Journal of Preventive Medicine

Introduction
Malaria is one of the most important infectious parasitic diseases and one of the important health issues in tropical countries. This disease is transmitted to humans by the Anopheles mosquito. Hormozgan Province, ranks second after Sistan and Baluchestan Province in terms of the number of malaria cases in Iran. Although there are treatments for malaria, due to the economic burden on the society and the severe pain and suffering experienced by the patient, it is better to use preventive measures. By identifying the predictors of malaria prevention behaviors, it can help to prevent and control this disease. Health education is one of the main priorities in malaria prevention. Among the effective models in disease prevention is the health belief model (HBM).
Considering that Parsian City located in the west of Hormozgan Province, south of Iran, is currently under the malaria elimination program, and given than there has been a possibility of malaria disease in this city from the past years until now, due to the presence of Afghan immigrants (who are one of the groups at risk of malaria) and the weather conditions, a study in this field in Parsian City seems necessary. Knowing the predictors of preventive behaviors against malaria can be effective in formulating educational programs and improving behavior. Therefore, this study was aims to find the factors predicting the preventive behaviors against malaria in Afghan immigrants living in Parsian City based on the HBM.

Methods
This cross-sectional study was conducted in 2023. The study population consisted of all Afghan immigrants aged >15 years referred to comprehensive health service centers in Parsian City. Of these, 200 immigrants were randomly selected from the list of files available in the SIB system and the questionnaires were completed by them. Those aged >15 years and lived in Parsian City for at least 6 months were included, and those who did not fill out the questionnaires were excluded. The data collection tool was a researcher-made questionnaire with four sections. The first section surveys 8 demographic factors; the second section includes questions about the knowledge of malaria disease and its prevention methods (11 items with a total score of 0-11); the third section includes questions related to the HBM constructs (perceived sensitivity, perceived severity, perceived benefits, perceived barriers, self-efficacy, cues for action); the fourth section included questions about preventive behaviors against malaria. The collected data were analyzed using descriptive statistics, correlation test, and linear regression analysis in SPSS software, version 25. The significance level was set at 0.05.

Results
Most of the participants were female, illiterate, aged 25-35 years, and housekeeper. They obtained the highest score in the variables of perceived barriers, perceived benefits, and knowledge, while the variables of behavior, self-efficacy and perceived severity showed the lowest scores. The results of Spearman correlation test showed is a significant correlation between all HBM constructs and malaria prevention behaviors (P<0.001). Linear regression analysis was used to find the predictors of malaria prevention behaviors based on the HBM constructs. The results showed that self-efficacy, perceived benefits, and perceived severity were the significant predictors of malaria prevention behaviors, where self-efficacy was a stronger predictor than perceived benefits and perceived severity. These constructs predicted 57% of the variance in malaria prevention behaviors of Afghan immigrants.

Conclusion
Self-efficacy, perceived benefits, and perceived severity are the significant predictors of malaria prevention behaviors of Afghan immigrants in Parsian City. The higher the self-efficacy, the more likely it is to perform malaria prevention behaviors. To adopt a preventive behavior, a person must find out the benefit in having the behavior and look for a behavior that is beneficial, feasible and effective. Highlighting the benefits through education is essential to promote preventive behaviors. By reducing the obstacles, it is possible to increase the self-efficacy of people to adopt a healthy behavior. The low level of perceived severity is the main obstacle. Hence, it should be considered and improved. It can be concluded that the HBM is capable of predicting malaria prevention behaviors in Afghan immigrants. The findings of this study can be used in the design of suitable intervention programs for malaria prevention in immigrants.

Ethical Considerations
Compliance with ethical guidelines
Ethical approval of this study was received from the Ethics Committee of Hormozgan University of Medical Sciences, Bandar Abbas, Iran (Code: IR.HUMS.REC.1402.153). Written informed consent was obtained from the people who participated in this study. The authors confirm that all methods are in accordance with the relevant guidelines and regulations.

Funding
This study received financial support from Deputy of Research, Hormozgan University of Medical Sciences, Bandar Abbas, Iran (Grant No.: 4020220).

Authors' contributions
All authors equally contribute to preparing all parts of the research.

Conflicts of interest
The authors declared no conflicts of interest.

Acknowledgements
The authors would like to acknowledge the financial support of the Hormozgan University of Medical Sciences, Bandar Abbas, Iran. 


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