\u003cspan class=\"CitationRef\"\u003e27\u003c/span\u003e].\u003c/p\u003e\n\u003cp\u003e\u003cimg 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\"\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSampling Method\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA multi-stage cluster sampling method was employed for the study. Each health center in Kharameh City was viewed a cluster (there are 7 health centers), out of which 2 health houses were randomly selected from these clusters and 1 center (Mozabad -Jaberi Center) was designated as the control group, while 1 center (Tohid Center) was chosen as the experimental group. Then the participants were picked up from the above centers using convenience sampling and divided into 2 groups by simple random method. In case of the participants dropping out of the study, the replacements were made by picking up additional eligible women from the same health centers to maintain the sample size.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData Collection Tool\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA demographics questionnaire containing the individuals\u0026rsquo; information and a standard HBM-oriented questionnaire were utilized to collect the data.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eDemographics questionnaire\u003c/strong\u003e: including 7 items: age, age at marriage, education, spouse\u0026apos;s education, occupation, spouse\u0026apos;s occupation, who you live with, and the history of underlying disease.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eHBM-focused questionnaire\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis section measured knowledge, attitude, behavior, and the HBM components on domestic violence.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eKnowledge\u003c/strong\u003e: initially, the part on Knowledge about domestic violence was made up of 18 items (like: I am a religious person; the opinions of younger parents are closer to their children; I have gained the necessary training on how to deal with violence from my textbooks ;). These items were designed as three options (True\u0026thinsp;=\u0026thinsp;score 3, I don\u0026rsquo;t know\u0026thinsp;=\u0026thinsp;score 2, and False\u0026thinsp;=\u0026thinsp;score 1). The range of scores was between 18 and 36, where higher score indicated higher knowledge about domestic violence.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAttitude\u003c/strong\u003e: The part on Attitude was composed of 18 items (such as: My relatives conduct violent behavior; my family problems affect the way I deal with others; my family members understand me). These items were designed as five options (Absolutely Agree\u0026thinsp;=\u0026thinsp;score 5, Agree\u0026thinsp;=\u0026thinsp;score 4, No Opinion\u0026thinsp;=\u0026thinsp;score 3, Disagree\u0026thinsp;=\u0026thinsp;score 2, and absolutely Disagree\u0026thinsp;=\u0026thinsp;score 1). The range of scores was between 18 and 90, and higher scores stood for higher attitude towards domestic violence.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003ePerceived Susceptibility\u003c/strong\u003e: The part on Perceived Susceptibility involved 7 items (including: I received the required training on how to deal with violence from TV programs; I read novels involving violent characters; I feel uncomfortable when people pock their nose into my private life.)\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003ePerceived Intensity\u003c/strong\u003e : The part about Perceived Intensity had 10 items (such as: My mother regularly visits me to check my life status; My father visits me regularly to check my living condition; My wife pays enough attention to my children\u0026rsquo;s education).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003ePerceived Benefits\u003c/strong\u003e: The part on Perceived Benefits included 6 items (such as: Home cooked food should be as the man desires; the woman\u0026rsquo;s type of makeup and clothing outside the house should be as the man wishes).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003ePerceived Barriers\u003c/strong\u003e: The part about Perceived Barriers had 8 items (like: A woman should totally obey her husband; if a woman disobeys her husband, he has the right to beat her; the most important duty of a woman is to take care of her husband).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eGuide to action\u003c/strong\u003e: The part on Guide to action involved 5 items (like: The book on the rules of marriage is effective in controlling domestic violence; Seeking help and guidance from a family member has an effect on managing domestic violence; Exercising and relaxing the soul exerts an impact on fending off domestic violence).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSelf-efficacy\u003c/strong\u003e: The part on Self-efficacy had 8 items (such as: If a married man has a relationship with another woman, there is no problem in case of a concubine; Where to live is only decided by the husband, and the wife should be subordinate to her husband; The man has the right to have marital relations with his wife even if his wife is not willing to do so).\u003c/p\u003e\n\u003cp\u003eThe next items were designed as 5 options (Absolutely Agree\u0026thinsp;=\u0026thinsp;score 5, Agree\u0026thinsp;=\u0026thinsp;score 4, I don\u0026rsquo;t know\u0026thinsp;=\u0026thinsp;score 3, Disagree\u0026thinsp;=\u0026thinsp;score 2, and absolutely Disagree\u0026thinsp;=\u0026thinsp;score 1). The score range was as follows: Perceived Intensity (10\u0026ndash;50), Perceived Susceptibility (7\u0026ndash;35), Perceived Barriers (8\u0026ndash;40), Perceived Benefits (6\u0026ndash;30), and Self-efficacy (8\u0026ndash;40). The scores for Cues to Action ranged from 5 to 25. Higher scores indicated a better situation regarding domestic violence against women.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eBehavior\u003c/strong\u003e: The part on Behavior was made up of 8 items (like: The definition of physical violence (hitting, slapping, throwing objects at others, pushing) and verbal violence (obscene words, disrespect, insulting, threatening, etc.). These questions were designed as three options (True\u0026thinsp;=\u0026thinsp;score 3, I don\u0026rsquo;t know\u0026thinsp;=\u0026thinsp;score 2, and False\u0026thinsp;=\u0026thinsp;score 1). The score ranged from 8 to 16, and higher scores indicated higher behavior towards domestic violence prevention.