Assessing preventive Behaviors of Leishmaniasis in health Ambassadors: Application of Cognitive-social Theory

Document Type : Research Paper


1 Master student of health education and health promotion, Faculty of Health, Mashhad University of Medical Sciences, Mashhad, Iran.

2 PhD Student of Health Education and Health Promotion, Department of Health Education and Health Promotion, School of Health, Social Determinants of Health Research Center & Research Committee, Mashhad University of Medical Sciences, Mashhad, Iran.

3 Assistant Professor of Health Education and Health Promotion, Faculty of Health, Social Factors Affecting Health Research Center, Mashhad University of Medical Sciences, Mashhad, Iran.

4 Assistant Professor of Biostatistics, Department of Epidemiology and Biostatistics, Faculty of Health, Center for Research on Social Factors Affecting Health, Mashhad University of Medical Sciences, Mashhad, Iran.

5 Assistant Professor of Health Education and Health Promotion, Department of Health Education and Health Promotion, Social Determinants of Health Research Center, School of Public Health, Mashhad University of Medical Sciences, Mashhad, Iran (Corresponding Author).


Introduction: Leishmaniasis is affected by individual, behavioral and environmental factors that are still unknown and their identification can help control and prevent the disease. The aim of this study was to determine the effect of social-cognitive factors affecting leishmaniasis prevention behaviors in health ambassadors.
Materials and Methods: This descriptive-analytical study was conducted in rural areas of Mashhad in 1400. 207 health ambassadors were selected by multi-stage random sampling. The data collection tool was a researcher-made questionnaire based on cognitive-social theory structures whose validity and reliability were confirmed. Data were analyzed and collected in SPSS software version 26 using Mann-Whitney, Kruskal-Wallis and Spearman correlation coefficients and linear regression.
Results: Based on linear regression test, the structures of emotional adjustment, self-control and self-efficacy in overcoming obstacles were significant predictors of preventive behavior of seekers and were able to predict 55.7% of the variance of this behavior. Emotional adjustment (β = 0.347, P <0.001) was the strongest predictor of behavior. After that, self-control (β = 0.295, P <0.001) and self-efficacy of overcoming obstacles (β = 0.158, P = 0.012) had a positive and significant correlation with behavior, respectively.
Conclusion: Findings of this study show that interventions to promote leishmaniasis prevention behaviors using emotional adaptation, self-control and self-efficacy strategies can be effective in overcoming barriers. Therefore, designing and implementing programs to promote leprosy-protective behaviors in this group of society is useful for controlling leishmaniasis.


