Effectiveness of Health Belief Model on Oral Cancer Prevention in Smoker Men


The purpose of the present study is investigating the effect of educational intervention based on health belief model (HBM) on oral cancer prevention in smoker men. This is a quasi-experimental study carried out on 200 smoker men with the age of 40 or older (100 subjects for the experimental group and 100 subjects for control group) resident in Fasa City, Fars Province, Iran, in 2017–2018. The educational intervention for the experimental group included seven educational sessions for 50 or 55 min-based HBM. A questionnaire consisted of items about demographic information, knowledge, HBM constructs (perceived susceptibility, severity, benefits, barriers, self-efficacy, and cues to action) was used to measure the oral cancer prevention before and 6 months after the intervention. The mean age of the men was 51.35±8.41 years in the experimental group and 52.28±8.09 years in the control group. Based on the obtained results, significant enhancement is observed in average scores of knowledge, perceived susceptibility, severity, benefits, self-efficacy, cues to action, and oral cancer prevention behaviors in experimental group; however, no significant changes are observed in average scores of knowledge, perceived susceptibility, severity, benefits, self-efficacy, cues to action, and oral cancer prevention behaviors of control group. Also, results indicated that, the educational program based on HBM model have positive effect on oral cancer prevention with the improvement of subject’s knowledge, perceived susceptibility, severity, benefits, and self-efficacy.

This is a preview of subscription content, log in to check access.


  1. 1.

    Greenberg MS, Glick M, Ship JA (2008) Burkett’s Oral Medicine, 11th edn. BC Decker Inc, Hamilton, pp 153–158

    Google Scholar 

  2. 2.

    Little JW, Falace DA, Miller CS, Rhodus NL (2013) Dental management of the medically compromised patients, 8th edn. Mosby Co, St. Louis, p 475

    Google Scholar 

  3. 3.

    Mehrotra R, Yadav S (2006) Oral squamous cell carcinoma: etiology, pathogenesis and prognostic value of genomic alterations. Indian J Cancer 43(2):60–66

    CAS  PubMed  Article  Google Scholar 

  4. 4.

    Schmidt BL, Kuczynski J, Bhattacharya A, Huey B, Corby PM, Queiroz EL et al (2014) Changes in abundance of oral microbiota associated with oral cancer. PLoS One 9(6):98741

    Article  Google Scholar 

  5. 5.

    Razavi SM, Siadat S, Rahbar P, Hosseini SM, Shirani AM (2012) Trends in oral cancer rates in Isfahan, Iran during 1991-2010. Dent Res J (Isfahan) 9(1):88–93

    Google Scholar 

  6. 6.

    Kao SY, Lim E (2015) An overview of detection and screening of oral cancer in Taiwan. Chin J Dent Res 18(1):7–12

    PubMed  Google Scholar 

  7. 7.

    Silverman S, Kerr AR, Epstein JB (2010) Oral and pharyngeal cancer control and early detection. J Cancer Educ 25(3):279–281

    PubMed  PubMed Central  Article  Google Scholar 

  8. 8.

    Iamaroon A, pattanaporn K, Pongsiriwet S, Wanachantarak S, Prapayasato K, Jittidecharaks S et al (2004) Analysis of 587 cases of oral squamous cell carcinoma in northern Thailand with a focus on young people. Int J Oral Maxillofac Surg 33(1):84–88

    CAS  PubMed  Article  Google Scholar 

  9. 9.

    La Vecchia C, tavani A, Franceschi S, Levi F, Corrao G, Negri E (1997) Epidemiology and prevention of oral cancer. Oral Oncol 33(5):302–312

    PubMed  Article  Google Scholar 

  10. 10.

    Filho VW (2002) The epidemiology of oral and pharyngeal cancer in Brazil. Oral Oncol 38(8):737–746

    Article  Google Scholar 

  11. 11.

    Silverman S. Oral Cancer 5th ed., Hamilton London, BC Decker Inc, 2003; 1–27.

  12. 12.

