Tropical Animal Health and Production

, Volume 51, Issue 2, pp 419–428 | Cite as

Preventive factors related to brucellosis among rural population using the PRECEDE model: an application of path analysis

  • Leila Jahangiry
  • Maryam Khazaee-Pool
  • Babak Mahdavi
  • Koen Ponnet
  • Parvin SarbakhshEmail author
Regular Articles


The purpose of this model-based study was to identify behavioral and environmental prevention factors for brucellosis and to determine the causal linkage among these factors in a rural area with high prevalence of the disease. A multi-stage random sampling method was used to select villages in Ahar County, located in East Azerbaijan Province, Iran. Participants (n = 400) were recruited from these villages. Data was collected in accordance with the PRECEDE model established in March 2016. This model consists of four phases intended to assess each participant’s health and quality of life. Standardized, structured questionnaires exploring different aspects of brucellosis prevention (predisposing, reinforcing, enabling, environmental, and behavioral factors) were used. Path analysis was applied to assess the pathway structure of the PRECEDE model. Overall, the model fitted the data well (χ2/df = 1.10; RMSEA = .016 (CI 95%: 0.00–0.07), SRMR = .02, CFI = .99). Significant positive associations were found among predisposing, reinforcing, and enabling factors on the one hand, and behavior, on the other hand. The predisposing factors showed significant positive associations with general health, and the reinforcing factors and general health showed significant positive associations with health-related quality of life (HRQOL). The results of this study support the use of the PRECEDE model for brucellosis prevention, and suggest that a high level of general health, in combination with reinforcing factors can increase HRQOL in an area with a high prevalence of brucellosis.


Brucellosis Path analysis PRECEDE Prevention 





quality of Life


PRECEDE model-based scales for brucellosis prevention


structural equation modeling


asymptotically distribution-free method


goodness of fit index


adjusted goodness of fit index


comparative fit index


normed fit index


relative fit index


root mean-square error of approximation



We acknowledge the contributions of Tabriz University of Medical Sciences, Tabriz, Iran for providing facilities to the study. Also, we express our deep appreciation and sincere thanks to Prof. Lawrence W. Green for his comments and suggestions on how to proceed with the study framework.

Authors’ contributions

LJ was the study’s supervisor and contributed to all aspects of the study and provided the manuscript. BM collected the data. PS conducted the analysis, MKH have helped and consulted us in data gathering process. KP contributed substantially to the data interpretation and critically revised the final article for important intellectual content. All authors read and approved the paper.

Compliance with ethical standards

Ethical approval

Informed consent was obtained from all participants. The study received ethical approval from the Ethics Committee of Tabriz University of Medical Sciences (NO: IR. TBZMED. REC. 1394. 596).

Consent for publication

The authors have agreed on the content of the manuscript.

Conflict of interest

The authors declare that they have no conflicts of interest.