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eValidity and Reliability of HBM questionnaire\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe HBM-focused questionnaire has already been used in the research done by Rakhshani et al. and its validity and reliability have been confirmed. Cronbach\u0026rsquo;s alpha was 0.74 for knowledge, 0.75 for perceived intensity, 0.82 for perceived susceptibility, 0.84 for perceived benefits, 0.76 for perceived barriers, 0.82 for self-efficacy, and 0.81 for behavior [\u003cspan class=\"CitationRef\"\u003e27\u003c/span\u003e]. In this study, the questionnaire\u0026rsquo;s validity was confirmed by twelve specialists and experts (outside the research team) in the fields of health education and health promotion (8 experts), physicians (2 ones), epidemiology (2 specialists), and statistics (1 expert). For reliability, Cronbach\u0026apos;s alpha coefficient was estimated for the model constructs and for the entire questionnaire. Cronbach\u0026apos;s alpha for the construct was 0.76 for knowledge, 0.79 for attitude, 0.76 for perceived susceptibility, 0.75 for perceived severity, 0.71 for perceived benefits, 0.81 for perceived barriers, 0.71 for self-efficacy, and 0.81 for behavior.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTraining Intervention\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eTo design the training intervention, a standard Health Belief Model-focused questionnaire was first distributed among the study participants once. Then, the intervention consisting of six 50\u0026ndash;60 minute sessions was held in the form of three training methods (lecture, question and answer (Q\u0026amp; A), and group discussion) at the question Health Center for preventive behaviors against domestic violence in the intervention group. Then, two months after the training intervention, the data were completed again and compared with those of the pre-intervention. During the training implementation, a group of experts including a mental health expert was consulted accompanied with the researcher, each of whom gave instructions about the items about preventive behaviors against domestic violence professionally. During the training course, the Ministry of Health training book, and the question and answer and group discussion method were used. The book Healthy Lifestyle according to the Guide to Improving Lifestyle for Senior Adults (compiled by the Ministry of Health of Iran) was employed to prepare the educational content in the training. The routine measures (elderly care) were taken into account for the control group. The explanations about the training intervention are given in Table \u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003e.\u003c/p\u003e\n\u003cdiv class=\"gridtable\"\u003e\n \u003ctable id=\"Tab1\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eDetails of Training Intervention\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eSession\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eGoal\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eTopic of education\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eDuration (minute)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eTraining method\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eInstructor\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1st\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eThe goal behind holding training courses and training knowledge \u0026amp; attitude constructs\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAcquaintance of group members with each other and the psychologist and stating the objectives.\u003c/p\u003e\n \u003cp\u003eTalking about domestic violence \u0026amp; getting familiar with types of home violence like verbal, physical and ,sexual violence in the aged\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e60\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eLecture\u003c/p\u003e\n \u003cp\u003eQuestion \u0026amp; Answer\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSpecialist group and expert\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2nd\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eTraining on perceived susceptibility \u0026amp; intensity constructs\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eCreating susceptibility in the aged women about this issue whether they know what sort of violence is domestic violence ,to determine and evaluate domestic violence induced perceived susceptibility\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e60\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eGroup discussion and Q\u0026amp;A\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePsychologist and expert\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3rd \u0026amp; 4th\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eTraining on perceived benefits \u0026amp; barriers constructs\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eIntroducing the benefits \u0026amp; barriers existing in the prevention of domestic violence\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e60\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eEducational videos \u0026amp; poster\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eConsultant \u0026amp; expert\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e5th\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eTraining the basics of self-efficacy \u0026amp; behavior constructs\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eRaising women\u0026rsquo;s self-efficacy ,increasing self-belief ,self-confidence and empowerment for preventing violence ,training anger control methods ,introducing some methods like leaving the location of strife ,keeping silent and settling down the conflicts\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e60\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eEducational videos \u0026amp; poster\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eConsultant \u0026amp; expert\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e6th\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSumming up \u0026amp; completing the questionnaire for the 2nd phase\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eCompleting the post-test questionnaire\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eResearcher\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003e\u003cstrong\u003eData Collection Method\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eIn data collection procedure, firstly the ethics code was achieved from the Ethics Committee (IR.SUMS.SCHEANUT.REC.1403.110) of Shiraz University of Medical Sciences. Then, when the necessary permits were gained from Shiraz University of Medical Sciences, the researcher visited the Comprehensive Health Center of Kharameh and once the consent of the eligible elderly was taken, the researcher selected the aged subjects for the study. Then, by visiting the center and coordinating with the elderly, the pre-test questionnaires were handed out among the households and the required information on how to complete the questionnaire, the study objective, and the conditions for quitting the research were supplied. In addition, the elderly women were given the opportunity to fill in the questionnaire, and a week later, the researcher collected the questionnaires by visiting the question centers. Then, when the experimental group was assigned and two months after the training interventions, the post-test questionnaires were collected again from the experimental and control groups.