Shiraz E-Med J. 2016 March; 17(3):e34772. doi: 10.17795/semj34772.

Published online 2016 February 20. Research Article

An Evaluation of the Effectiveness of a Reproductive Health Education

Program for Nonmedical Students in Iran: A Quasi-Experimental
Pre-Test, Post-Test Research
Fatemeh Yari,1 Zahra Behboodi Moghadam,2,* Soror Parvizi,3 Nahid Dehghan Nayeri,4 Elham Rezaei,5
and Mina Saadat2
1
Department of Reproductive Health, Nursing and Midwifery Faculty, Lorestan University of Medical Sciences, Khoramabad, IR Iran
2
Department of Reproductive Health, Nursing and Midwifery Faculty, Tehran University of Medical Sciences, Tehran, IR Iran
3
Department of Pediatric Nursing, Center for Educational Research in Medical Sciences (CERMS), Nursing and Midwifery Faculty, Iran University of Medical Sciences, Tehran,
IR Iran
4
Nursing and Midwifery Care Research Center, School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, IR Iran
5
Department of Midwifery, Nursing and Midwifery Faculty, Urmia University of Medical Sciences, Urmia, IR Iran
*
Corresponding author: Zahra Behboodi Moghadam, Department of Reproductive Health, School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, IR
Iran. Tel: +98-9122494201, E-mail: bahar_behboodi@yahoo.com

Received 2015 November 23; Revised 2016 January 16; Accepted 2016 February 13.

Abstract

Background: Young people age 10 - 25 are an important population to evaluate the female youth educational program essential to
the prevention of issues related to reproductive health.
Objectives: This study evaluated the effectiveness of the education program for improving university student’s reproductive health.
Patients and Methods: This quantitative study was conducted in Iran from July 2014 to March 2015. The questionnaire addressed
socio-demographic features, knowledge of reproductive problems, and attitudes. Program effectiveness was examined using a
quasi-experimental research design with pre-intervention and post-intervention. Data from questionnaires was collected pre-
intervention and post-intervention from 150 female students.
Results: In this study, results showed that an intervention and education program had a significant effect on several issues related
to reproductive health. Most participants stressed the need to provide reproductive health services for young girls.
Conclusions: The results of this study suggest that the reproductive health education program improved the students’ knowledge
and attitudes about sexuality and decision-making after the program and that these educational programs are important for youths.

Keywords: Young, Reproductive Health, Education Program

1. Background use, weight changes, eating problems, AIDS, drug abuse,

time management, fear of examinations, and serious psy-
chological concerns (6). Reproductive health education
Young people age 10 - 25 are an important population
is essential to the prevention of issues related to repro-
group with a great potential for physical, mental, and psy-
duction (7). The sexual reproductive health knowledge of
chological development, and young people in Iran are a
young people in Iran is one of the most under-researched
significant proportion of the population (1). Youth are of
aspects in the Iranian population. Little is known about
particular concern in relation to reproductive health (2).
the reproductive health youth education program in Iran.
At the international conference on population and devel-
Therefore, it is essential to evaluate these programs in the
opment (ICPD) held in Cairo in 1994, the terms reproduc-
female youth population. The aim of this study was to eval-
tive and sexual health were disseminated widely among all
uate the effectiveness of a reproductive health education
community sectors (3). Young girls have increasingly neg-
program for nonmedical students in Iran.
ative reproductive health outcomes (4). Most of the pop-
ulation in Iran is under 25 years of age. According to the
statistical center of Iran, a total of 60% of the population
2. Objectives
is under 25 years old, and over 50% are under 20 years (5).
In the Islamic Republic of Iran, students form a large part
of the population, and separation from their parents ex- The present study evaluates the effectiveness of the ed-
poses them to sexual reproductive health problems, such ucational program for improving university students’ re-
as love relationships, physical health problems, alcohol productive health.

