الفهرس 
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Abstract
Health education is a fundamental requirement for all health professionals.It is designed to influence the knowledge base of individuals as well as their behaviours, attitudes, and values. This leads to a conscious personal decision to change unhealthy behaviors. Moreover, health education contributes to an atmosphere that supports and fosters public health as well as the health of individuals, families, communities, workplaces, and organizations.
Nursing students as a university student are the future masters of society. They should engage in health-promoting activities to take care of themselves because they play a crucial role in healthcare as well as being life savers. It is reasonable to believe that nursing students’ personal health concerns will help them improve their patients’ care.
As a result, nursing students should follow healthy nutritional behaviours, which are considered essential components for nursing students’ health and have a significant positive impact on nursing students’ main concerns by contributing to maintaining an optimum weight, improving physical and intellectual performance, and reducing the risk of diseases such as heart disease, cancer, stroke, and/or being overweight. Hence, health education and promotion are important for nursing students personally and professionally.
The aim of the current study was:
Determine the effect of implementing a health education program on nutritional behaviors and self-efficacy of overweight nursing students.
Materials and method:
Study Design:
A quasi- experimental research design was used in this study.
Setting:
This study was carried out at The Faculty of Nursing, Damanhour University, at the Medical Surgical Nursing Department, where the first-year nursing students are enrolled at fundamental of nursing course.
Subjects:
All first-year nursing students who are enrolled in Medical Surgical Nursing department, Faculty of Nursing, Damanhur University, during the first academic semester of the academic year 2022-2023, were assessed for overweight, Then, according to the revealed results about 108 out of 150 overweight nursing students were included in the study and were assigned randomly by systematic random sampling into two equal groups (the study and control groups), about 54 students in each group as follow:
• The study group: received the health education program using Pender’s health promotion model about nutritional behaviors.
• The control group: not received any intervention.
Tools of the study: -
Four tools were used for data collection:
Tool I: Nursing students’ knowledge assessment about healthy nutrition questionnaire. It is a self-reported questionnaire to assess nursing students’ knowledge about healthy nutrition. It was divided into 3 parts as follows:
Part 1: Benefits of healthy nutrition.
Part 2: Barriers of healthy nutrition.
Part 3: Interpersonal influences for healthy nutrition.
In addition to, nursing students’ socio demographic, academic and clinical data was attached and was consisted of 2 parts:
Part I: Socio demographic and Academic Data: This partwasincluded information about the students’ personal data as; age, sex, residence, parent’s education, parent’s work, family income and previous educational grade.
Part II: Clinical Data: This part was included information about the students’ clinical data as; family history of overweight and reasons of overweight (inactivity, increase calories (overeating), or psychological factors).
Tool II: Nursing students’ nutritional behavior assessment.
This tool was developed by the researcher for assessing nursing students’ nutritional behaviors. It was included approximately 20 statements about: types of foods, amount, methods of food preparation & cooking and eating inside and outside the home and frequency of water drinking.
Tool III: Anthropometric measurements.
This tool was used to measure weight and height to calculate Body Mass Index (BMI) with the formula of weight in kilograms divided by height in meters squared (kg/m2).
Tool IV: Nursing students’ Self-Efficacy Scale.
This tool was adapted for assessing nursing student’s self-efficacy regarding healthy nutrition.
The study was carried out on four phases.
Phase I: Assessment phase:
The first-year nursing students were enrolled in Medical Surgical Nursing department (fundamental course), were assessed for overweight pre-implementation of the program, using tool(III) Anthropometric measurements data, in which nursing students’ weight and height was measured and BMI was calculated with the formula of weight in kilograms divided by height in meters squared (kg/m2). Then, according to the revealed results a purposive sample of 108 overweight nursing students were recruited to participate in the study and were assigned randomly by systematic random sampling into the study and control group.
Initial assessment of all study sample (study and control group) was carried out pre-implementation of the health education program using Pender health promotion model by the study tools (tool I, II, IV).Tool 1 to assess nursing student’s knowledge about healthy nutrition(benefits, barriers and interpersonal factors) , tool II to assess nursing student’s nutritional behavior, and tool IV to assess nursing student’s self-efficacy, in addition to socio demographic, academic& clinical data respectively to collect the needed data.
Phase II: Planning phase
Priorities, outline, objectives, contents, and outcomes of the health education program using Pender model was formulated based on the results of the initial assessment. The program’s content sessions were formulated according to Pender health education model (prior related behavior, benefits of action, barriers to action, self-efficacy, affect-related behavior, situational and interpersonal influences, and commitment to a plan of action. Illustrative colored booklet was prepared by the researcher regarding overweight (causes, severity, and complications), healthy and unhealthy nutritional behaviors, and food guide pyramid. Colored booklet was distributed in the implementation phase to each student of the study group only.
Expected outcomes according to Pender’s HPM:
• Demonstrate the benefits and barriers of healthy nutrition using the program booklet throughout the program sessions.
• Follow healthy nutritional behaviors daily.
• Exhibit a reduction in BMI and body weight after measurement about 3 kg and BMI equal or less than 25 within 3 months.
Teaching methods: the researcher instructions were planned through interactive lecture, group discussion and brainstorming.
