J. Biol. Today's World.

2014 Oct; 3 (10): 223-226

∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙

Journal of Biology and Today's World

ISSN 2322-3308
http://www.journalbio.com
Received: 25 July 2014 • Accepted: 30 August 2014

Research

doi:10.15412/J.JBTW.01031004

Beliefs of Female Teenagers on Prevention of Urinary

Tract Infection: Application of Health Belief Model
Maryam Changizi1*, Davood Shojaei Zadeh2, Fazel Zinat-Motlagh3, Mohammad Fattahi4 Mohammad Mahboubi1,5

1 Abadan College of Medical Sciences and Health Services, Abadan, Iran

2 Department of Health Education and Promotion, School Health, Tehran University of Medical Sciences, Tehran, Iran
3 Social Determinants of Health Research Center, Yasuj University of Medical Sciences, Yasuj, Iran
4 Shadegan Health Center, Abadan College of Medical Sciences and Health Services, Abadan, Iran
5 Health Services Administration, Kermanshah University of Medical Sciences, Kermanshah, Iran

*correspondence should be addressed to Maryam Changizi, Abadan College of Medical Sciences and Health Services, Abadan, Iran; Tell:
+989163333083; Fax: +989163333083; Email: mrs.changizi@yahoo.com.

ABSTRACT
Urinary tract infection is a common infection among women and is followed by several complications. The aim of this study
was determine the prevalence and factors influencing prevention of urinary tract infection based on health belief model. A
cross-sectional study was conducted among 166 female students in Shadegan city, Iran; which was randomly selected with
the proportional to size among different girls high school at Shadegan city for participation in this study. A structured
questionnaire was applied for collecting data and data were analyzed by SPSS version 20 using bivariate correlations and
logistic regression statistical tests. Almost 22.3% of the participants had history of experience urinary tract infection at last
one in lifelong. The best predictor for urinary tract infection was perceived susceptibility with odds ratio estimate of 0.810
[95% CI: 0.664, 0.987]. Based on our result, it seems that designing and implementation of educational programs to
increase susceptibility about chance of getting urinary tract infection among the female students may be useful in order to
prevent urinary tract infection.
Key words: Urinary Tract Infection, Female Students, Health Belief Model
Copyright © 2014 Maryam Changizi et al. This is an open access article distributed under the Creative Commons Attribution License.

1. INTRODUCTION Prevalence of UTI between women is high; in this regard,

U
rinary tract infection (UTI) is known as a common Eriksson et al in their study reported 29.6% of women
infection among women; in more than 95 percent were diagnosed as having UTI at least one (6).
of cases urinary infection is created by a certain Furthermore, Sorto et al reported the UTI incidence among
group of bacteria; the major pathogen of urinary infection the women in their study was of 35.8% (7). Studies
is E.coli bacteria, which is a normal bacterial flora in showed the prevalence of UTI in different parts of the
intestines (1). It seems that the reasons for increased world, which made it necessary to determine and control
prevalence of such infections among women are proximity its predisposing factors (8). Along this, personal health
of their urethral and anus, short length of urethral and behaviors were considered as the major predisposing
warm and wet environment of perineal (2); postponing factors to relapse of urinary infection (9). Various factors
urination, pregnancy, menopause, frequent intercourse, are reflected in human behavior and it is vital to know the
records on urinary infection during childhood are causality network to affect impressive factors on behavior,
considered as predisposing factor to the infection (3). A which has been investigated through years by behaviorists.
quarter of women who reported urinary infection for the Knowing effective factors on behavior showed to be
first time would be re-infected in less than 3 months (4). operational in designing educational programs. On the
Early diagnose of urethral infection was considered very other hand, studies on designing education programs
important to prevent relapse and indication of its showed that the most effective educational programs were
complications such as rental failure, adhesions among based on theory-based approaches rooted in behavior
pregnant women, abortion and early delivery (5). change patterns. The very first step to plan an education
program is to choose a proper pattern or theory in health