Copyright © 2016, Shiraz University of Medical Sciences. This is an open-access article distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0
International License (http://creativecommons.org/licenses/by-nc/4.0/) which permits copy and redistribute the material just in noncommercial usages, provided the
original work is properly cited.
 Yari F et al.

3. Patients and Methods 3.1. Ethical Issues

This study is a part of the first author’s doctoral dis-
sertation. The ethics committee of Tehran University of
This study’s purpose was to evaluate a reproductive Medical Sciences approved the study proposal and corrob-
health education program on the improvement of repro- orated its ethical considerations.
ductive health for nonmedical students in Iran using a
questionnaire to assess their knowledge and attitudes. A 3.2. Statistical Analysis
quasi-experimental, pre-test, post-test research design was Results were expressed as frequency, mean, and stan-
conducted to evaluate the nonmedical students’ knowl- dard deviation (SD) for qualitative and quantitative data,
edge and attitudes about reproductive health before and respectively. The data was analyzed using SPSS, version 21.
after the program. The interval between the pre-test and A value of P < 0.05 was considered statically significant.
post-test was about nine months. The study was conducted
in the city of Khoramabad in southwest Iran. The Khoram- 3.3. Education Program
abad region has a population of 348,216. This study was
conducted in a nonmedical university (Lorestan Univer- The Reproductive Health Program at Lorestan Univer-
sity) from July 2014 to March 2015. Lorestan University is sity in Khoramabad was implemented in July 2014 to March
the oldest higher education institute in Khoramabad. It 2015, and the program, called the Yari Program, aimed to
was established in 1977 as the education center of Lorestan. help female students with reproduction health issues. This
Currently, this university has seven faculties and serves was a nine-month program, and the main project activ-
8,239 students. The present study was conducted in the fac- ities included peer education, reproductive health mate-
ulty of sciences, which serves 1,785 students studying for rials, counseling, workshops, lecture meetings, education
bachelor’s, master’s, and doctorate degrees (8). carnivals, education camps, and mass media. The topics in-
cluded menstrual hygiene, pregnancy, antenatal care, var-
A quantitative design based on the questionnaire ap-
ious methods of contraception, sexually transmitted dis-
proach was used to conduct this study based on similar
eases (STDs) and HIV, unwanted pregnancy, and cancer pre-
studies of knowledge and attitudes in different countries
vention. First, students took the pre-test, and after the
(9, 10). The questions were modified according to Iranian
intervention with a comprehensive health education pro-
culture and social norms. The questionnaire used in this
gram, its effect was evaluated with a post-test question-
study consisted of 100 items, including the knowledge test
naire.
of 34 items, which asked students if the question was true
or false, 0) false or 1) true, and scores ranged from 0 to 34
3.3.1. Peer Education
points. The higher the score, the more knowledge they had
about reproductive health. The attitude test had 28 items In this study, 15 peer educators were educated in vari-
and asked students if they agreed or disagreed, 1) strongly ous levels and in this course, and they were responsible for
disagree to 5) strongly agree, and the possible score range education and counseling with other students in the uni-
was from 28 to 135 points. Demographic information in- versity.
cluded 12 items: four items, religious information; seven
items, marriage age and pregnancy information; and 15 3.3.2. Counseling
items, friends’ and parents’ information. The instrument With the establishment of the Center for Reproductive
was assessed for content validity by 15 specialists in repro- Health two days per week on Sundays and Tuesdays, stu-
ductive health, and after its validity was estimated, its re- dents referred to the center for advice on issues related to
liability was measured by the test-retest method. Accord- reproductive health.
ingly, the questionnaire was administered twice to 30 stu-
dents within a two-week interval, and the correlation coef- 3.3.3. Workshops
ficient was 0.8. During the nine months, about six workshops on re-
A total of 150 female students were chosen for this productive health issues were held at the university.
study based on convenience sampling. All participants
were informed about the purposes and the methods em- 3.3.4. Lecture meetings
ployed in this study. They were informed that participa- Two sessions a week, Monday and Thursday nights, lec-
tion was voluntary and they could refuse to participate at tures were held at the university dormitories with group
any time without being deprived of the services delivered discussion and a question-and-answer session on issues re-
to them. lated to reproductive health.