\u003c/p\u003e\n\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\n \u003ch2\u003eData Analysis\u003c/h2\u003e\n \u003cp\u003eData analysis was done using SPSS-27. Mean, standard deviation, and frequency indicators were employed to describe the data. For data analysis, the normality of the data was first measured via Kolmogorov-Smirnov test, and then Chi-squared test, independent t-test, and paired t-test tests were used for analyzing the data. The significance level in all tests was considered 0.05.\u003c/p\u003e\n\u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003eThe demographics of the experimental and control groups in the study are depicted in Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e2\u003c/span\u003e. The results of the Chi-squared test divulged the two groups being homogeneous in terms of education, spouse's education, occupation, spouse's occupation, underlying disease, and who they currently live with (P\u0026thinsp;\u0026gt;\u0026thinsp;0.05). Moreover, pursuant to the independent t-test, no tangible difference popped up between the mean age (P\u0026thinsp;=\u0026thinsp;0.721) and the mean age at marriage (P\u0026thinsp;=\u0026thinsp;0.842) in the two groups (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eComparison of frequency distribution of study participants\u0026rsquo; primary variables in two groups\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"6\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003eVariable\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eExperimental group n.(%)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eControl\u003c/p\u003e\u003cp\u003egroup n.(%)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003eStatistics\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cp\u003eP-value\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eEducation\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eUnder- diploma\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e62(88.57)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e60(85.71)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eChi\u003csup\u003e2\u003c/sup\u003e\u0026thinsp;=\u0026thinsp;2.15\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e0.615*\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003ePost- diploma\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e8(11.42)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e10(14.25)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eSpouse\u0026rsquo;s education\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eUnder- diploma\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e65(92.85)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e68(97.14)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eChi\u003csup\u003e2\u003c/sup\u003e\u0026thinsp;=\u0026thinsp;2.36\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e0.784\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003ePost- diploma\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e5(7.14)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e2(2.85)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eOccupation\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eHousewife\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e(90)63\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e65(92.85)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eChi\u003csup\u003e2\u003c/sup\u003e\u0026thinsp;=\u0026thinsp;0.487\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e0.495**\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=\"left\" colname=\"c3\"\u003e\u003cp\u003e7(10)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e5(7.14)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eSpouse\u0026rsquo;s occupation\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eOffice holder\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e6(8.57)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e9(12.85)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eChi\u003csup\u003e2\u003c/sup\u003e\u0026thinsp;=\u0026thinsp;2648\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e0.136*\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=\"left\" colname=\"c3\"\u003e\u003cp\u003e64(91.42)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e61(87.14)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eUnderlying disease\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e20(28.57)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e32(45.71)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eChi\u003csup\u003e2\u003c/sup\u003e\u0026thinsp;=\u0026thinsp;1.954\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e0.533*\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e50(71.42)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e38(54.28)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003eWho they live with\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eSpouse\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e58(82.85)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e62(88.57)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003eChi\u003csup\u003e2\u003c/sup\u003e\u0026thinsp;=\u0026thinsp;0.945\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e0.215*\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eChild\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e10(14.25)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e7(10)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eClose relatives\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e2(2.85)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1(1.42)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003eAge (Mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e72.04\u0026thinsp;\u0026plusmn;\u0026thinsp;4.89\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e69.04\u0026thinsp;\u0026plusmn;\u0026thinsp;4.21\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003et\u0026thinsp;=\u0026thinsp;0.086\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.721**\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003eAge at marriage (Mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e17.04\u0026thinsp;\u0026plusmn;\u0026thinsp;3.02\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e16.04\u0026thinsp;\u0026plusmn;\u0026thinsp;3.99\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003et\u0026thinsp;=\u0026thinsp;0.125\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.842**\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"6\" nameend=\"c6\" namest=\"c1\"\u003e\u003cp\u003e*Chi-squared test\u003c/p\u003e\u003cp\u003e** Independent t-test\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e2\u003c/span\u003e presents the comparison of the mean score of knowledge, attitude and model constructs in the intervention and control groups of pre-and post-intervention. Considering the normality of the mean scores of knowledge and model constructs, independent t-test was applied for intergroup comparison (experimental and control) and paired t-test was used for intragroup comparison. As shown by the results of the independent t-test, the pre-intervention revealed no statistically significant difference between the intervention and control groups concerning the mean score of knowledge, attitude, perceived susceptibility, perceived severity, perceived benefits, perceived barriers, cues to action, self-efficacy and behavior (P\u0026thinsp;\u0026gt;\u0026thinsp;0.05), while the post-intervention indicated a tangible difference between the health belief model constructs in the experimental and control groups (P\u0026thinsp;\u0026lt;\u0026thinsp;0.05).