A Randomized Controlled Trial of a Theory-Based Health Education on Prevention of Elective Cesareans in Iran

The high prevalence of Cesarean section (CS) is a global health concern globally, especially in Iran. The current study aimed to evaluate the effect of a Theory of Planned Behavior (TPB) based educational intervention on preventing elective cesareans.

An interventional study (NCT02929875) was conducted on a sample of 100 nulliparous pregnant women attending health care centers in Kermanshah, Iran, 2016. Women were randomly selected and assigned into either intervention or control groups on a 1:1 basis. The intervention group received a theory-based (Theory of Planned Behavior) health education intervention, while the control group received only standard care. A questionnaire containing items on TPB constructs, including attitude, subjective norms, perceived behavioral control, and intention, was used to collect baseline and 1-month follow-up assessments. Each woman also received a phone call after childbirth to record their delivery method. Data were analyzed using SPSS version 15 at a significance level of p<0.05. The paired t-test, the independent t-test, the chi-square, and ANCOVA were used for data analysis.

The results revealed significant differences in scores of attitude, subjective norms, perceived behavioral control, and behavioral intention in the intervention group before and after the intervention (p<0.05). Additionally, the intervention group chose elective cesarean less than the control group (p<0.05). The risk of having an elective cesarean section in the intervention group was about one-fifth of the control group (RR= 0.21; CI=0.4197 to 0.0018).

According to this randomized control trial results, the TPB-based education improved the TPB constructs and NVD rates by providing education to women and their close friends or relatives during pregnancy.