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 Yari F et al.

3.3.5. Reproductive Health Materials Table 1. Characteristics of the Demographic Data by Participating in the Study
The program was enhanced using a picture drama and
reproductive materials. Reproductive materials included Group No. (%)
audio-visual aids, such as a blackboard, posters, charts, Age
videos, and pamphlets. The picture material included
18 - 25 118 (79)
14 pieces of drama material measuring 30 cm by 42 cm.
26 - 33 20 (13)
The picture drama used two different trees with youths at
the top of the trees indicating the two different decision- 34 - 41 9 (6)

making paths for young adolescents who engaged in sex- > 42 3 (2)
ual activities and their negative consequences. It also ex- Marriage status
plained positive ways to stay healthy and explained the cir-
Single 137 (91.3)
cumstance in which having sex early can spoil their future
Married 13 (8.7)
plans and shorten their lives (11).
Lodging

3.3.6. Mass Media Dormitory 111 (74)

Material relating to reproductive health by mass media Home 39 (26)

(television) programs was broadcast twice a week on Sun- Degree
days and Wednesdays via the native network AFLAK, and
Bachelor’s 128 (85.3)
the programs were sent out at the same time via SMS mes-
Master’s 15 (10)
saging to inform students.
Doctorate 7 (4.7)

3.3.7. Education Carnivals Literate parents

During the nine months, about three education carni- Literate 138 (92.3)

vals on reproductive health issues were held at the univer- Illiterate 12 (7.7)
sity.

3.3.8. Education Camps was noted following the intervention (P < 0.05). It was ob-
During the nine months, about four education camps served that knowledge and attitudes improved to a great
were held inside and outside for advice on issues related to extent after the intervention for various issues of reproduc-
reproductive health. tive health.
Results showed that there was a significant difference
between religious information before and after the inter-
4. Results vention, as seen in Table 2. The mean and standard devi-
ation of a student’s religious information before the inter-
4.1. Demographic Data vention was 2.61, and after the intervention was 3.056, with
In this study, 150 questionnaires were distributed to a significance level of P < 0.000. The intervention had a
students. Participants’ ages ranged from 18 to 52, with a significant improvement on the content of students’ reli-
mean age of 24.13 (SD = 6.912). The majority (79%) of par- gious information.
ticipants were in the age group of 18 - 25 years. The major- As seen in Table 2, the mean and standard deviation
ity (91.3%) of students were never married, and 74% lived in of attitudes toward marriage age and pregnancy before
the dormitories. Of the students, 85.3% had a bachelor’s de- the intervention was 2.7467 and after the intervention was
gree, 10% a master’s degree, and 4.7% a doctorate degree. 3.0124, with a significance level of P > 0.05. The interven-
A total of 21 (14%) were majoring in geology, 28 (18.8%) in tion had no significant differences in the attitude toward
chemistry, 19 (12.7%) in statistics, 17 (11.3%) in mathematics, marriage age and pregnancy.
24 (18%) in biology, 13 (8.7%) in computers, and 25 (16.6%) in Also, the study results showed the mean and standard
physics. The majority (92.3%) of their parents was literate deviation of knowledge of reproductive health issues be-
(Table 1). fore the intervention was 1 and after the intervention was
Table 2 shows the awareness and attitudes of students 1.58, with a significance level of P < 0.000. The interven-
regarding the availability of information on reproductive tion showed a significant increase in students’ knowledge
issues. It was observed that their knowledge and attitudes of reproductive health issues (Table 2).
were poor during pre-test, and remarkable improvement According to Table 2, the mean and standard deviation

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 Yari F et al.