    Canto MT, Devesa SS (2002) Oral cavity and pharynx cancer incidence rates in the United States 1975 – 98. Oral Oncol 38(6):610–617

    PubMed  Article  Google Scholar 

  13. 13.

    FU YS, Wenig BM, Abemayor E et al (2001) Head and neck pathology with clinical correlations. Phialdelphia. Chur Chill Living stone, Pennsylvania, pp 385–386

    Google Scholar 

  14. 14.

    Shap JP (2001) Cancer of the head and neck. BC Decker Inc, Hamilton London, pp 1–15 100

    Google Scholar 

  15. 15.

    Neville BW, Damm DD, Allen CM et al (2002) Oral & Maxillofacial pathology, 2nd edn. W.B. Saunders company, Philadelphia, pp 356–370

    Google Scholar 

  16. 16.

    Rhodus NL (2005) Oral cancer: leukoplakia and squamous cell carcinoma. Dent Clin N Am 49(1):43–65

    Article  Google Scholar 

  17. 17.

    Brennan JA, Jo B, Koch WM, Goodman SN, Hruban RH, Eby YJ et al (1995) Association between cigarette smoking and mutation of the p53 gene in squamous cell carcinoma of the head and neck. N Engl J Med 332(11):712–717

    CAS  PubMed  Article  Google Scholar 

  18. 18.

    O’Hanlon S, Forster DP, Lowry RJ (1997) Oral cancer in the north – east of England: incidence, mortality trends and the link with material deprivation. Community Dent Oral Epidemiol 25(5):371–376

    PubMed  Article  Google Scholar 

  19. 19.

    Sharifirad G, Hazavehei M, Hasanzadeh A, Daneshamouz A. The effect of health education based on health belief model on preventive actions of smoking in grade one, middle school students. Arak Univ Med Sci J 2007; 10(1): 79–86. [In Persian].

  20. 20.

    WHO, Regional Office for the Eastern Mediterranean. Tobacco free initiative [Online]. 2012; Available from: URL: http://www.emro.who.int/pak/programmes/tobacco-free-initiative.html/

  21. 21.

    Wong YK, Tsai WC, Lin JC, Poon CK, Chao SY, Hsiao YL, Chan MY, Cheng CS, Wang CC, Wang CP, Liu SA (2006) Socio-demographic factors in the prognosis of oral cancer patients. Oral Oncolo 42:893–906

    Article  Google Scholar 

  22. 22.

    Tasci-duran E, Koc SO, Korkmaz M (2014) Turkish social attitudes towards to cancer prevention: a health belief model study. AsianPac J Cancer Prev 15:7935–7940

    Article  Google Scholar 

  23. 23.

    Tan BS, Ng KH, Esa R (2001 Mar) Health beliefs in oral cancer: Malaysian estate Indian scenario. Patient Educ Couns 42(3):205–211

    CAS  PubMed  Article  Google Scholar 

  24. 24.

    Khwankong S, Sriplung H, Kerdpon D. 2016 Knowledge and Health belief attitudes of oral cancer and its screening among at-risk southern Thai Muslims. J Cancer Educ . [Epub ahead of print]

  25. 25.

    Jeihooni AK, Jamshidi H, Kashfi SM, Avand A, Khiyali Z (2017) The effect of health education program based on health belief model on oral health behaviors in pregnant women of Fasa City, Fars Province, South of Iran. J Int Soc Prev Community Dent 7(6):336–343. https://doi.org/10.4103/jispcd.JISPCD_339_17

    PubMed  PubMed Central  Article  Google Scholar 

  26. 26.

    Dodd VJ, Watson JM, Choi Y, Tomar SL, Logan HL (2008) Oral cancer in African Americans: addressing health disparities. Am J Health Behav 32(6):684–692. https://doi.org/10.5555/ajhb.2008.32.6.684.

    PubMed  Article  Google Scholar 

  27. 27.