\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eComparison of mean and standard deviation of knowledge, attitude and model constructs in two groups of pre- and post-intervention\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"6\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eModel Constructs\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eGroup\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003ePre-intervention\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003ePost-intervention\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eP-value **\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eEffect size (Cohen\u0026rsquo;s d)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eMean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eMean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eKnowledge\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eExperimental\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e19.84\u0026thinsp;\u0026plusmn;\u0026thinsp;2.70\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e24.46\u0026thinsp;\u0026plusmn;\u0026thinsp;2.18\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.64\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eControl\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e19.98\u0026thinsp;\u0026plusmn;\u0026thinsp;2.47\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e19.75\u0026thinsp;\u0026plusmn;\u0026thinsp;3.94\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.245\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003eP-value *\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.523\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" morerows=\"1\" nameend=\"c6\" namest=\"c5\" rowspan=\"2\"\u003e\u003cp\u003e*Independent t-test\u003c/p\u003e\u003cp\u003e** Paired t-test\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003eEffect size(Cohen\u0026rsquo;s d)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.63\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eAttitude\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eExperimental\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e42.55\u0026thinsp;\u0026plusmn;\u0026thinsp;10.21\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e71.77\u0026thinsp;\u0026plusmn;\u0026thinsp;11.17\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.33\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eControl\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e42.64\u0026thinsp;\u0026plusmn;\u0026thinsp;11.76\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e42.46\u0026thinsp;\u0026plusmn;\u0026thinsp;10.16\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.942\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003eP-value*\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.125\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" morerows=\"1\" nameend=\"c6\" namest=\"c5\" rowspan=\"2\"\u003e\u003cp\u003e*Independent t-test\u003c/p\u003e\u003cp\u003e** Paired t-test\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003eEffect size(Cohen\u0026rsquo;s d)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.60\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003ePerceived susceptibility\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eExperimental\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e15.33\u0026thinsp;\u0026plusmn;\u0026thinsp;2.50\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e21.82\u0026thinsp;\u0026plusmn;\u0026thinsp;2.36\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.45\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eControl\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e15.03\u0026thinsp;\u0026plusmn;\u0026thinsp;2.40\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e15.46\u0026thinsp;\u0026plusmn;\u0026thinsp;2.47\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.115\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003eP-value*\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.945\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" morerows=\"1\" nameend=\"c6\" namest=\"c5\" rowspan=\"2\"\u003e\u003cp\u003e*Independent t-test\u003c/p\u003e\u003cp\u003e**Paired t-test\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003eEffect size(Cohen\u0026rsquo;s d)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.45\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003ePerceived intensity\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eExperimental\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e21.33\u0026thinsp;\u0026plusmn;\u0026thinsp;9.50\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e32.64\u0026thinsp;\u0026plusmn;\u0026thinsp;7.74\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.41\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eControl\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e21.26\u0026thinsp;\u0026plusmn;\u0026thinsp;9.06\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e21.94\u0026thinsp;\u0026plusmn;\u0026thinsp;10.62\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.065\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003eP-value*\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.972\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.00\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" morerows=\"1\" nameend=\"c6\" namest=\"c5\" rowspan=\"2\"\u003e\u003cp\u003e*Independent t-test\u003c/p\u003e\u003cp\u003e**Paired t-test\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003eEffect size(Cohen\u0026rsquo;s d)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.58\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003ePerceived