  1. Brown, T. Confirmatory factor analysis for applied research. New York: Guilford. (2006).Google Scholar
  2. Corbel, M. (2006) Brucellosis in Humans and Animals: FAO, OIE, WHO. Available: Accessed 2017 May 10.
  3. Dean, A.S., Crump, L., Greter, H., Schelling, E., Zinsstag, J. 2012. Global burden of human brucellosis: a systematic review of disease frequency. PLoS Neglected Tropical Diseases, 6 (10):e1865.CrossRefGoogle Scholar
  4. El Idrissia, A. FAO works to curb the burden of brucellosis in endemic countries. 2014. Avalable at:
  5. Finney, S.J, DiStefano, C. 2006. Non-normal and categorical data in structural equation modeling. Structural equation modeling. A second course, 269–314.Google Scholar
  6. Franc, K. A., Krecek, R. C., Häsler, B. N., & Arenas-Gamboa, A. M. (2018). Brucellosis remains a neglected disease in the developing world: a call for interdisciplinary action. BMC public health, 18(1), 125.CrossRefGoogle Scholar
  7. Glantz K, Rimer BK, Viswanath K (2008) The scope of health behavior and health education. In: Glanz K, Rimer BK, Viswanath K (eds) Health behavior and health education: theory, research, and practice, 4th edn. Jossey-Bass, San Francisco, p 3–22Google Scholar
  8. Glaser, L., Carstensen, M., Shaw, S., Robbe-Austerman, S., Wunschmann, A., Grear, D., & Thomsen, B. (2016). Descriptive epidemiology and whole genome sequencing analysis for an outbreak of bovine tuberculosis in beef cattle and white-tailed deer in northwestern Minnesota. PloS One,11(1), e0145735.CrossRefGoogle Scholar
  9. Green, L.W., Kreuter, M.W. 2005. Health program planning: An educational and ecological approach. McGraw-Hill Companies.Google Scholar
  10. Hox J. Multilevel analysis: techniques and applications. Mahwah, NJ: Lawrence Erlbaum Associates; 2002.Google Scholar
  11. Jahangiry, L., Nadrian, H., Mahdavi, B., Allahverdipour, H., Kousha, A. 2017. Primary Development and Psychometric Properties of PRECEDE Model-based Scales for Brucellosis Prevention among an Iranian Rural Population. Infect Dis. ; 12(3):e62957.Google Scholar
  12. Javanparast, S., Baum, F., Labonte, R., Anders, D., Heidari, G., Rezaie, S. 2011. A policy review of the community health worker programme in Iran. Journal of public health policy. 32 (2):263–76.CrossRefGoogle Scholar
  13. Kafil, H.S., Baha Hosseini, S., Sohrabi, M., Asgharzadeh, M. 2014. Brucellosis: presence of zoonosis infection 3500 years ago in North of Iran. Asian Pacific Journal of Tropical Disease ,4:S684-S86.CrossRefGoogle Scholar
  14. Kansiime, C., Rutebemberwa, E., Mugisha, A., Mugisha, S., Asiimwe, B.B., Rwego, I.B. and Kiwanuka, S.N., 2014. Determinants of Patients’ choice of provider in accessing brucellosis care among pastoral communities adjacent to Lake Mburo National Park in Kiruhura District, Uganda. PloS One, 9(8), e105276.CrossRefGoogle Scholar
  15. Lai, S., Zhou, H., Xiong, W., Gilbert, M., Huang, Z., Yu, J., & Mu, D. (2017). Changing epidemiology of human brucellosis, China, 1955–2014. Emerging infectious diseases, 23(2), 184.CrossRefGoogle Scholar
  16. Lindahl, E., Sattorov, N., Boqvist, S. and Magnusson, U., 2015. A study of knowledge, attitudes and practices relating to brucellosis among small-scale dairy farmers in an urban and peri-urban area of Tajikistan. PloS One, 10(2), e0117318.CrossRefGoogle Scholar
  17. MacCallum, R.C., Browne, M.W., & Sugawara, H.M. 1996. Power analysis and determination of sample size for covariance structure modeling. Psychological Methods, 1, 130149.CrossRefGoogle Scholar
  18. Mamdani, M., Bangser, M. 2004. Poor people's experiences of health services in Tanzania: a literature review. Reproductive Health Matters, 12(24):138–53CrossRefGoogle Scholar
  19. Maydeu-Olivares, A., Shi, D., & Rosseel, Y. (2018). Assessing fit in structural equation models: A Monte-Carlo evaluation of RMSEA versus SRMR confidence intervals and tests of close fit. Structural Equation Modeling: A Multidisciplinary Journal, 25(3), 389–402.CrossRefGoogle Scholar
  20. Montazeri, A., Harirchi, A.M., Shariati, M., Garmaroudi, G., Ebadi, M. and Fateh, A., 2003. The 12-item General Health Questionnaire (GHQ-12): translation and validation study of the Iranian version. Health and Quality of Life Outcomes, 1(1), 66.CrossRefGoogle Scholar
  21. Montazeri, A., Vahdaninia, M., Mousavi, S.J. and Omidvari, S., 2009. The Iranian version of 12-item Short Form Health Survey (SF-12): factor structure, internal consistency and construct validity. BMC Public Health, 9(1), 341CrossRefGoogle Scholar
  22. Musallam, I. I., Abo-Shehada, M. N., Hegazy, Y. M., Holt, H. R., & Guitian, F. J. (2016). Systematic review of brucellosis in the Middle East: disease frequency in ruminants and humans and risk factors for human infection. Epidemiology & Infection, 144(4), 671–685.CrossRefGoogle Scholar
  23. Nicoletti P. Brucellosis: past, present and future. Prilozi 2010;31(1):21–32Google Scholar
  24. Ragan, V., Vroegindewey, G., Babcock S. 2013. International standards for brucellosis prevention and management. Revue scientifique et technique (International Office of Epizootics). 32(1):189–98.Google Scholar
  25. Shang D. Progress in the study of prevention and control of Brucellosis in China in last 50 years. Zhonghua liu xing bing xue za zhi 2000;21(1):55-7Google Scholar
  26. Smits, H.L. 2013.Brucellosis in pastoral and confined livestock: prevention and vaccination. Revue scientifique et technique (International Office of Epizootics). 32(1):219–28Google Scholar
  27. Sofian, M., Aghakhani, A., Velayati, A.A., Banifazl, M., Eslamifar, A. and Ramezani, A., 2008. Risk factors for human brucellosis in Iran: a case–control study. International Journal of Infectious Diseases, 12(2), 157–161.CrossRefGoogle Scholar
  28. World Health Organisation. 1997. World Health Organisation. Fact Sheet: N173.Google Scholar

Copyright information

© Springer Nature B.V. 2018

Authors and Affiliations

  1. 1.Tabriz Health Services Management Research CenterTabriz University of Medical SciencesTabrizIran
  2. 2.Health Education and Health Promotion Department, School of Public HealthTabriz University of Medical SciencesTabrizIran
  3. 3.Department of Health Education and Promotion, School of Public HealthZanjan University of Medical SciencesZanjanIran
  4. 4.Faculty of Social Sciencesimec-mict-Ghent UniversityGhentBelgium
  5. 5.Faculty of Social SciencesUniversity of AntwerpAntwerpBelgium
  6. 6.Epidemiology and Biostatistics Department, School of Public HealthTabriz University of Medical SciencesTabrizIran

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