Table 2. Comparison of Knowledge and Attitudes of Students Toward Reproductive Health Issues Pre-Intervention and Post-Intervention

Row/Variable/Time Mean ± SD The Mean Standard Error P Value

1 0.000

Religious information

Pre-test 2.6133 ± 0.45071 0.03680

Post-test 3.0567 ± 0.40817 0.03333

2 0.214

Attitude toward marriage age and pregnancy

Pre-test 2.7467 ± 0.24835 0.02028

Post-test 3.0124 ± 2.59771 0.21210

3 0.000

Knowledge of reproductive health issues

Pre-test 1.0067 ± 0.02268 0.00185

Post-test 1.5761 ± 0.23864 0.01948

4 0.000

Attitude toward reproductive health issues

Pre-test 1.5884 ± 0.57566 0.04700

Post-test 2.4396 ± 0.41234 0.03367

5 0.000

Knowledge of HIV and STDs

Pre-test 1.1716 ± 0.02001 0.00163

Post-test 1.6974 ± 0.19901 0.01625

6 0.000

Attitude toward HIV and STDs

Pre-test 1.6810 ± 0.86627 0.07073

Post-test 2.3733 ± 0.54938 0.04486

7 0.624

Knowledge of pre-marriage intercourse

Pre-test 2.0187 ± 0.93273 0.07616

Post-test 2.0667 ± 0.74109 0.06051

8 0.000

Knowledge of the use of mass media

Pre-test 1.0100 ± 0.04468 0.00365

Post-test 1.8825 ± 0.43210 0.03528

of attitudes toward reproductive health issues before the and after the intervention was 1.7, with a significance level
intervention was 1.588 and after the intervention was 2.44, of P < 0.000. The intervention had significant differences
with a significance level of P < 0.000. The intervention in the knowledge of HIV and STDs and increased students’
had significant differences in the attitude of reproductive knowledge of HIV and STDs (Table 2).
health issues and improved students’ attitudes toward re-
According to Table 2, the mean and standard deviation
productive health issues.
of attitudes toward HIV and STDs before the intervention
Results showed the mean and standard deviation of was 1.68 and after the intervention was 2.37, with a signifi-
knowledge of HIV and STDs before the intervention was 1.17 cance level of P < 0.000. The intervention had significant

4 Shiraz E-Med J. 2016; 17(3):e34772.

 Yari F et al.

