Cutaneous Leishmaniasis (CL) is a skin infection that is still a major global health problem, especially in tropical and subtropical countries. CL, which is considered a neglected disease, is becoming more prevalent worldwide [1]. The disease is endemic in more than 98 countries [2], and 12 million people are infected with the disease worldwide, 350 million people are at risk [3,4,5,6,7], and every year, 1.5 million new cases of CL [5, 8] and 20,000 to 40,000 deaths due to this disease occur. [9, 10].
Iran is among the first ten countries in the world based on the number of cases [11]. According to WHO's report in 2017, more than 95% of new cases of CL occurred in Afghanistan, Algeria, Brazil, Colombia, Iran, Iraq, and Syria. [6, 12].
In Iran, CL is an important disease that is endemic in 18 provinces [13].In this country, more than 22,000 cases of leishmaniasis are being annually reported 80% of which are zoonotic CL [14]; however, the true number of infected cases is always 4 to 5 times more than the reported and recorded cases because of fear of treatment, and spontaneous improvement in patients, [15].
Comparison of statistics of CL in Iranian provinces indicates that it has the highest prevalence in Isfahan, Fars, and Khorasan provinces [16].For example, Jarghouyeh located in the east of Isfahan is among this province regions in which CL is highly prevalent [17].
This disease can cause many problems for patients, including psychological consequences due to prolonged wound period, the development of undesirable scars on the face, the possibility of secondary infections, the high cost of treatment for the society, the long treatment period, and side effects of treatment with existing drugs [18].
Researchers' failure to develop vaccines for CL and its high prevalence have made health education the top priority of WHO [19].
Numerous studies have also emphasized the importance of health education and public participation in the prevention of CL [2, 20]. Many researchers have suggested other disease control and prevention programs such as vaccine and drug production, environmental improvement, the extermination of mice, and poison spraying along with health education programs [7].
A major contributing factor to the development of this disease is that most people living in endemic areas don’t have enough knowledge about the way in which the disease transmission is prevented. Various studies have found that the public’s knowledge about CL is low [21, 22].This is a serious alarm because the necessary and correct information is the first and the most fundamental step towards any proper behavior [22].
The results of some studies suggest that instead of authentic resources, people obtain their information from family members, neighbors, and friends who are likely to convey incomplete information and misconceptions to people in society. [3, 23].
Attitude and beliefs of people living in endemic regions of CL need to be corrected or changed. For example, some people wrongly believe that mosquitoes transmitting CL are only present in regions and houses in which dogs and sheep are kept, suitable emollient creams and perfumes can prevent CL, and luck and God's wrath play roles in developing CL, etc. [24].
A very effective factor, which helps students living in endemic areas of leishmaniasis pursue CL preventive behaviors, is how much family, friends, classmates, health workers, principals, teachers, and educators take care to perform such behaviors. Family, friends, classmates, and teachers can play a major role in the process of behavior change in students.
A barrier to CL prevention behaviors is that even if people are encouraged to perform the behavior by education, some environmental limitations, such as lack of preventive tools, including proper netting and mosquito nets, insect repellent pen, etc. can prevent them from adopting appropriate behavior. [25].
Young groups and 10 to 15-year-old students are the most vulnerable groups to CL in the endemic areas. [26] In a study in Morocco, the children's face lesions were more than adults’ [27].
Given that students are the most vulnerable group to this disease and the most accessible group who can, by education, improve knowledge, attitude, and ultimately health behaviors of families, they were selected as the target group of the current study.
The selection of a model or theory is the most important measure taken in educational planning. A model or theory should be based on circumstances, problem, and alignment, and the quality of model/theory to be efficient and convergent with the purpose of the education program [28].
Since that the above-mentioned factors relating to CL preventive behaviors include:attitude, subjective norm, enabling factors, and behavioral intention, the researchers came to the conclusion that a suitable educational intervention can be designed and implemented to teach students to adopt CL preventive behaviors using the BASNEF model. (Fig. 1) [23].
Therefore, the present study aimed to investigate the effect of educational intervention based on the BASNEF model on CL prevention behaviors in male first-grade high school students in the east Isfahan.