benefits\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eExperimental\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e15.00\u0026thinsp;\u0026plusmn;\u0026thinsp;3.12\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e21.60\u0026thinsp;\u0026plusmn;\u0026thinsp;3.60\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.65\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eControl\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e15.06\u0026thinsp;\u0026plusmn;\u0026thinsp;3.89\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e15.02\u0026thinsp;\u0026plusmn;\u0026thinsp;3.64\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.945\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003eP-value*\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.341\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" morerows=\"1\" nameend=\"c6\" namest=\"c5\" rowspan=\"2\"\u003e\u003cp\u003e*Independent t-test\u003c/p\u003e\u003cp\u003e**Paired t-test\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003eEffect size(Cohen\u0026rsquo;s d)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.61\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003ePerceived barriers\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eExperimental\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e22.23\u0026thinsp;\u0026plusmn;\u0026thinsp;5.50\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e19.21\u0026thinsp;\u0026plusmn;\u0026thinsp;5.02\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.45\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eControl\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e22.96\u0026thinsp;\u0026plusmn;\u0026thinsp;4.55\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e22.96\u0026thinsp;\u0026plusmn;\u0026thinsp;4.60\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.078\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003eP-value*\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.123\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" morerows=\"1\" nameend=\"c6\" namest=\"c5\" rowspan=\"2\"\u003e\u003cp\u003e*Independent t-test\u003c/p\u003e\u003cp\u003e**Paired t-test\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003eEffect size(Cohen\u0026rsquo;s d)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.70\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eGuide to action\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eExperimental\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e13.00\u0026thinsp;\u0026plusmn;\u0026thinsp;1.72\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e17.00\u0026thinsp;\u0026plusmn;\u0026thinsp;1.52\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.64\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eControl\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e13.50\u0026thinsp;\u0026plusmn;\u0026thinsp;1.79\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e13.50\u0026thinsp;\u0026plusmn;\u0026thinsp;1.45\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.065\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003eP-value*\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.161\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" morerows=\"1\" nameend=\"c6\" namest=\"c5\" rowspan=\"2\"\u003e\u003cp\u003e*Independent t-test\u003c/p\u003e\u003cp\u003e**Paired t-test\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003eEffect size(Cohen\u0026rsquo;s d)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.42\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eSelf-efficacy\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eExperimental\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e21.46\u0026thinsp;\u0026plusmn;\u0026thinsp;2.30\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e26.44\u0026thinsp;\u0026plusmn;\u0026thinsp;1.69\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eControl\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e21.42\u0026thinsp;\u0026plusmn;\u0026thinsp;2.90\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e21.38\u0026thinsp;\u0026plusmn;\u0026thinsp;1.45\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.51\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003eP-value*\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.845\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" morerows=\"1\" nameend=\"c6\" namest=\"c5\" rowspan=\"2\"\u003e\u003cp\u003e*Independent t-test\u003c/p\u003e\u003cp\u003e** Paired t-test\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003eEffect size(Cohen\u0026rsquo;s d)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.58\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eBehavior\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eExperimental\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e8.75\u0026thinsp;\u0026plusmn;\u0026thinsp;1.95\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e13.22\u0026thinsp;\u0026plusmn;\u0026thinsp;3.30\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.001\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=\"c2\"\u003e\u003cp\u003eControl\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e8.98\u0026thinsp;\u0026plusmn;\u0026thinsp;1.09\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e8.30\u0026thinsp;\u0026plusmn;\u0026thinsp;1.73\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.060\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003eP-value*\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.512\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" morerows=\"1\" nameend=\"c6\" namest=\"c5\" rowspan=\"2\"\u003e\u003cp\u003e*Independent t-test\u003c/p\u003e\u003cp\u003e** Paired t-test\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003eEffect size(Cohen\u0026rsquo;s d)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.51\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThe present study targeted to outline the HBM intervention-induced effect on the prevention of domestic violence among the elderly women, and the results suggested that the above intervention worked out effectively for the HBM variables. The HBM-focused education was able to familiarize the elderly women with violent behavior (raising knowledge), to misunderstand the violence being natural (promoted attitude), to point out the psychological and physical consequences of violence (established susceptibility and perceived severity), to state the reasons for violence (perceived barriers), and ultimately, to result in violence prevention (self-efficacy and behavior).\u003c/p\u003e\u003cp\u003eAs reported, the training intervention significantly increased the mean knowledge score regarding violent behaviors in the experimental group compared to the control group, which is in accord with the results of the previous studies, including the research done by Craig et al. (2025) [\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e], Saudah et al. (2025) [\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e], and Ullman et al. (2025) [\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e]. Interpreting the results illustrates that the HBM-focused and face-to-face intervention was influential in raising the knowledge of the aged women about violence. During the training process, the researcher initially tried to define violence for the study elderly women, and the researcher's definition was in agreement with the native language and the prevailing culture in the county. This helped the elderly recognize some dimensions of violence after ages and to get familiar with the aspects of violence including verbal violence that they had not known about until then. On the other hand, during the training process, the researcher realized that the dynamics of aging has changed the elderly women\u0026rsquo;s experience of violence, and now they no longer consider every issue as violence as they used to do in their youth, and this could be one of the hidden reasons for lack of real prevalence of violence against the aged, while elderly women experience different types of violence such as psychological violence and verbal abuse, compared to younger women who undergo the experiences of physical and sexual violence.