    Gupta B, Johnson NW.2014 Systematic Review and Meta-analysis of association of smokeless tobacco and of betel quid without tobacco with incidence of oral cancer in South Asia and the Pacific. Li Y, ed PLoS ONE ;9(11):e113385. doi:https://doi.org/10.1371/journal.pone.0113385.

    PubMed  PubMed Central  Article  Google Scholar 

  28. 28.

    Shepperd JA, Emanuel AS, Howell JL, Logan HL (2015) Predicting scheduling and attending for an oral cancer examination. Ann Behav Med: Publ Soc Behav Med 49(6):828–838. https://doi.org/10.1007/s12160-015-9717-0.

    Article  Google Scholar 

  29. 29.

    Azad A, Talattof Z, Niakan N (2015) Evaluation of knowledge and diagnostic skills of general physicians and dentists in the City of Shiraz about squamous cell carcinoma. J Mashhad Dent Sch 39(4):291–302

    Google Scholar 

  30. 30.

    Shiva A, Mousavi S.J, Evaluation of dentists knowledge about oral cancer in Sari-Iran in 2013. J Mazand Univ Med Sci 2014; 24(109): 164–171 (Persian).

  31. 31.

    Hoffman LM, Rollins L, Akintobi TH, Erwin K, Lewis K, Hernandez N, Miller A (2017) Oral health intervention for low-income African American men in Atlanta, Georgia. AJPH 107(Supplement 1):S1

    Google Scholar 

  32. 32.

    Renuka P, Pushpanjali K (2014) Effectiveness of health belief model in motivating for tobacco cessation and to improving knowledge, attitude and behavior of tobacco users. Cancer Oncol Res 2(4):43–50. https://doi.org/10.13189/cor.2014.020401

    Article  Google Scholar 

  33. 33.

    Watson JM, Tomar SK, Dodd V, Logan HL, Choi Y (2009) Effectiveness of a social marketing media campaign to reduce oral cancer racial disparities. J Natl Med Asoc 101(8):774–782

    Google Scholar 

  34. 34.

    Sadeghi R, Khanjani N, Hashemi M, Movagheripour M (2014) Usinghealth belief model to prevent skin cancer among farmers. Iran J Health Educ Health Promot 2(3):215–222

    Google Scholar 

  35. 35.

    Velasques K, Michels LR, Colome LM, Haas SE (2016) Educational activities for rural and urban students to prevent skin cancer in Rio Grande do Sul, Brazil. Asian Pac J Cancer Prev 17(3):1201–1207

    PubMed  Article  Google Scholar 

  36. 36.

    Stankeviciūte V, Zaborskis A, Petrauskiene A, Valiukeviciene S (2004) Childrens health education on protection from sun exposure and the assessment of its efficiency. Medicina (Kaunas) 40(4):386–393

    Google Scholar 

  37. 37.

    Saridi MI, Rekleiti MD, Toska AG, Souliotis K (2014) Assessing a sun protection program aimed at Greek elementary school students for malign melanoma prevention. Asian Pac J Cancer Prev 15(12):5009–5018

    PubMed  Article  Google Scholar 

  38. 38.

    Jeihooni AK, Kashfi SM, Hatami M, Avand A, Bazrafshan MR (2017) The effect of educational program based on PRECEDE model in promoting prostate cancer screening in a sample of Iranian men. J Cancer Educ. https://doi.org/10.1007/s13187-017-1282-8.

    Article  Google Scholar 

  39. 39.

    Khiyali Z, Aliyan F, Kashfi SH, Mansourian M, Khani Jeihooni A (2017 Oct 26) Educational intervention on breast self-examination behavior in women referred to health centers: application of health belief model. Asian Pac J Cancer Prev 18(10):2833–2838

    PubMed  PubMed Central  Google Scholar 

  40. 40.

    Jornet P L, Garcia FJ G, Lucero Berdugo M, Parra Perez F, A Pons-Fuster Lopez. Mouth self-examination in a population at risk of oral cancer. Aust Dent J 2015; 60: 59–53.

    PubMed  Article  Google Scholar 

  41. 41.

