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The Effect of a Health Belief Model-Based Educational Intervention on Environmental Protection Behaviors among High School Students in Khoy City, Northwest Iran: A School-Based Quasi-Experimental Study

This school-based quasi-experimental study in Khoy City, Iran, demonstrates that a Health Belief Model-based educational intervention significantly improved environmental protection knowledge, attitudes, and behaviors among high school students compared to a control group.

Original authors: Mohammad Saeed Jadgal, Mehrdad Karimi, MoradAli Zareipour, Habibe Zakariaie

Published 2026-07-27

📖 4 min read☕ Coffee break read

CC BY 4.0

Original authors: Mohammad Saeed Jadgal, Mehrdad Karimi, MoradAli Zareipour, Habibe Zakariaie

Original paper licensed under CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). ✨ This is an AI-generated explanation of the paper below. It is not written or endorsed by the authors. For technical accuracy, refer to the original paper. Read full disclaimer

Imagine the world as a giant, shared house where everyone lives together. Sometimes, the house gets messy, the air gets dusty, and the water gets dirty. While grown-ups often argue about how to fix the house, scientists have realized that the best time to teach kids how to keep it clean is right now, while they are still in school. But teaching isn't just about handing out a list of rules like "don't litter." It's about changing how kids think and feel about the mess. This is where a famous idea called the "Health Belief Model" comes in. Think of this model as a mental checklist that helps people decide if they should take action. It asks: "Do I think this problem is scary? Do I think it could happen to me? Do I believe I have the power to fix it? And is it worth the effort?" If the answer to all these questions is "yes," people are much more likely to pick up the trash. This study dives into whether a special kind of school lesson, built exactly around this checklist, can turn high school students into environmental superheroes.

The researchers in Khoy City, Iran, decided to test this idea with 200 high school students. They split the class into two teams: a "Super Team" (the intervention group) and a "Regular Team" (the control group). The Regular Team just went about their normal school day, while the Super Team got a special treat: four 45-minute lessons designed to tick every box on that mental checklist. The lessons weren't just boring lectures; they were like a game where the students learned that pollution is a real threat (severity), that it could hurt them and their families (susceptibility), that they actually have the power to help (self-efficacy), and that the rewards of helping are huge (benefits). The teachers even gave them specific "cues to action," like reminders and practical tips on how to recycle or save water.

After three months, the researchers checked the scorecards. The results were a clear victory for the Super Team. The students who got the special lessons didn't just know more facts; they actually changed their behavior. Their scores for environmental protection behaviors jumped significantly, going from an average of about 43 points to nearly 49 points, while the Regular Team stayed almost exactly the same. The study found that the lessons worked best at boosting the students' confidence that they could make a difference and their belief that their actions would actually help. The math showed that this change wasn't just luck; the "Super Team" improved in knowledge, their sense of danger, their confidence, and their actual habits, all with a level of certainty that suggests this method really works.

Interestingly, the study also looked at what didn't change much. While the students felt more confident and saw more benefits, the lessons didn't completely erase the feeling that being eco-friendly is hard or expensive (perceived barriers). It seems that even when you know you can do it and that it's good, the obstacles can still feel a bit heavy. However, the overall message is powerful: by using a structured plan that addresses how students think and feel, schools can successfully teach teenagers to protect their environment. The study suggests that if we want to save the planet, we shouldn't just tell kids what to do; we need to help them believe they can do it and that it matters. This isn't just a theory; it's a proven strategy that turned a group of high schoolers into a more environmentally conscious crew, proving that with the right kind of education, the next generation is ready to take care of their shared house.

Technical Summary: The Effect of a Health Belief Model-Based Educational Intervention on Environmental Protection Behaviors

Problem Statement
Despite the critical role of environmental protection in sustainable development, adolescents' engagement in pro-environmental behaviors remains suboptimal. While environmental degradation poses severe threats to biodiversity and public health, existing educational interventions often focus on knowledge acquisition and attitudinal change rather than sustained behavioral outcomes. Furthermore, many studies lack a structured theoretical framework to guide these interventions. This gap is particularly notable in under-studied regions such as Khoy City, Northwest Iran, where the application of behavioral theories like the Health Belief Model (HBM) to school-based environmental programs is limited.