\u003c/p\u003e\u003cp\u003eThe results demonstrated that the training intervention led to a meaningful increase in the mean score of attitude towards violent behaviors in the experimental group compared to that of the control group. Comparison with the existing literature displays that most of the prior research cases have verified the positive impact of the interventions on attitudes towards violence; although these studies did not target the elderly, they addressed violence in women. For example, the results of the previous studies, including those by Fisher et al. (2025) [\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e], Mohd et al. (2024) [\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e], Kumari et al. (2024) [\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e], Sutherland et al. (2024) [\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e], demonstrated the tangible impact induced by the training intervention on attitudes, which is congruent with the findings of the present study. In the study elderly women, the noticeable point was that some of these women considered violence as natural, which originates from the individual's beliefs. In traditional societies such as Iranian society, this is true about some women to some extent, and since the study group was elderly women being raised in very traditional families in terms of culture and not considering many cases of violence, like verbal violence, as substantial, the stance which might have caused the study aged women not to have a negative attitude towards violence. In this respect, despite the researcher\u0026rsquo;s efforts to change the women\u0026rsquo;s attitude and based on the comparison of the mean scores of the pre-and post-test, the researcher was somewhat successful, perhaps this higher mean is merely related to answering the questions and in reality, not much variation was felt towards violence in the elderly women.\u003c/p\u003e\u003cp\u003eIn accordance with the results, the training intervention critically increased the mean score of perceived susceptibility and severity towards violent behaviors in the experimental group compared to that of the control group. This finding was consistent with the results of the previous studies, including those performed by Villard\u0026oacute;n-Gallego et al. (2023) [\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e], Bacchus et al. (2023) [\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e], Elbelassy et al. (2023) [\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e], Leight et al. (2023) [\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e],and Akram et al. (2023) [\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e]. In the training program on perceived susceptibility and severity, the researcher made efforts to elaborate on the psychological and physical dimensions of violence to the senior women and the psychological consequences of violence such as stress, depression and anxiety for the elderly, resulting in upgrading the susceptibility towards violence and the severity of the consequences of violence for women, it was also successful as the results reported.\u003c/p\u003e\u003cp\u003ePursuant to the results, the training intervention meaningfully raised the mean score of perceived benefits towards violent behaviors in the experimental group compared to that of the control group, which is in line with the results of the formerly conducted studies, including those done by Ezenwosu et al. (2025) [\u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e], and Cerd\u0026aacute;n-Torregrosa et al. (2025) [\u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e]. In this stage of the training, the researcher tried to make women aware of the benefits they expressed regarding their response to violence. One of the methods recommended by the researcher was to leave the place of strife and not to react quickly. The researcher reminded the elderly women about not being able to react abruptly due to being old, so it is better to leave the place during physical conflicts and entertain themselves with other activities such as praying and cooking, or during verbal violence, it is better to remain silent and take action against the violence at another proper occasion.\u003c/p\u003e\u003cp\u003eThe results exposed that the training intervention significantly reduced the mean score of perceived barriers to violent behavior in the experimental group compared to that of the control group. This finding was consistent with the results of the prior studies, including the research cases by H\u0026ouml;ppner et al. (2025) [\u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e43\u003c/span\u003e], and Şat S\u0026Ouml; et al. (2025) [\u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e43\u003c/span\u003e]. In the process of educating the elderly on barriers, the researcher verified that regardless of age, some barriers only affect women, which include hesitation about abandoning a violent partner and lack of accurate knowledge about what support expert assistance can provide. Thus, by recognizing such barriers, they would try to get them resolved by finding logical reasons. For instance, if the obstacle is giving up your partner, it is better to talk to him logically and ask him to stop being violent, or if violence is age-related, it is better to consider that biologically age cannot be changed, so it is better to cope with this barrier.\u003c/p\u003e\u003cp\u003eBased on the results, the training intervention tangibly increased the mean self-efficacy score towards violent behaviors in the experimental group compared to that of the control group, which is congruent with the results of the prior studies, including those by Simmons et al. (2022) [\u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e44\u003c/span\u003e] and Turan et al. (2022), [\u003cspan citationid=\"CR45\" class=\"CitationRef\"\u003e45\u003c/span\u003e] and Stark et al. (2022) [\u003cspan citationid=\"CR46\" class=\"CitationRef\"\u003e46\u003c/span\u003e]. These researchers added some points that employing health interventions in building self-efficacy in women is effective in preventing violence.