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The aim of this study was to compare the effects of feedback, interactive education, and social media interventions based on the health belief model on protective beliefs in adults at risk of exposure to secondhand smoke at home.
Secondhand smoke (SHS) exposure, also known as environmental tobacco smoke, passive smoke or involuntary smoke, is caused by the burning of cigarettes and other tobacco products and the smoke exhaled by a smoker. Although Turkey is one of the best countries in combating SHS exposure, one in four adults is exposed to SHS at home. One of the most important reasons for this exposure is the lack of deterrent policies for the home environment, which is considered a private area. It is entirely possible for non-smoking individuals to be protected from SHS exposure at home through their own efforts. In this context, the knowledge, behaviors and perceptions of non-smoking adults about exposure are important in preventing or reducing SHS exposure at home. Interventions based on the behavior change model can be effective in developing protective behaviors in adults at risk of SHS exposure at home. Individual and group interventions using multiple educational materials and methods based on the Health Belief Model (HBM) (SHS exposure feedback, interactive group education and social media sharing) can develop protective behaviors in individuals at home.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Exposure feedback group | Experimental |
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| Interactive education group | Experimental |
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| Social media group | Experimental |
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| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Exposure feedback | Behavioral |
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| Measure | Description | Time Frame |
|---|---|---|
| Health belief model scale for prevention behaviors of secondhand smoke exposure (HBM-SHS) | The 35-item scale, scored on a five-point Likert scale from "Strongly Disagree (1)" to "Strongly Agree (5)," assesses six subdimensions: "perceived susceptibility," "perceived seriousness," "perceived benefits," "perceived barriers," "self-efficacy," and "behavioral cues." Items on "perceived susceptibility" and "perceived barriers" are reverse coded. Scores range from 35 to 175, with higher scores indicating stronger health beliefs about SHS exposure and greater beliefs in each subdimension. | Baseline and at first month later after intervention |
| Measure | Description | Time Frame |
|---|---|---|
| Secondhand Smoke Exposure Risk Assessment | Risk assessment is conducted through four questions addressing whether there is a smoker in the household, household tobacco use rules, tobacco use in enclosed areas, and the time since the last use. Responses are scored categorically: absence of risk is scored as 0, while the presence and intensity of risk are scored as 1 or more. A score of at least one indicates "risk." SHS exposure risk is scored from 0 to 10, with any score of 1 or above indicating the presence of risk. Total risk assessment scores are represented on a real risk scale of 0-10. According to expert evaluations, the content validity index (CVI) of the questions assessing participants' SHS exposure risk level is 0.86. |
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İnclusion Criteria
Exclusion Criteria:
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| Name | Role | Phone | Extension | |
|---|---|---|---|---|
| Ercan Asi | Contact | +905342087249 | ercanasi@akdeniz.edu.tr |
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| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Akdeniz University Faculty of Nursing | Antalya | Konyaaltı | 07070 | Turkey (Türkiye) |
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| Interactive education | Behavioral | Slide presentation, video presentation, Q&A, evaluation of learning and discussion of results |
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| Social media post | Behavioral | Sharing informational materials such as messages, brochures, and videos related to SHS exposure, including ways to protect yourself from SHS exposure and the adverse health effects of SHS exposure. |
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| Baseline and at first month later after intervention |
| Actual Risk Assessment | In adults at risk of SHS exposure, urinary cotinine analysis will be conducted using a cotinine urine test kit. The test detects cotinine in the urine, indicating SHS exposure. The strip is dipped into the urine sample for 10 seconds, and the result is read within 5 minutes. In a negative result, both the control (C) and test (T) lines will appear, while in a positive result, only the control line (C) will appear. If neither the C nor T lines are visible, or if only the T line appears, the test is invalid. | Baseline and at first month later after intervention |
| Perceived SHS Exposure Risk | In adults, SHS exposure risk will be assessed based on the perceived level of risk. Participants' awareness of SHS exposure will be measured by their responses to the question, "How would you describe your risk of being exposed to SHS in your home?" with options such as "No risk at all," "Somewhat at risk," or "At very high risk." Additionally, participants' perceived SHS exposure risk level will be evaluated based on their numerical responses to the question, "What would your risk of SHS exposure in your home be on a scale from 0 to 10?" Each number will represent the participant's perceived (exposure risk probability) risk. | Baseline and at first month later after intervention |
| ThirdHand Smoke Beliefs Scale (BATHS) | This scale was developed by Haardörfer and colleagues in 2017 to identify beliefs about third-hand smoke (THS). The scale includes 5 items related to the health effects of THS and 4 items regarding its persistence in the environment. The items are rated using a 5-point Likert scale, with the following coding: 5 = Strongly agree, 4 = Agree, 3 = Neutral, 2 = Disagree, 1 = Strongly disagree. The total score of the scale is obtained by dividing the sum of the item scores by the number of items. A score closer to 5 for each item indicates the individual believes in the health and environmental effects of THS, while a score closer to 1 indicates disbelief. | Baseline and at first month later after intervention |