    Sargeran K, Abbasi AJ, Fazeli F (2017) Treatment and care for oral cancer patients at Shariati hospital in Tehran in 2003-2013. J Dent Med Tehran Univer Med Sci 30(2):104–110

    Google Scholar 

  42. 42.

    Hillhouse J, Turrisi R, Stapleton J, Robinson J (2008) A randomized controlled trial of an appearance-focused intervention to prevent skin cancer. Cancer 113(11):3257–3266. https://doi.org/10.1002/cncr.23922

    PubMed  PubMed Central  Article  Google Scholar 

  43. 43.

    Jeihooni AK, Hidarnia A, Kaveh MH, Hajizadeh E, Askari A (2015) Effects of an osteoporosis prevention program based on health belief model among females. Nurs Midwifery Stud 4(3):e26731

    PubMed  PubMed Central  Article  Google Scholar 

  44. 44.

    Mohebbi S Z, Yazdani R, Mirmolaei S T, Tartar Z3, Janeshin A. Effect of an educational intervention on midwifery students’ knowledge and preparedness aboutoral health care in pregnant mothers.J Dent Med Tehran Univ Med Sci 2014; 26(4):306–313

  45. 45.

    Bates SB, Riedy CA (2012) Changing knowledge and beliefs through an oral health pregnancy message. J Public Health Dent 72(2):104–111. https://doi.org/10.1111/j.1752-7325.2011.00289.x

    PubMed  Article  Google Scholar 

  46. 46.

    Bahri N, Tohidinik HR, Bahri N, Iliati HR, Moshki M, Darabi F (2015) Educational intervention to improve oral health beliefs and behaviors during pregnancy: a randomized-controlled trial. J Egypt Public Health Assoc 90(2):41–45. https://doi.org/10.1097/01.EPX.0000464139.06374.a4

    PubMed  Article  Google Scholar 

  47. 47.

    Jeihooni AK, Rakhshani T (2018 Jan 8) The effect of educational intervention based on health belief model and social support on promoting skin cancer preventive behaviors in a sample of Iranian farmers. J Cancer Educ. https://doi.org/10.1007/s13187-017-1317-1

    Article  Google Scholar 

  48. 48.

    Jeihooni AK, Hidarnia A, Kaveh MH, Hajizadeh E, Askari A (2015) The effect of an educational program based on health belief model on preventing osteoporosis in women. Int J Prev Med 6:115

    PubMed  PubMed Central  Article  Google Scholar 

  49. 49.

    Khiyali Z, Manoochri M, Khani Jeihooni A, Babaei Heydarabadi A, Mobasheri F (2017) Educational intervention on preventive behaviors on gestational diabetes in pregnant women: application of health belief model. Int J Pediatr 5(5):4821–4831. https://doi.org/10.22038/ijp.2016.7750

    Article  Google Scholar 

  50. 50.

    Solhi M, Shojaei Zadeh D, Seraj B, Faghih ZS (2010) The application of the health belief model in oral health education. Iran J Publ Health 39(4):114–119

    CAS  Google Scholar 

  51. 51.

    Wickremasinghe WMPNR, Ekanayake L (2017) Effectiveness of a health education intervention based on the health belief model to improve oral health behaviours among adolescents. Asian Pac J Health Sci 4(1):48–55

    Article  Google Scholar 

  52. 52.

    Howell J, Shepperd J, Logan HL (2013) Barriers to oral cancer screening: a focus group study of rural Black American adults. Psychooncology 22:1306–1311

    PubMed  Article  Google Scholar 

  53. 53.

    Rahmati-Najarkolaei F, Rahnama P, Gholami Fesharaki M, Behnood V (2016) Predictors of oral health behaviors in female students: an application of the health belief model. Iran Red Crescent Med J 18(11):e24747

    PubMed  PubMed Central  Article  Google Scholar 

  54. 54.