differences in the attitudes toward HIV and STDs and in- on 25 female students, showed that nearly all of the par-
creased students’ attitudes toward HIV and STDs. ticipants wanted sexual health education to be offered for-
According to Table 2, the mean and standard devia- mally in their curriculum and were interested in taking a
tion of attitudes toward pre-marriage intercourse before course on reproductive health in the university (18).
the intervention was 2.0187 and after the intervention was Also this study revealed that more girls had not com-
2.0667, with a significance level of P > 0.05. The interven- municated about sex and HIV/AIDS with their parents. Var-
tion had no significant differences in the attitude toward ious studies have shown that adolescent girls who com-
pre-marriage intercourse. municate more with their parents had significantly higher
Results showed the mean and standard deviation of knowledge and attitudes about reproductive health than
knowledge of the use of the mass media before the inter- those who did not communicate. Another report found
vention was 1.01 and after the intervention was 1.88, with that parents considered sexual communication difficult
a significance level of P < 0.000 and a confidence interval and embarrassing (19), while Yari et al. illustrated that the
of 99%. The intervention had a significant increase in stu- majority of students believed that family is a very impor-
dents’ knowledge of the use of the mass media (Table 2). tant factor in the development of sexual behavior (18).
Also, results showed more girls had not communicated Our results showed the intervention had no signifi-
about sex and HIV/AIDS with their parents. cant differences in the attitudes toward marriage age and
In this study, outcomes revealed that, among the pro- pregnancy and pre-marriage intercourse. The P value was
grams that were implemented, peer education (73%) and 0.214 and 0.624, respectively. The results of the qualita-
mass media (81%) have the greatest effect on the promotion tive study about problems of reproductive health in Ira-
of reproductive health issues with the students. nian female students showed that some of the participants
only thought of reproduction as pregnancy. This theme in-
5. Discussion cluded the following: lack of awareness and accurate infor-
mation on reproductive health; lack of coverage of sexual
This study examined the effectiveness of the education and reproductive health problems by the media; and lack
program for improving university students’ reproductive of nonmedical reproductive health-related books. Another
health issues. The greatest changes were observed regard- qualitative study in Iran illustrated that, considering the
ing knowledge and attitudes. Research results indicated Iranian cultural and religious background, families and re-
that students of the Lorestan University have large sexual ligious beliefs play an important role in reducing high-risk
and reproductive health needs. According to the results, sexual behaviors among Iranian adolescents (20).
students’ awareness of reproductive issues, such as sex- In this study, results showed that, among the programs
ually transmitted disease, pregnancy, contraception, and that were implemented, peer education (73%) and mass
sexual health, is inadequate. The lack of knowledge about media (81%) have the greatest effect on the promotion of
sex and reproductive health among youth is also a factor reproductive health issues with the students. A study by
reported by studies carried out in many developing coun- Kalembo et al. revealed that the media plays an important
tries (11-13). role in enhancing their reproductive health of adolescents
The findings indicated an increase in knowledge and in sub-Saharan Africa (7). A study by Peykari et al. showed
attitudes that showed a statistically significant difference that peer education was an acceptable program for univer-
between pre-test and post-test in students. The study by sity students (21).
Frida and Shigeko in 2011 showed a reproductive health In conclusion, it is necessary to enhance the knowl-
program for both girls and boys improved students’ edge of the youth and increase the participation of experts
knowledge and behavior about sexual decision-making and specialist teachers in developing educational materi-
(14). als that comply with the cultural and religious values of
In addition, a study by Gallant and Maticka-Tyndale the society.
found that knowledge and attitudes are easy to change,
while changing behavior is challenging (15). Similar re-
sults appeared in a systematic review by Paul- Ebhohimhen
Acknowledgments
et al. which reviewed 23 articles and reported that knowl-
edge and attitudes were most likely to change, while be-
havior changes were less likely to occur (16). Various stud- This study was funded and supported by Tehran Uni-
ies have shown the effectiveness of interventions in in- versity of Medical Sciences. The authors wish to express
creasing knowledge of reproductive health in developing their sincere gratitude to the study participants, without
countries (17). Yari et al. (2015), in their qualitative study whom this study could not have been conducted.

Shiraz E-Med J. 2016; 17(3):e34772. 5

 Yari F et al.