223
 J. Biol. Today's World. 2014 Oct; 3 (10): 223-226
∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙

education while effective health education directly depends and painful urination, involuntary urination and swallow
on the dominance on using best theories and proper are the symptoms of urinary infection.
approaches in each event (10). Several studies, also,
reported that it was essential to focus on mental factors in 2.4. Part three- questions on health belief model
health education comprehensive preventive programs as HBM scale was designed based on a standard
mediating and predicators of behavior; as the result health questionnaire (19). To measure HBM structures,
care providers should be aware of various effective factors researchers made use of sample questionnaires applicable
on fulfilling preventive and health improving behaviors to to HBM to design their required questionnaire and
be able to design and implement advantageous programs in structures were investigated through a 5-scale ranking.
the field (11-18). Hereof, it is worth to mention that health Experts of the field approved evaluation and the validity of
belief model (HBM) is an analytical behavior theory, the designed questionnaires. Its reliability was confirmed
which has been used in several studies on different fields through test-retest method at 0.83, which was explained at
of preventive behaviors (19-21). This model focused on following structures:
how personal beliefs and perceptions about fear of health
problems and evaluating perceived benefits and barriers of 2.4.1. Perceived benefits
preventive behavior led to behavior adoption (22). It was studied through 5 questions, e.g. anxiety and stress
Considering health belief model, people should first feel about complications of urinary infection decreases through
the risk to adopt preventive operations (perceived appropriate and at time prevention.
susceptibility), then understand the risk and severity of
2.4.2. Perceived barrier
physical and mental complications of the illness or the
It was studied through 5 questions, e.g. I do not know
behavior( perceived severity), and, later, proceed to adopt
preventive ways to UTI.
the preventive behavior in the case of positive benefit
evaluation and avoiding major barriers (10). Considering
2.4.3. Perceived severity
the importance of the issue, the main objective of present
It was investigated through 4 questions, e.g. there would be
study was determined, the prevalence and factors
negative complication if the proper treatment was not
influencing prevention of UTI based on health belief
followed accordingly.
model.
2.4.4. Perceived susceptibility
It was studied through 5 questions, e.g. my body is strong
2. MATERIALS AND METHODS enough to resist against urinary infection.
It is a cross-sectional study investigating 166 female
students in Shadegan city, Iran. Four female high schools 2.4.5. Self-efficacy

in Shadegan city were selected randomly and samples were It was studied through 5 questions, e.g. I can avoid urinary
selected randomly among high school students retention even if frequent urination is bothering to me.
proportional to size. Participants were asked to complete a Data were analyzed by SPSS version 20 using multiple
questionnaire designed in this regard and information was bivariate correlations, and logistic regression statistical
gathered through self-reporting. Study subjects were tests at 95% significant level.
justified about how to do the study, security of the
information and the aim of the study. Samples declared
their willingness to participate in the study. 3. RESULTS AND DISCUSSION
Diagram 1 shows the history of experience UTI among
2.1. Measure participants; based on our findings 22.3 percent of students
The variables assessed in this study included three sections. had history of experience UTI.
Prior to conducting the main project, a pilot study was
carried out. Initially the relevant questionnaires were
administered to 30 female students who were similar to
study population in order to estimate the duration of the
study conduction and to evaluate the reliability of the
questionnaire.

2.2. Part one- demographic information

it investigated information like age, marital status, parent’s
education level and history of experience UTI.

2.3. Part two- awareness questions

Students’ awareness about UTI was investigated through
answering 10 questions on yes or no scale, e.g. frequent

224
 J. Biol. Today's World. 2014 Oct; 3 (10): 223-226
∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙

Results from the present study showed that 22.3 percent of

students had history of experience UTI. Regarding, the
age of participants: 53.6 percent were seventeen, 31.9
percent were eighteen, and 14.5 percent were nineteen or
older. Almost, 92.8 % of participants were single and
7.1 % were married. Furthermore, 34.9 percent of students
(58 people) reported, were guided on urinary infection by
family, 16.9 percent (28 people) by medicine doctor, 15.7
percent (26 people) by mass media (radio and television),
and 13.3 percent (22 people) by health care staff. Table 1
shows perceived awareness, benefit, barriers, susceptibility
and severity of urinary infection among understudy female
students.
Diagram 1. Percentage of UTI experience among participants

Table 1 . Frequency of Awareness, Benefit, Barriers, Susceptibility and Severity toward UTI
Variable Weak Average Good

n % N % n %

Knowledge 2 1.2 45 27.1 119 71.8

Perceived Benefits 3 1.8 29 17.5 134 80.7

Perceived Barriers 30 18.1 85 51.2 51 30.7

Perceived Susceptibility 10 6 31 18.7 125 75.5

Perceived Severity 7 4.2 49 29.5 110 66.3

Table 2 shows students self-efficacy condition. Our result (85 people) in dietary habits, and 31.1 (50 people) in
showed, 33.7 percent (56 people) reported good self- urinary habits.
efficacy rates of urinary infection in dressing, 51.2 percent

