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International Journal of Adolescent Medicine and Health

Editor-in-Chief: Merrick, Joav

Editorial Board: Birch, Diana ML / Blum, Robert W. / Greydanus, MD, Dr. HC (Athens), Donald E. / Hardoff, Daniel / Kerr, Mike / Levy, Howard B / Morad, Mohammed / Omar, Hatim A. / de Paul, Joaquin / Rydelius, Per-Anders / Shek, Daniel T.L. / Sher, Leo / Silber, Tomas J. / Towns, Susan / Urkin, Jacob / Verhofstadt-Deneve, Leni / Zeltzer, Lonnie / Tenenbaum, Ariel

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Using theory of planned behavior for prediction of delivery mode among pregnant women: a theory-based cross-sectional research

Mohtasham Ghaffari
  • Environmental and Occupational Hazards Control Research Center, School of Public Health, Shahid Beheshti University of Medical Sciences, Tehran, Iran
  • Other articles by this author:
  • De Gruyter OnlineGoogle Scholar
/ Atefeh Afshari / Sakineh Rakhshanderou
  • Environmental and Occupational Hazards Control Research Center, School of Public Health, Shahid Beheshti University of Medical Sciences, Tehran, Iran
  • Other articles by this author:
  • De Gruyter OnlineGoogle Scholar
/ Bahram Armoon
  • Corresponding author
  • Infertility and Reproductive Health Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran, Phone/Fax: +982122432040-41
  • Email
  • Other articles by this author:
  • De Gruyter OnlineGoogle Scholar
Published Online: 2017-11-23 | DOI: https://doi.org/10.1515/ijamh-2017-0106



Nowadays, in Iran cesarean rates have increased from the recommended level of the World Health Organization (WHO).


The objective of the present study was to determine which theory of planned behavior (TPB) constructs predict intentions and delivery mode among pregnant women.


One hundred and four pregnant nulliparous women in their third trimesters of pregnancy referred to Semirom health care centers were investigated based on census reports. The data were collected by valid and reliable questionnaire based on the TPB constructs and analyzed by SPSS16.


In examining predictors using linear regression analysis to choose normal vaginal delivery (NVD), all constructs of TPB, including attitude toward NVD (p < 0.0001), subjective norms (p < 0.05) and perceived behavioral control (p < 0.001) were significantly correlated. Finally, after telephone follow-up with the women who had delivered newborns on their delivery method, it was found that 71.15% had a NVD and 28.14% had a cesarean delivery.


Regarding the effect of attitude to NVD, subjective norms and perceived behavioral control in NVD intention and its crucial role in anticipating the final delivery method, it is recommended considering these constructs in designing educational interventions for safe delivery in the investigated area.

Keywords: cesarean; normal vaginal delivery; theory of planned behavior


  • [1]

    Cunningham F, leveno KJ, Bloom SL, Hauth JC, Rouse DJ, Spong CY. Abortion. Williams obstetrics. New York: McGraw Hill, 2010.Google Scholar

  • [2]

    Gibbons L, Belizán JM, Lauer JA, Betrán AP, Merialdi M, Althabe F. The global numbers and costs of additionally needed and unnecessary caesarean sections performed per year: overuse as a barrier to universal coverage. World Health Rep. 2010;30:1–31.Google Scholar

  • [3]

    Laluei A, Kashanizadeh N, Teymouri M. The influence of academic educations on choosing preferable delivery method in obstetrics medical team: investigating their viewpoints. Int J Med Educ. 2009;9(1):69–78.Google Scholar

  • [4]

    World Health Statistic. Available from: http://www.who.int/gho/publications/world_health_statistics/EN_WHS2012_Full.pdf. [Accessed May 4, 2013]. 2012.Google Scholar

  • [5]

    Statistics of Iranian Ministry of Health. Health, Care and Education Office. Available from: http://behdasht.gov.ir/. [Accessed May 4, 2012]. 2011.Google Scholar

  • [6]

    Harper MA, Byington RP, Espeland MA, Naughton M, Meyer R, Lane K. Pregnancy-related death and health care services. Obstet Gynecol. 2003;102(2):273–8.PubMedGoogle Scholar

  • [7]

    Landon MB, Hauth JC, Leveno KJ, Spong CY, Leindecker S, Varner MW, et al. Maternal and perinatal outcomes associated with a trial of labor after prior cesarean delivery. N Engl J Med. 2004;351(25):2581–9.CrossrefPubMedGoogle Scholar

  • [8]

    Dietz H, Lanzarone V, Simpson J. Predicting operative delivery. Ultrasound Obstet Gynecol. 2006;27(4):409–15.CrossrefPubMedGoogle Scholar

  • [9]

    Fenwick J, Gamble J, Hauck Y. Believing in birth–choosing VBAC: the childbirth expectations of a self-selected cohort of Australian women. J Clin Nurs. 2007;16(8):1561–1570.PubMedCrossrefGoogle Scholar

  • [10]