  1. Alizadeh I, Gorouhi MA, Afshar AA, Sharifi I, Zamaninasab Z. Anthroponotic Cutaneous
    Leishmaniasis: Knowledge, Attitudes, Practices, and Risk Factors among residents in endemic
    Communities in Kerman City in the Southeast of Iran. Authorea Preprints. 2020 May 14
    2. World Health Organization. Neglected tropical diseases in the Eastern Mediterranean Region. World
    Health Organization. Regional Office for the Eastern Mediterranean; 2018.
    3. Valero NN, Uriarte M. Environmental and socioeconomic risk factors associated with visceral and
    cutaneous leishmaniasis: a systematic review. Parasitology Research. 2020 Feb; 119(2):365-84.
    4. Jeihooni AK, Harsini PA, Kashfi SM, Rakhshani T. Effect of educational intervention based on the
    PRECEDE-PROCEED model on preventive behaviors of cutaneous leishmaniasis among housewives.
    Cadernos de saude publica. 2019 Jul 29; 35:e00158818.
    5. Mirzaei N, Mohammadzadeh M, Jannat B, Takhtfiroozeh S. Frequency of cutaneous leishmaniasis in
    Meshkan, Center of Iran. J ent Res. 2019 Sep; 43(3):407-12.
    6. Boukthir A, Bettaieb J, Erber AC, Bouguerra H, Mallekh R, Naouar I, Gharbi A, Alghamdi M, Plugge
    E, Olliaro P, Ben Salah A. Psycho-social impacts, experiences and perspectives of patients with
    Cutaneous Leishmaniasis regarding treatment options and case management: An exploratory qualitative
    study in Tunisia. Plos one. 2020 Dec 1; 15(12):e0242494.
    7. Khatami A, Emmelin M, Talaee R, Miramin-Mohammadi A, Aghazadeh N, Firooz A, Stenberg B. Lived
    experiences of patients suffering from acute Old World cutaneous Leishmaniasis: a qualitative content
    analysis study from Iran. Journal of Arthropod-Borne Diseases. 2018 Jun;12(2):180
    8. Pires M, Wright B, Kaye PM, da Conceição V, Churchill RC. The impact of leishmaniasis on mental
    health and psychosocial well-being: a systematic review. PLoS One. 2019 Oct 17; 14(10):e0223313.
  2. 9. Sarkari B, Qasem A, Shafaf MR. Knowledge, attitude, and practices related to cutaneous leishmaniasis
    in an endemic focus of cutaneous leishmaniasis, Southern Iran. Asian Pacific journal of tropical
    biomedicine. 2014 Jul 1; 4(7):566-9.
    10. Bennis I, Thys S, Filali H, De Brouwere V, Sahibi H, Boelaert M. Psychosocial impact of scars due to
    cutaneous leishmaniasis on high school students in Errachidia province, Morocco. Infectious diseases of
    poverty. 2017 Dec; 6(1):1-8.
    11. Nadri K, Sajedi H, Sayahi A, Shahmoradi L. Designing a mobile-based self-care application for patients
    with cutaneous Leishmaniasis: An effective step in patients’ self-care and participation. Frontiers in
    Health Informatics. 2020 Mar 21; 9(1):29.
    12. Buzanovsky LP, Sanchez-Vazquez MJ, Maia-Elkhoury AN, Werneck GL. Major environmental and
    socioeconomic determinants of cutaneous leishmaniasis in Brazil-a systematic literature review. Revista
    da Sociedade Brasileira de Medicina Tropical. 2020 Jun 1; 53.
    13. Doe ED, Egyir-Yawson A, Kwakye-Nuako G. Knowledge, attitude and practices related to cutaneous
    leishmaniasis in endemic communities in the Volta region of Ghana.2019; 7(1), p.12.
    14. Sarkhani N, Pashaeypoor S, Negarandeh R. Student Health Ambassadors: A New Program to Promote
    Health among the Adolescent. International Journal of Community Based Nursing and Midwifery. 2021
    Jan; 9(1):88.
    15. Mokarrami E, Jalili Z, Tavakoli Ghouchani H. The Effect of Education Based on the Theory of Planned
    Behavior on Preventive Behaviors of Vaginitis in Health Ambassadors. Iranian Journal of Health
    Education and Health Promotion. 2019 May 10; 7(2):211-9.
    16. Salehi T, Maroufi Z, Haghani SH. Impact of Education Based on the Health Belief Model on the
    Nutritional Knowledge and Performance of Female Health Ambassadors. Iran Journal of Nursing. 2021
    Feb; 33(128):15-26.
    17. World Health Organization. Mental health of people with neglected tropical diseases: towards a personcentred approach.2020.
