Journal of Preventive Medicine

Extended Abstract
Introduction
Childhood is one of the most important stages of life, the quality of which is directly related to the quality of life (QoL) and well-being of people in adulthood. The wide and frequent reflection of incidents caused by child abuse shows that child abuse is a pervasive social problem that has disastrous effects. Diagnosing child abuse in cases of clear physical symptoms is not a difficult task, but about 60% of children who suffer from sexual abuse do not have any obvious physical symptoms; thus, the need to have sufficient awareness in this field cannot be denied. Comprehensive health service centers are a good place to identify children at risk because they are in an ideal position to help children and protect them from harm, they face the child in a more specialized way and have the opportunity to observe and obtain strong evidence about the nature of the injuries. This shows the importance of the role of activists in this field in diagnosing and reporting cases of abuse, as well as the importance of empowering them to recognize the signs of child abuse. Formulation and development of educational programs for health care workers can be an effective step towards identifying and treating victims of violence. In order to obtain effective results, education must be principled and based on defined theories and models. According to the results of different studies, the PROCEED model provides a framework, by which predisposing, reinforcing, and enabling factors are determined as factors affecting behavior in educational diagnosis. This study was conducted with the aim of determining the effect of training based on the PROCEED model on the empowerment of health care workers in identifying cases of child abuse in 2017.
Methods
The current study was a semi-experimental interventional study with a pre-test post-test design and intervention and control groups. In this research, the study population consisted of health care workers working in the health centers of Semnan city. Simple random sampling was done; first, a list of health centers in Semnan was prepared, and then, among the 14 health centers, the healthcare workers of seven health centers were randomly selected as the intervention group and the healthcare workers of the other seven health centers were considered as the control group. Sampling in each center was done based on the inclusion criteria, and 44 health care workers were considered for each of the intervention and control groups. Data were collected before the intervention and one month after the intervention and analyzed by SPSS v. 22 software. 
The data collection tool was a researcher-made questionnaire based on the constructs of the PROCEED model, which was compiled by researchers and approved by a panel of experts. The validity of the questionnaire was verified using the content validity method. The test-retest method was used to determine reliability. According to the information obtained from the pre-test results, the educational content was designed based on the constructs of the PROCEED model and implemented for the intervention group in four sessions of 60 minutes. Ethical considerations, including maintaining the confidentiality of data and obtaining the consent of the participants to participate in the study, were observed and approved by receiving the code of ethics from the Science and Research Branch, Islamic Azad University, Tehran.
Results 
Health care providers in both the intervention and control groups were 16% male and 84% female. The average age in the intervention group was 35±8.48 years and in the control group was 33±7.14 years. The highest frequency in the intervention and control groups was related to married people. In terms of being a parent, the highest frequency in the intervention and control groups was related to the group with children. Regarding the level of education, the highest frequency in the intervention and control groups was related to bachelor’s degrees. In terms of employment status, the highest frequency in the intervention and control groups was related to contract workers. 
Regarding knowledge as the most important predisposing factor in the PROCEED model, the results showed that healthcare workers in Semnan had good knowledge about child abuse and the average score of knowledge of healthcare workers was 14.17 out of 19. Also, the attitude of health care workers regarding child abuse was favorable and the average total score of attitude was 47.17 out of 56. 
After the educational intervention, the average scores of awareness (P<0.001), attitude (P<0.001), reinforcing factors (P=0.001), and enabling factors (P<0.05) in the intervention group showed a significant increase compared to the control group. The difference between the average score of the behavior in the two intervention and control groups was not significant before the intervention, but after the implementation of the educational intervention, the average score of the behavior increased and the difference between the two intervention and control groups became significant (P<0.001).
Discussion 
The findings of this research showed that the design and implementation of an educational program based on the PROCEED model are effective in changing predisposing factors (awareness and attitude), reinforcing factors, enabling factors, and behavior in identifying cases of child abuse by health care workers. Because in this model, with the educational and ecological diagnosis and determination of the factors affecting the behavior, it is expected that the recommended behavior will be done and it can be used as a framework for designing interventions for training employees. Although it is very difficult to change the enabling factors only through education and it requires more time and additional support along with education, the role of educational interventions in increasing the level of awareness, attitude, and performance of people is very prominent. If these interventions are carried out in a scientific and planned manner through comprehensive models, including the PROCEED model, and also spending enough time, it will certainly have better results, because models, such as the PROCEED model create a systematic movement to carry out healthy behavior in the individual.
Ethical Considerations
Compliance with ethical guidelines
Ethical approval was received for this study from the Ethics Committee of the Science and Research Branch, Islamic Azad University (IR.IAU.SRB.REC.1396.55).
Funding
This research is taken from the thesis of Fatemeh Arab Zainali, a master's student in health education, faculty of medical sciences, Science and Research Branch, Islamic Azad University, and she did not have a financial sponsor and all expenses were borne by the student.
Authors' contributions
Data collection, statistical analysis and article writing: Fatemeh Arab Zainli; Cooperation in writing and revising the article: Reza Tavakoli; Study design: Fatemeh Arab Zainli, Reza Tavakoli; Read and approved the final manuscript: All authors.
Conflicts of interest
The authors declared no conflict of interest.
Acknowledgements
The authors of this article acknowledge and thank the Science and Research Branch, Islamic Azad University. Also, they thank all the participants in this research.
 

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