# Developing a theory-based health education intervention to prevent adolescent students from smokeless tobacco use

## TL;DR

This study developed a health education program based on protection motivation theory to help prevent adolescent students in Nepal from using smokeless tobacco.

## Contribution

A new theory-based health education intervention was developed and validated for preventing smokeless tobacco use among adolescents.

## Key findings

- Students had insufficient knowledge and many misconceptions about smokeless tobacco.
- The intervention showed high reliability and validity with Cronbach’s alpha values over 0.8.
- Over 80% of participants in the pilot test agreed the intervention was effective and appropriate.

## Abstract

Smokeless tobacco is a kind of tobacco that is chewed or sniffed in the forms of khaini, gutkha, pan parag and zarda paan with tobacco constituents. Although these products are harmful to health, over 300 million people worldwide use them. Its use among adolescent students in Nepal is increasing. A theory-based health education intervention is needed to prevent students from consuming smokeless tobacco.

Four focus group discussions were conducted among ninth-grade students following guidelines based on the constructs of protection motivation theory. Based on a rigorous review of the literature and feedback from the supervisor, a module of protection motivation theory-based health education intervention was drafted. Subsequently, a pilot test of the intervention was conducted among the students of grade 9. Data from 16 students who participated in the pilot test were analyzed to identify the reliability and face validity of the intervention. The content validity of the intervention was assured through feedback from the supervisor and the literature. Subsequently, the final draft of the theory-based health education intervention was prepared.

Students who participated in focus group discussions had insufficient knowledge regarding smokeless tobacco and its harmful effects. They had many misconceptions regarding smokeless tobacco use. They recognized the necessity of acquiring skills to prevent smokeless tobacco use. They voiced that strict rules should be implemented on school premises to control tobacco use. Drawing on such information and findings derived from the needs assessment, a protection motivation theory-based health education intervention was developed. Cronbach’s alpha values of each objective of each session were greater than 0.8. More than 80% of participants in the pilot test agreed with the effectiveness and appropriateness of the components of the intervention.

We developed a highly reliable and valid protection motivation theory-based health education intervention. Its proper implementation might raise students’ knowledge regarding smokeless tobacco and its effects and enhance their skills to prevent its use.

The online version contains supplementary material available at 10.1186/s12889-025-26000-0.