    18. El-Mouhdi K, Chahlaoui A, Fekhaoui M. The Cutaneous Leishmaniasis and the Sand Fly: Knowledge
    and Beliefs of the Population in Central Morocco (El Hajeb). Dermatology Research and Practice. 2020
    Nov 18; 2020.
    19. Hazavehei SM, Heshmati H, Hasanzadeh A, Pourmazar SA, Maghsoodlo D. The effect of volunteer
    health workers educational program on the basis of BASNEF model on promotion of their practices
    about cutaneous leishmaniasis. Zahedan J Res Med Sci (ZJRMS) 2014; 16(5): 16-21.
    20. DiClemente RJ, Crosby R, Kegler MC, editors. Emerging theories in health promotion practice and
    research. John Wiley & Sons; 2009 Sep 29.
    21. Bandura A. Health promotion by social cognitive means. Health education & behavior. 2004 Apr;
    22. Mokarrami E, Jalili Z, Tavakoli Ghouchani H. The Effect of Education Based on the Theory of Planned
    Behavior on Preventive Behaviors of Vaginitis in Health Ambassadors. Iranian Journal of Health
    Education and Health Promotion. 2019 May 10; 7(2):211-9.
    23. Bandura A. Health promotion from the perspective of social cognitive theory. Psychology and health.
    1998 Jul 1; 13(4):623-49.
    24. Shakiba E, Shahabadi S, Marzbani B, Barkhordar Poor Eayvazi N. The Effect of Self-Care Training for
    Health Ambassadors on the Number of Doctor Appointments Due to the Treatment of Minor Ailments.
    Iranian Journal of Health Education and Health Promotion. 2021 Mar 10; 9(1):68-79.
    25. Haghpanah Behzad, J.A.A., Shadzi, Shahin., Soleimani, Bahram., Yadali, Mojdeh,. 2001. The
    effectiveness of education to health liaisons in raising the level of women's awareness about the
    prevention of leishmaniasis. Research in Medical Sciences.5(4).pp 294-8.
    26. Hosseini SH, Rajabzadeh R, Hakkak HM, Panahi R. Effect of the BASNEF-based Educational
    Intervention on the Prevention of Cutaneous Leishmaniasis Disease in the Volunteer Health Workers and
    Families Covered by Them: A Quasi-Experimental Prospective Study. Zahedan Journal of Research in
    Medical Sciences. 2020 Jul 31; 22(3).
    27. Ghoreishi M, Vahedian-Shahroodi M, Esmaily H, Tehrani H. Predictive Factors Related To Self-Care
    Behaviors among Type2 Diabetic Patients by Using Social Cognitive Model. Iran J Health Educ Health
    Promot. 2018; 6 (3):241-250.
    28. Hamadzadeh S, Ezatti ZH, Abedsaeidi ZH, Nasiri N. Coping Styles and Self-Care Behaviors among
    Diabetic Patients. Iran Journal of Nursing. 2013 Feb 1; 25(80), 24-33.
    29. Jalily M, Barati M, Bashirian S. Using social cognitive theory to determine factors predicting nutritional
    behaviors in pregnant women visiting health centers in Tabriz, Iran. Journal of Education and
    Community Health. 2015 Apr 20; 1(4):11-21.
    30. Khani Jeihooni A, Hidarnia A, Kaveh M H, and Hajizadeh E. Survey of predictors osteoporosis
    preventive behaviors among women in Fasa: Integrated of the Health Belief Model and Social Cognitive
    Theory. HSR. 2015; 11 (1):53-67.
    31. Tazval J, Ghafari M, Mohtashami Yeganeh F, Babazadeh T, Rabati R. Efficiency of protection
    motivation theory on prediction of skin cancer and sunlight preventive behaviors in farmers in Ilam
    county. J Health. 2016; 7(7):656-7.
    32. Masoudy G, Karimi-aval M, Ansari A, Abasi MH, Abaszadeh-Bazi M. The predictors of preventive
    Behaviors of Crimean-Congo Hemorrhagic fever in Zabol ranchers based on health belief model. Iranian
    Journal of Health Education and Health Promotion. 2015 Dec 10;3(4):381-90.
    33. Taghdisi MH, Dehdari T, Dehnabi A, Zarati M. Predictors of Adopting Preventive Nutritional Behaviors
    of Breast Cancer among Women Based on Social-Cognitive Theory variables. Health and Development
    Journal. 2020 May 1; 9(1):19-28.
    34. Bakht R, Shobeiri F, Roshanaei G, Fakouri E.,2016. The factors affecting cervical cancer screening
    among addicted women of Hamedan in 2015: On the basis of Protection Motivation Theory model.
    Jorjani Biomed J. 4 (2):68-80.