Table 2 . Frequency of Perceived Levels of Self-Efficacy (Dressing, Dietary and Urinary Habits)
Variable Weak Average Good

n % N % n %

Dietary Habits 11 6.6 70 42.2 85 51.2

How to dress 19 11.4 91 54.8 56 33.7

Urinary habits. 34 20.5 82 49.4 50 30.1

Total self-efficacy 5 3 98 59 63 38

Table 4. Multiple Logistic Regression Analysis for Health Belief Model Variables Related To
UTI
Table 3 shows bivariate correlations between the health Variable Odds Ratio 95.0% CI P value
belief model constructs which were statistically significant Lower Upper
at either .05 or .01 level. Perceived Susceptibility 0.810 0.664 0.987 0.037

Final model: Step 5

Table 3. Predictor Variables Correlation Matrix

X1 X2 X3 X4

X1. Knowledge 1 Our findings indicated 22.3 % of students had history of

X2. Perceived Benefits 0.155* 1 experience UTI at last one in lifelong; that could lead to
X3. Perceived Barriers 0.108 0.052 1 several complications to them; therefore, it seems neces
X4. Perceived Susceptibility 0.208** 0.207** 0.227** 1

X5. Perceived Severity 0.155* 0.184* -0.104 0.091 sary to determine related factors to preventive behaviors
* p <0.05, ** p <0.01 among them. Furthermore, 34.9 % of students were guided
on UTI in family and 15.7 percent by mass media.
A step-wise model (Table 4) building procedure was Considering parents education level, 31.9 percent of
conducted and finally on 5rd step the procedure stopped students’ mothers were illiterate and 41 percent were at
and the best model was selected, among the HBM elementary level; it is plausible that needed information
constructs: perceived susceptibility was the more was not transferred to young girls. Therefore, it was
influential predictor on UTI infection. suggested to design proper messages, convey them through
connection channels to girls, and make use of high
potential of mothers to convey health conceptions to
teenagers. Results of our study reported that there were