Footnote terials to prevent unwanted pregnancy to adolescent. St Lukes College

Nurs Bull. 2010(36):74–85.
Funding/Support: This study is funded by Tehran Univer- 12. Rani M, Lule E. Exploring the socioeconomic dimension of adolescent
reproductive health: a multicountry analysis. Int Fam Plan Perspect.
sity of Medical Sciences.
2004;30(3):110–7. doi: 10.1363/ifpp.30.110.04. [PubMed: 15381465].
13. Regmi PR, van Teijlingen E, Simkhada P, Acharya DR. Barriers to sex-
ual health services for young people in Nepal. J Health Popul Nutr.
References 2010;28(6):619–27. [PubMed: 21261208].
14. Walsh AP, Omar AB, Marron KD, Walsh DJ, Salma U, Sills ES. Recipi-
1. Geneva Foundation for Medical Education and Research . Training ent screening in IVF: first data from women undergoing anonymous
Course in Sexual and Reproductive Health Research 2014 2014. Avail- oocyte donation in Dublin. Reprod Health. 2011;8:8. doi: 10.1186/1742-
able from: http://www.gfmer.ch/SRH-Course-2014/. 4755-8-8. [PubMed: 21507224].
2. UNAIDS . Report on the global AIDS epidemic. 4th global report. ; 15. Gallant M, Maticka-Tyndale E. School-based HIV prevention pro-
2004. grammes for African youth. Soc Sci Med. 2004;58(7):1337–51.
3. Alcala MJ. Commitments to sexual and reproductive health and 16. Paul-Ebhohimhen VA, Poobalan A, van Teijlingen ER. A systematic re-
rights for all: framework for action. Family Care International; 1995. view of school-based sexual health interventions to prevent STI/HIV in
4. Bazarganipour F, Foroozanfard F, Taghavi SA, Hekmatzadeh F, Sarviye sub-Saharan Africa. BMC Public Health. 2008;8:4. doi: 10.1186/1471-2458-
M, Hosseini N. Evaluation of Female Youth Educational Needs about 8-4. [PubMed: 18179703].
Reproductive Health in Non-Medical Students in the City of Qom. J 17. Rao RS, Lena A, Nair NS, Kamath V, Kamath A. Effectiveness of re-
Family Reprod Health. 2013;7(2):67–72. [PubMed: 24971106]. productive health education among rural adolescent girls: a school
5. Deputy of Strategic Planning and Control . Report 2014. Available based intervention study in Udupi Taluk, Karnataka. Indian J Med Sci.
from: http://www.space.ir/barnameh/Baranmeh%20gozashe%20h/ 2008;62(11):439–43. [PubMed: 19265233].
367/p4.htm29/5/. 18. Yari F, Moghadam ZB, Parvizi S, Nayeri ND, Rezaei E. Sexual and
6. Mohammadi MR, Mohammad K, Farahani FKA, Alikhani S, Zare M, reproductive health problems of female university students in
Tehrani FR, et al. Reproductive knowledge, attitudes and behav- Iran: a qualitative study. Glob J Health Sci. 2015;7(4):278–85. doi:
ior among adolescent males in Tehran, Iran. Int Fam Plan Persp. 10.5539/gjhs.v7n4p278. [PubMed: 25946946].
2006;32(1):35–44. 19. Jerman P, Constantine NA. Demographic and psychological predic-
7. Kalembo FW, Zgambo M, Yukai D. Effective adolescent sexual and re- tors of parent-adolescent communication about sex: a represen-
productive health education programs in sub-Saharan Africa. Califor- tative statewide analysis. J Youth Adolesc. 2010;39(10):1164–74. doi:
nian J Health Promot. 2013;11(2):32–42. 10.1007/s10964-010-9546-1. [PubMed: 20458614].
8. Lorestan University . Lorestan University homepage 2012. Available 20. Parvizy S, Nikbahkt A, Pournaghash Tehrani S, Shahrokhi S. Ado-
from: Lu.ac.ir . lescents’ perspectives on addiction: qualitative study. Nurs Health
9. Dawson DA. The effects of sex education on adolescent behavior. Fam Sci. 2005;7(3):192–8. doi: 10.1111/j.1442-2018.2005.00237.x. [PubMed:
Plann Perspect. 1986;18(4):162–70. [PubMed: 3792529]. 16083482].
10. Simbar M, Ramezani Tehrani F, Hashemi Z. The needs of reproductive 21. Peykari N, Tehrani FR, Malekafzali H, Hashemi Z, Djalalinia S. An Ex-
health of the university students of Qazvin. JQUMS. 2003;7:5–13. perience of Peer Education Model among Medical Science Univer-
11. Madeni FE, Horiuchi S, Jitsuzaki M. Reduction of maternal mortality sity Students in Iran. Iran J Public Health. 2011;40(1):57–62. [PubMed:
rate in Tanzania: development of reproductive health awareness ma- 23113055].

6 Shiraz E-Med J. 2016; 17(3):e34772.