Media used: power-point presentation and colored booklet were used to support the given information.
Phase III: Implementation:
Health education program based on Pender health promotion was implemented for the study group, on 4 sessions; each session was continued for 45-60 minutes, one session/week for one month. A colored booklet about healthy and unhealthy nutrition was distributed to each student of the study group.
The first session: Was included the following content:
It included knowledge regarding healthy diet, food guide pyramid and different healthy foods groups. Also, knowledge about unhealthy nutrition and how it negatively affects nursing students’ health. In addition, it included knowledge about overweight (definition, causes, severity and complications).
The second session: it included knowledge about,
1. Prior related behavior: The researcher asked the students to express their previous and past behavior related to diet modification and weight reduction.
2. The benefits and barriers of healthy nutrition. The researcher concentrated on enhancing student’s perceptions of benefits and barriers of healthy nutrition, through providingknowledge about benefits of healthy nutritional behavior to increase awareness of the need to change. Also, discussed barriers to healthy nutritional behavior, and ways of overcoming them, through group discussion, brainstorming and lectures. And teaching media were colored booklet with illustrated pictures.
3. Promotion of Self-efficacy; in this session the researcher evaluated perceived self-efficacy, that is the student’s judgment of their personal ability and work to change behavior gradually and in short-term goals. Also, the researcher was clarified strategies to promote self-efficacy throughasking students to discuss their past attempts of nutritional behaviors’ change,goal setting, monitoring their progress againstbehavior change and weight reduction goals, via recording of their progress into a work sheet (self-assessment)and asking for support from their families, peers, and friends.
The third session: It was included,
1. Activity related affect construct: in this session the researcher clarified the concept of activity related –affect as their positive feelings during and after practicing healthy nutritional behaviors and asked the students to record their feeling before during and after practicing healthy nutritional behaviors.
2. Interpersonal influences: the researcher evaluated interpersonal influences (family, peers, and friends), as social support and role models; students are influenced by the behaviors, beliefs, or attitudes of relevant other individuals when making decisions about eating habits. Also, the researcher discussed parents’ roles to support and encourage their children to practice healthy nutritional behaviors through group discussion.
The fourth session: was included the following content:
• In the beginning of this session, the researcher encouraged the commitment of the program instructions. The nursing students was instructed to report their efforts to reach their goals via small discussion. The researcher taught them how to re-plan and take action to follow healthy diet and nutritional behaviors throughout goal setting, action planning, obstacles identification, committing and the students were encouraged to write down their feedback and goals into a worksheet to monitor their progress.
• Finally, the researcher reviewed and summarized the content of previous sessions, gave explanation, clarifications and answered the students’ questions and evaluated the complying of health nutritional behavior that is the desired behavioral end point or outcome of health education program. Also, the researcher taken feedback from students regarding their opinions in the program.
Phase IV: Evaluation phase:
Study tools (I, II,III & IV) were used again with both subjects’ groups, immediately (first assessment) and 3 months post completion of health education program sessions (second assessment), and after 6 months (third assessment) to evaluate the effect of implementing a health education program using Pender’s health promotion model on nutritional behaviors and self-efficacy of overweight nursing students.
The main results of this study were:
• More than two thirds (68.5%) of nursing students of study group aged 18 years, and more than half (55.6%) of them were females, Moreover, three quarters of students were rural residents and had enough income.
• It was noticed that nearly three quarters (70.4%) of nursing students of the study group compared to more than half (57.4%) of nursing students of the control group had no family history of overweight.
• Pre and immediately post the program there were no statistically significant differences inbody mass index for the study group and control group p=0.318 and 0.918 respectively, whereas 3 and 6 months post the program there was statistically significant difference in body mass index mean score between study and control groups in favor to study group (p<0.001).
• There were statistically significant differences between study and control groups in relation to overall nursing students’ knowledge about healthy nutrition post implementing the program (p=<0.001).
• Also, there was statistically significant differences in relation to nutritional behaviors mean score post implementing the program in the study group (p=<0.001).
• As well, there were statistically significant differences between study and control groups in relation to mean score ofself-efficacy post the program implementing (p=<0.001).
• There was no statistically significant correlation between nursing student’s sociodemographic and overall knowledge among study and control groups immediately, three and six months post the program implementation,
• There was no statistically significant correlation between nursing students’ sociodemographic and nutritional behaviour among study and control groups immediately, three and six months post the program implementation.
• There was no statistically significant correlation between nursing students’ sociodemographic and self-efficacy among study and control groups immediately, three and six months post the program implementation.
• There was statistically significant correlation between self-efficacy and nutritional behaviors in the study group immediately, three and six months post the program implementation.
Conclusion and recommendations
Conclusion:
The results of the current study concluded that implementing health education program based on Pender health promotion model has a positive effect on improving nursing students’ knowledge and self-efficacy levelleading to improving nutritional behavior.
Recommendations:
Based on the findings of the present study, the following recommendations should be considered:
Recommendations for students:
1. Conducting periodically routine screening by measuring body mass index for undergraduate nursing students who are at high-risk for obesity.
2. Health promotion program should be implemented to motivate nursing students for regular physical activity, proper or healthy nutrition and stress management.
3. Replication of the study on large probability sampling.