225
 J. Biol. Today's World. 2014 Oct; 3 (10): 223-226
∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙

still some barriers to accept health behavior, though AUTHORS CONTRIBUTION

students understood the benefits of doing correct health This work was carried out in collaboration between all
behavior and recognized complication of being infected authors.
and its possibility to them. The most important perception
to be tailored in this regard would be lack of knowledge on
preventing paths to the disease. In this regard, perceived
CONFLICT OF INTEREST
barriers to adopt proper health behavior could be justified
through motivating and assuring (10). Low susceptibility The authors declared no potential conflicts of interests with
of students to avoiding urinary infection and being respect to the authorship and/or publication of this article.
frequently affected by that were considered as main beliefs
of perceived susceptibility and severity in present study; in
this regard, several studies reported that teens believed REFERENCES
1. Shah G, Upadhyay J. Controversies in the diagnosis and management of
they were not vulnerable to dangers of risky and
urinary tract infections in children. Pediatric Drugs. 2005;7(6):339-46.
deleterious behaviors to health. They showed low 2. Nicolle LE. Urinary tract infection: traditional pharmacologic therapies.
vulnerability beliefs to their circumference risks; in other Disease-a-month. 2003;49(2):111-28.
3. Mehnert-Kay SA. Diagnosis and management of uncomplicated urinary
words, they considered themselves to be safe against health tract infections. Am Fam Physician. 2005;72(3):451-6.
risks and threats and did not feel the necessity to adopt 4. Nosseir SB, Lind LR, Winkler HA. Recurrent uncomplicated urinary tract
infections in women: a review. Journal of women's health. 2012;21(3):347-54.
preventive behaviors. Therefore, eternality or 5. Bremberg SG, Edström S. Outcome assessment of routine medical
invulnerability could be the terms to describe person’s practice in handling child urinary tract infections: estimation of renal scar
incidence. Ambulatory child health. 2001;7(3‐4):149-55.
understanding of the belief that “I am not in danger as
6. Eriksson I, Gustafson Y, Fagerström L, Olofsson B. Prevalence and
much as others”, which weakened possible adoption of factors associated with urinary tract infections (UTIs) in very old women.
preventive behavior. On the other hand, if a person Archives of gerontology and geriatrics. 2010;50(2):132-5.
7. Sorto R, Irizar S, Delgadillo G, Alberú J, Correa-Rotter R, Morales-
conceived himself vulnerable to disease, there would be Buenrostro L, editors. Risk factors for urinary tract infections during the first
higher possibility to fulfill preventive behaviors (22). year after kidney transplantation. Transplantation proceedings; 2010:
Elsevier.
Therefore, it is essential to consider enhancement of 8. Raszka WV, Jr., Khan O. Pyelonephritis. Pediatrics in review / American
perceived susceptibility and severity by students on Academy of Pediatrics. 2005;26(10):364-70.
possibility of being affected by urinary infections and their 9. Olaitan J. Asymptomatic bacteriuria in female student population of a
Nigerian University. Int J Microbiol. 2006;2(2):4-9.
sever complications in education programs. Self-efficacy 10. Glanz K, Rimer BK, Viswanath K. Health behavior and health education:
was known as an important factor in adopting known theory, research, and practice: John Wiley & Sons; 2008.
11. Jalilian F, Matin BK, Alavijeh MM, Ataee M, Mahboubi M, Motlagh F, et
preventive behaviors; it was considered as a behavior al. Prevalence and Factor Related to Ritalin Abuse among Iranian Medical
perception to increase likely to require agenda and health College Student: An Application of Theory of Planned Behavior.
Terapevticheskii Arkhiv. 2013;85(4):22-6.
promotion behaviors (10). Present study reported lower 12. Zinatmotlagh F, Ataee M, Jalilian F, Mirzaeialavijeh M, Aghaei A, Shirazi
self-efficacy among students on urinary habits in KK. Predicting aggression among male adolescents: an application of the
comparison with other issues, and only 38 percent of theory of planned behavior. Health promotion perspectives. 2013;3(2):269.
13. Ataee M, Jouybari T, Jalilian F, Alavijeh MM, Valadbeigi A, Weisi F, et al.
students showed acceptable self-efficacy, which Gender Differences in Communicate with People Who Stuttering: an Explain
corresponded to results by Javaheri Tehrani et al. (23). of Attitude, Subjective Norms and Behavior Intention. 2014.
14. Jalilian F MA, Mahboby M, Motlagh F, Aghaei A, Mirzaei Alavijeh M,
Improving self-efficacy on fitting urinary habits among Hatamzadeh N. Explain of Ecstasy Use among Kermanshah Adolescents,
female students may introduce beneficial results to prevent the West of Iran: an Application of the Theory of Planned Behavior. Life
Science Journal. 2014;11(1):82-6.
urinary infection. 15. Matin BK, Jalilian F, Alavije MM, Ashtarian H, Mahboubi M, Afsar A.
Using the PRECEDE Model in Understanding Determinants of Quality of Life
Among Iranian Male Addicts. Global Journal of Health Science.
4. CONCLUSION 2014;6(6):p19.
Results of present study reported long records of urinary 16. Mirzaei Alavijeh M KMB, Jalilian F, Rakhshani F, Mahboubi M, Emdadi
SH. Pap smear test Promotion among Women: An Educational Intervention
infection among female students, which could result in Based on Theory of Planned Behavior. Journal of Biology and today's world.
several complications. It emphasized the need to offer 2014;3(4):79-82.
17. Jalilian F, Emdadi S. Factors related to regular undergoing Pap-smear
training interventions among female students living in test: application of theory of planned behavior. Journal of research in health
Shadegan city, Iran. Results, also, showed low levels of sciences. 2011;11(2):103-8.
self-efficacy on good urinary habits among female students, 18. Eslami AA, Jalilian F, Ataee M, Alavijeh MM, Mahboubi M, Afsar A, et al.
Intention and Willingness in Understanding Ritalin Misuse Among Iranian
which represents the importance of designing training Medical College Students: A Cross-Sectional Study. Global Journal of
interventions in the field to improve students self-efficacy. Health Science. 2014;6(6):p43.
19. TAGHDISI MOHAMMAD H, NEJADSADEGHI E. THE EFFECT OF
HEALTH EDUCATION BASED ON HEALTH BELIEF MODEL ON
BEHAVIORAL PROMOTION OF URINARY INFECTION PREVENTION IN
ACKNOWLEDGMENT PREGNANT WOMEN. JOURNAL OF RESEARCH. 2012.
Hereby the authors appreciate participant students, 20. Jalilian F, Motlagh FZ, Solhi M, Gharibnavaz H. Effectiveness of self-
management promotion educational program among diabetic patients based
Shadegan city education organization and health care on health belief model. Journal of education and health promotion. 2014;3.
center to support present study. 21. Jalilian F, Hazavehei SMM, Vahidinia AA, Jalilian M, Moghimbeigi A.
Prevalence and Related Factors for Choosing Self-Medication among
Pharmacies Visitors Based on Health Belief Model in Hamadan Province,
West of Iran. Journal of research in health sciences. 2013;13(1):81-5.
22. Rosenstock IM, Strecher VJ, Becker MH. Social learning theory and the

226
 J. Biol. Today's World. 2014 Oct; 3 (10): 223-226
∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙

health belief model. Health Education & Behavior. 1988;15(2):175-83.

23. Javaheri Tehrani F NS. Effect of an Educational Program Based on the
Health Belief Model on Preventive Behaviors of Urinary Tract Infect ion
among Women. Preventive Care in Nursing and Midwifery Journal.
2012;3(1):1-11.

227