\u003c/p\u003e\u003cp\u003eThe results indicated that the training intervention meaningfully promoted the mean score of violence-preventing behaviors in the experimental group compared to that of the control group, which is in agreement with the results of the prior studies, like the ones by Airaoje et al. (2025) [\u003cspan citationid=\"CR47\" class=\"CitationRef\"\u003e47\u003c/span\u003e] and Nishan et al. (2025), [\u003cspan citationid=\"CR48\" class=\"CitationRef\"\u003e48\u003c/span\u003e], Sousa et al. (2025) [\u003cspan citationid=\"CR49\" class=\"CitationRef\"\u003e49\u003c/span\u003e], and Yosep et al. (2024) [\u003cspan citationid=\"CR50\" class=\"CitationRef\"\u003e50\u003c/span\u003e]. When behavior is concerned in elderly women, we are largely faced with lack of justification or infeasibility of certain behaviors because such women are in the aging process and therefore, do not have the ability to do certain reactions. On the other hand, elderly women are less likely to abandon their partners compared to young ladies. Consequently, the researcher tried to recommend leaving the place of violence, keeping silent, and going to their children's house during the face-to-face training interventions. In addition, the researcher begged the elderly women that it would be better to spend their time on walking, attending Quran recitation classes, and praying to prevent some unwanted reactions instead of engaging in behaviors that could provoke their partner to violence.\u003c/p\u003e\u003cp\u003eEventually, it can be stated that due to the population\u0026rsquo;s aging, the need for help and support to perform various activities in the elderly goes up. Dependence on daily life activities creates tough nuisances for old people and their caregivers. Such problems may lead to long-term care and pertinent costs, which may lead to abusing old individuals, so it is better to take measures to protect the elderly and prevent some types of violence.\u003c/p\u003e\u003cp\u003e\u003cb\u003eStrengths\u003c/b\u003e\u003c/p\u003e\u003cp\u003eThe current study strong points encompass designing a Health Belief Model-focused training intervention; applying face-to-face training, conducting a study in an at-risk group, and providing useful educational materials.\u003c/p\u003e\u003cp\u003e\u003cb\u003eLimitations\u003c/b\u003e\u003c/p\u003e\u003cp\u003eOf the present study limitations, we can point out the self-reporting of the individual, and due to the presence of the researcher when completing the questionnaire, it was possible for the respondent not to answer the questions accurately, and short follow-up period was another drawback here; thus, it is recommended for future studies to benefit from longer intervention studies. Conducting similar studies with aged population and focusing exclusively on this group made the justification of the results somewhat ambiguous. And not being able to generalize the results of this project to other areas because of the prevailing cultural differences. Consequently, it is proposed to develop and execute this project in other provinces as well.\u003c/p\u003e\u003cp\u003e\u003cb\u003eConcluding Remarks\u003c/b\u003e\u003c/p\u003e\u003cp\u003eRegarding the current study drawn results, the Health Belief Mode-focused training program managed to prevent violent behaviors against elderly women. The HBM-oriented training program was able to make the study aged women acquainted with violent behavior (building up knowledge), misunderstanding violence as natural (altering attitude), reminding the psychological and physical consequences of violence (creating susceptibility and perceived severity), counting the reasons for violence (perceived barriers), and ultimately, leading to violence prevention (self-efficacy and behavior). The results of the current study can be potentially employed first by the elderly women themselves and then by comprehensive health centers, Fars University of Medical Sciences, Shiraz, and the Ministry of Health, and also provide information for designing and planning future interventions to affiliated organizations such as the Ministry of Health, the universities of medical sciences, and municipalities.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAcknowledgement\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors appreciates the Deputy of Research, Shiraz University of Medical Sciences, as well as to all individuals, such as the fellows from the Comprehensive Health Center in Kharameh, Health Education at Shiraz University of Medical Sciences, and the elderly women who collaborated in implementing this project.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eClinical trial number\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026rsquo; contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eGT, LT, RZ and SR conceived and designed the study. ST and LT Collected and analyzed the data. SH A, interpreted the data. GT, LT, RZ, LGH and SR wrote the manuscript and prepared the tables. ST, SHA and LG revised the manuscript. All authors reviewed and approved the final manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study received no external funding.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData availability\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets generated and/or analyzed during the current study are not publicly available due to privacy and ethical restrictions but are available from the corresponding author on reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe protocol for this study was approved by the ethics committee of Shiraz University of Medical Sciences with the code of ethics (IR.SUMS.SCHEANUT.REC.1403.110). Moreover, the study adhered to the Declaration of Helsinki and informed consent was obtained from the participants before collecting the data.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare no competing interests.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n \u003cli\u003eSt\u0026ouml;ckl H, Sorenson SB. Violence against women as a global public health issue. Annual review of public health. 2024 May 20;45(1):277-94. https://doi.org/10.1146/annurev-publhealth-060722-025138\u003c/li\u003e\n \u003cli\u003eGuaita-Fern\u0026aacute;ndez P, Mart\u0026iacute;n JM, Ribeiro-Navarrete S, Puertas R. Analysing the efficiency of public policies on gender-based violence: A literature review. 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Optimization of eHealth interventions for intimate partner violence and abuse: a qualitative study amongst Arabic‐speaking migrant women. Journal of Advanced Nursing. 2023 Apr;79(4):1414-25. https://doi.org/10.1111/jan.15437\u003c/li\u003e\n \u003cli\u003eLeight J, Cullen C, Ranganathan M, Yakubovich A. Effectiveness of community mobilisation and group-based interventions for preventing intimate partner violence against women in low-and middle-income countries: A systematic review and meta-analysis. Journal of global health. 