Effectiveness of a Precede-Proceed Model-based Educational Program on the Health Related Quality of Life and Preventive Behaviors of Patients with Cancer Undergoing Chemotherapy

Background: Adverse drug reactions (ADRs) are problematical in cancer chemotherapy.  Through education, the severity of these complications can be reduced. Educational models have been widely used to change clients' health behaviors. The aim of this study was to determine the effect of an educational program based on Precede-Proceed model on the health related quality of life (HRQOL) and preventive behaviors of patients with cancer undergoing chemotherapy. Methods: This quasi - experimental impact evaluation study was performed on 90 outpatients with breast cancer (stages I and II) undergoing chemotherapy, referring to Shahid Beheshy hospital in Kashan province, Iran during September 2018 to December 2019. The subjects were randomly assigned into the experimental (n= 45) and control (n= 45) groups.  The experimental group received eight two-hours sessions of educational program based on the precede-proceed model in one month. The control group only received routine care for cancer patients. The subjects in both groups completed the European Organization for the Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C30) and a researcher-made Precede-Proceed questionnaire (including predisposing, enabling, and reinforcing factors) to assess preventive behaviors before and immediately after the intervention and two months after the last session of the intervention. Data were analyzed using the SPSS 16.  The level of significance was set at 0.05. Results: The results of the repeated measure ANOVA showed that in the experimental group, the total score of HRQOL before, immediately after and two months after the intervention were 52.65±17.14, 64.79±15.66, 63.95±18.63 respectively. The total score HRQOL and its dimensions (physical, role, emotional, and symptoms) increased significantly over time (p<0.01). The results also showed that in the experimental group, the scores of predisposing and enabling factors increased immediately after and two months after the last session of the intervention (p< 0.05); however, the score of reinforcing factor (social support) did not increase significantly (p> 0.05). Conclusion: Precede-Proceed model is recommended to be used to improve the HRQOL and preventive behaviors of cancer patients undergoing chemotherapy.