    Kouhpayeh A, Jeihooni AK, Kashfi SH, Bahmandoost M (2017) Effect of an educational intervention based on the model of health beliefs in self-medication of Iranian mothers. Invest Educ Enferm 35(1):59–68. https://doi.org/10.17533/udea.iee.v35n1a07

    PubMed  Article  Google Scholar 

  55. 55.

    Bandura A (2004) Health promotion by social cognitive means. Health Educ Behav 31(2):143–164

    PubMed  Article  Google Scholar 

  56. 56.

    Rhoads, Kelley E. 2012.An educational tobacco intervention: impact of the health belief model on college students. Florida Atlantic University, ProQuest Dissertations Publishing

  57. 57.

    Dehbari SR, Dehdari T, Dehdari L, Mahmoudi M (2015) Predictors of sun-protective practices among Iranian female college students: application of protection motivation theory. Asian Pac J Cancer Prev 16(15):6477–6480

    PubMed  Article  Google Scholar 

  58. 58.

    Buglar, Maria and White, Katherine M. and Robinson, Natalie G. The role of self-efficacy in dental patients’ brushing and flossing: testing an extended health belief model. Patient Educ Couns 2010; 78: 269–272.

    PubMed  Article  Google Scholar 

  59. 59.

    Jeihooni AK, Hidarnia A, Kaveh MH, Hajizadeh E, Askari A (2016) Application of the health belief model and social cognitive theory for osteoporosis preventive nutritional behaviors in a sample of Iranian women. Iran J Nurs Midwifery Res 21(2):131–141. https://doi.org/10.4103/1735-9066.178231

    PubMed  PubMed Central  Article  Google Scholar 

  60. 60.

    Walker KK, Steinfort EL, Keyler MJ (2015) Cues to action as motivators for children’s brushing. Health Commun 30(9):911–921. https://doi.org/10.1080/10410236.2014.904030

    PubMed  Article  Google Scholar 

  61. 61.

    Glasser A, Shaheen M, Glenn BA, Bastani R (2010) The sun sense study: an intervention to improve sunprotection in children. Am J Health Behav 34(4):500–510

    PubMed  Article  Google Scholar 

  62. 62.

    Kashfi SM, Khani Jeihooni A, Rezaeianzade A (2012 Dec 13) Effect of health workers’ training programs on preventive behavior of leishmaniosis based on BASNEF model. J Res Health Sci. 12(2):114–118

  63. 63.

    Kashfi SM, Khani Jeihooni A, Rezaianzadeh A, Karimi S (2014) The effect of mothers education program based on the precede model on the mean weight in children (6-12 months) at health centers in Shiraz, Fars Province. Med J Islam Repub Iran 28:95

    PubMed  PubMed Central  Google Scholar 

  64. 64.

    Shamsi M, Hidarnia A, Niknami S, Rafiee M, Zareban I, Karimy M (2014) The effect of educational program on increasing oral health behavior among pregnant women: applying health belief model. Health Educ Health Promot 1(2):21–36

    Google Scholar 

  65. 65.

    Shahnazi H, Hosseintalaei M, Esteki Ghashghaei F, Charkazi A, Yahyavi Y, Sharifirad G (2016) Effect of educational intervention on perceived susceptibility self-efficacy and DMFT of pregnant women. Iran Red Crescent Med J 18(5):e24960. https://doi.org/10.5812/ircmj.24960.

    PubMed  PubMed Central  Article  Google Scholar 

  66. 66.

    BLack JM, Hawaks JH (2009) Medical–surgical nursing, 4th edn. Sanders Elsevier Publishing, London, p 504

    Google Scholar 

Download references

Author information



Corresponding author

Correspondence to Ali Khani Jeihooni.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Jeihooni, A.K., Dindarloo, S.F. & Harsini, P.A. Effectiveness of Health Belief Model on Oral Cancer Prevention in Smoker Men. J Canc Educ 34, 920–927 (2019). https://doi.org/10.1007/s13187-018-1396-7

Download citation


  • Health belief model (HBM)
  • Knowledge
  • Oral cancer
  • Self-efficacy