Methodology
The study employed a school-based quasi-experimental design to evaluate the efficacy of an HBM-based educational intervention.

Participants: A total of 200 first-year high school students (mean age 14.52 years) were recruited from four secondary schools in Khoy City. Schools were selected based on comparable cultural and socioeconomic characteristics. Participants were randomly allocated to an intervention group ( $n=100$ ) and a control group ( $n=100$ ).
Intervention: The intervention group received four structured 45-minute educational sessions over the first semester of the 2023–2024 academic year. These sessions were explicitly designed around the six core constructs of the Health Belief Model: perceived susceptibility, perceived severity, perceived benefits, perceived barriers, cues to action, and self-efficacy. Content included lectures, group discussions, and educational materials focusing on waste segregation, energy conservation, and pollution reduction. The control group received no intervention during the study period.
Data Collection: Data were collected using a validated, researcher-developed questionnaire at baseline and three months post-intervention. The instrument measured demographic characteristics, environmental knowledge, HBM constructs, and environmental protection behaviors. Reliability was confirmed via Cronbach's alpha coefficients (ranging from 0.57 to 0.85), and content validity was established by a panel of experts.
Statistical Analysis: Descriptive statistics and tests for baseline equivalence (independent t-tests, Chi-square) were performed. Within-group changes were analyzed using the Wilcoxon Signed Ranks Test, while between-group differences were assessed using the Mann-Whitney U test. Crucially, Analysis of Covariance (ANCOVA) was conducted with pre-test scores as covariates to control for baseline differences and enhance statistical precision. Effect sizes were reported using partial Eta squared ( $\eta^2$ ).

Key Results
The intervention yielded statistically significant improvements in the intervention group compared to the control group across multiple dimensions:

Knowledge and HBM Constructs: The intervention group showed significant gains in environmental knowledge ( $p=0.001$ ), perceived susceptibility ( $p=0.020$ ), self-efficacy ( $p=0.006$ ), perceived benefits ( $p=0.008$ ), and cues to action ( $p=0.001$ ). The control group demonstrated no significant changes over time.
Behavioral Outcomes: Most notably, the intervention group exhibited a significant increase in environmental protection behaviors ( $p=0.002$ ), surpassing the control group post-intervention despite a slight baseline disadvantage.
ANCOVA Findings: After adjusting for baseline scores, ANCOVA confirmed significant between-group differences for all constructs. The effect size for environmental protection behavior was moderate-to-large ( $F=24.22, p<0.001, \eta^2=0.109$ ), indicating that the intervention accounted for approximately 11% of the variance in behavioral outcomes.

Key Contributions

Theoretical Application: The study successfully operationalized the Health Belief Model within a school-based environmental education context, demonstrating that targeting specific cognitive and motivational constructs (susceptibility, severity, benefits, barriers, cues, and self-efficacy) can effectively drive behavioral change.
Behavioral Focus: Unlike many prior studies that stop at knowledge or attitude, this research provides empirical evidence of measurable shifts in actual environmental protection behaviors among Iranian adolescents.
Methodological Rigor: The use of a quasi-experimental design with random allocation, a control group, and ANCOVA to control for baseline differences strengthens the internal validity of the findings. The inclusion of a three-month follow-up provides preliminary evidence of the intervention's sustained impact.

Significance and Claims
The authors conclude that structured, theory-based educational interventions are effective tools for promoting environmental stewardship among high school students. The study claims that integrating HBM-guided environmental health education into school curricula offers a replicable approach to fostering environmentally responsible citizenship. By addressing cognitive, emotional, and motivational pathways simultaneously, such interventions can translate environmental awareness into practical, sustained action.

The paper modestly notes that while the results are promising, the reliance on self-reported data and the relatively short three-month follow-up limit definitive conclusions regarding long-term behavioral sustainability. Consequently, the authors suggest that while this approach is a fundamental commitment to preparing future generations, longitudinal studies are warranted to determine the persistence of these behavioral changes. The findings support the broader integration of environmental education into school systems, accompanied by teacher training, to cultivate a generation capable of addressing ongoing environmental challenges.

Technical Summary: The Effect of a Health Belief Model-Based Educational Intervention on Environmental Protection Behaviors

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