2023 Oct 20;13:04115. doi: 10.7189/jogh.13.04115\u003c/li\u003e\n \u003cli\u003eAkram N, Yasmin M. Sexual violence against women: Global interventions and an evidence from Pakistan. InWomen\u0026apos;s Studies International Forum 2023 Mar 1 (Vol. 97, p. 102691). Pergamon. https://doi.org/10.1016/j.wsif.2023.102691\u003c/li\u003e\n \u003cli\u003eEzenwosu IL, Uzochukwu BS. 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Scientific Reports. 2025 Jan 15;15(1):2022.https://doi.org/10.1038/s41598-024-84867-2\u003c/li\u003e\n \u003cli\u003eSousa M, Gouveia C, Freitas B, Caridade S, Cunha O. The effectiveness of psychological intervention for women who committed child sexual abuse: an empty systematic review. Trauma, Violence, \u0026amp; Abuse. 2025 Jan;26(1):156-66. https://doi.org/10.1177/15248380241277274\u003c/li\u003e\n \u003cli\u003eYosep I, Mardhiyah A, Hazmi H, Fitria N, Lukman M, Yamin A, Pahria T. A scoping review of nursing interventions for reducing the negative impacts of domestic violence among women. BMC nursing. 2024 Nov 14;23(1):834.https://doi.org/10.1186/s12912-024-02453-3\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-geriatrics","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bgtc","sideBox":"Learn more about [BMC Geriatrics](http://bmcgeriatr.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bgtc/default.aspx","title":"BMC Geriatrics","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Elderly Women, Violence, Training Intervention, Preventive Behaviors, Health Belief Model (HBM)","lastPublishedDoi":"10.21203/rs.3.rs-7018292/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7018292/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e\u003cp\u003eThe majority of the accessible evidence on violence against women is focused on the group of women of reproductive age (from 15 to 49), and globally speaking, there is inadequate evidence on the patterns and types of violence against elderly women, while a better perception of the patterns and different dynamics of violence experienced by aged women is necessary in order to guarantee appropriate policy making or the implemented program\u0026rsquo;s outcomes, which can lead to conducting some behaviors in the senior women. Thus, the present study was developed and performed to outline the Impact of Health Belief Model-Oriented Training Intervention on the Prevention of Domestic Violence against Elderly Women referring to comprehensive rural health service centers located in Kharameh City in 2024.\u003c/p\u003e\u003ch2\u003eMaterial and Methods\u003c/h2\u003e\u003cp\u003eThe present quasi-experimental study was conducted in 2024 on 140 aged females referring to comprehensive health centers in Kharameh city, Fars province. Cluster sampling method was applied and the subjects were allocated to two groups as experimental and control by simple random method (n\u0026thinsp;=\u0026thinsp;70 in the experimental group and n\u0026thinsp;=\u0026thinsp;70 in the control group). The data were collected by standard Health Belief Model (HBM) questionnaire completed by the control and experimental groups before and two months after the intervention. The training intervention consisted of 6 face-to-face HBM-focused sessions for violence prevention, which were held during two months for the experimental group. After entering the data into SPSS-27, they were analyzed by paired t-test, independent t-test, and Chi-squared test.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e\u003cp\u003eThe independent t-test results divulged that the pre-training intervention came up with no statistically significant difference between the intervention and control groups in terms of the mean score of knowledge, attitude, perceived susceptibility, perceived severity, perceived benefits, perceived barriers, cues for action, self-efficacy and behavior (P\u0026thinsp;\u0026gt;\u0026thinsp;0.05), while the post-training intervention revealed a tangible difference between the HBM constructs in the experimental and control groups (P\u0026thinsp;\u0026lt;\u0026thinsp;0.05).\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e\u003cp\u003eThe present study results indicated that the HBM-focused training program proved effective in preventing violent behaviors against aged women. Pursuant to this research, the HBM-focused training program promoted the establishment of susceptibility and severity towards violence by creating a connection between knowledge and attitude, and the elderly women identified the potential benefits and barriers and were able to build up their self-efficacy and behavior by adopting cues for action.\u003c/p\u003e","manuscriptTitle":"Health Belief Model-Oriented Training Intervention’s Impact on Prevention of Domestic Violence against Elderly Women: A quasi-experimental study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-10-23 08:54:32","doi":"10.21203/rs.3.rs-7018292/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"editorInvitedReview","content":"","date":"2026-05-22T05:22:17+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"21607100141870848432410823571009906284","date":"2026-05-22T05:19:43+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"59084530167536596964987035323113384706","date":"2025-10-21T19:08:49+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-10-21T19:08:08+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"59656973011652127961601422163355129195","date":"2025-10-16T17:34:19+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-10-09T14:35:26+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-09-12T11:34:53+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-07-09T12:58:22+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-07-08T14:53:07+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Geriatrics","date":"2025-07-08T13:35:31+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-geriatrics","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bgtc","sideBox":"Learn more about [BMC Geriatrics](http://bmcgeriatr.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bgtc/default.aspx","title":"BMC Geriatrics","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"be8d2209-12e4-498f-b905-12cf8b1e1160","owner":[],"postedDate":"October 23rd, 2025","published":true,"recentEditorialEvents":[{"type":"editorInvitedReview","content":"","date":"2026-05-22T05:22:17+00:00","index":90,"fulltext":""},{"type":"reviewerAgreed","content":"21607100141870848432410823571009906284","date":"2026-05-22T05:19:43+00:00","index":89,"fulltext":""}],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2025-10-23T08:54:32+00:00","versionOfRecord":[],"versionCreatedAt":"2025-10-23 08:54:32","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7018292","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7018292","identity":"rs-7018292","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}