    Fathian Z, Sharifirad GR, Hasanzadeh A, Fathian Z. Study of the effects of behavioral intention model education on reducing the cesarean rate among pregnant women of Khomeiny-Shahr, Isfahan, in 2006. Zahedan J Res Med Sci. 2007;9(2):123–31.Google Scholar

  • [11]

    Fenwick J, Gamble J, Hauck Y. Believing in birth–choosing VBAC: the childbirth expectations of a self-selected cohort of Australian women. J Clin Nurs. 2007;16(8):1561–70.PubMedCrossrefGoogle Scholar

  • [12]

    Bernstein SN, Matalon-Grazi S, Rosenn BM. Trial of labor versus repeat cesarean: are patients making an informed decision? Am J Obstet Gynecol. 2012;207(3):201–6.Web of ScienceGoogle Scholar

  • [13]

    Lowe RH, Frey JD. Predicting Lamaze childbirth intentions and outcomes: an extension of the theory of reasoned action to a joint outcome. Basic Appl Soc Psych. 1983;4(4):353–72.CrossrefGoogle Scholar

  • [14]

    Mohammadpourasl A, Asgharian P, Rostami F, Azizi A, Akbari H. Investigating the choice of delivery method type and its related factors in pregnant women in Maragheh. Knowledge Health. 2009;4(1):36–9.Google Scholar

  • [15]

    Negahban T, Ansari Jaberi A, Kazemi M. Preference method of delivery and it’s relevant causes in view of pregnant women referring to public and private clinics in Rafsanjan city. JRUMS. 2006;5(3):161–8.Google Scholar

  • [16]

    Pakenham S, Chamberlain SM, Smith GN. Women’s views on elective primary caesarean section. J Obstet Gynaecol Can. 2006;28(12):1089–94.CrossrefPubMedGoogle Scholar

  • [17]

    Ridley RT, Davis PA, Bright JH, Sinclair D. What influences a woman to choose vaginal birth after cesarean? J Obst Gyn Neo. 2002;31(6):665–72.CrossrefGoogle Scholar

  • [18]

    Sharifirad GR, Fathian Z, Tirani M, Mahaki B. Study on behavioral intention model (BIM) to the attitude of pregnant women toward normal delivery and cesarean section in province of Esfahan–Khomeiny shahr-1385. J Ilam Univ Med Sci. 2007;15(1):19–23.Google Scholar

  • [19]

    Smart DA. Attitudes, social support, and self-efficacy (ASE): a predictive model for vaginal birth intentions. Loma Linda: Loma Linda University; 2004.Google Scholar

  • [20]

    Fardi AZ, Jafari SM. A survey for determining factors on women’s attitudes toward vaginal and cesarean delivery. Med J Tabriz Univ Med Sci. 2003;59(3):66.Google Scholar

  • [21]

    Fathian Z, Sharifirad GR, Fathian Z, Pezeshkihebi F. Frequency of cesarean section and its related factors in Khomeinyshahr-Isfahan province 2005. Health Serv Res. 2011;6(4):786–93.Google Scholar

  • [22]

    Fertman CI, Allensworth DD. Health promotion programs: from theory to practice. Hoboken, NJ: John Wiley & Sons; 2010.Google Scholar

  • [23]

    Francis JJ, Eccles MP, Johnston M, Walker A, Grimshaw J, Foy R, et al. Constructing questionnaires based on the theory of planned behaviour. Newcastle upon Tyne, UK: Centre for Health Services Research, University of Newcastle upon Tyne; 2004.Google Scholar

  • [24]

    Glanz K, Rimer BK, Viswanath K. Health behavior and health education: theory, research, and practice. Hoboken, NJ: John Wiley & Sons; 2008.Google Scholar

  • [25]

    Hajian S, Vakilian K, Shariati M, Esmaeel AM. Attitude of pregnant women, midwives, obstetricians and anesthesiologists toward mode of delivery: a qualitative study. Payesh. 2011;10(1):39–48.Google Scholar

  • [26]

    Kringeland T, Daltveit AK, Møller A. How does preference for natural childbirth relate to the actual mode of delivery? A population-based cohort study from Norway. Birth. 2010;37(1):21–7.CrossrefWeb of SciencePubMedGoogle Scholar

  • [27]

    Saffari M, Shojaeizadeh D, Ghofranipour F, Heydarnia A, Pakpour A. Health education and promotion-theories, models and methods. Tehran, Iran: Sobhan Publication; 2009. p. 55–7.Google Scholar

  • [28]

    Yari P, Abadi A, Eetemad K. Study of effective factors on delivery mode selection in pregnant women referring in to the Tehran hospitals. J Knowledge Health. 2010;5(1):130–5.Google Scholar

  • [29]

    Chu K-H, Tai C-J, Hsu C-S, Yeh M-C, Chien L-Y. Women’s preference for cesarean delivery and differences between Taiwanese women undergoing different modes of delivery. BMC Health Serv Res. 2010;10(1):1.Web of ScienceGoogle Scholar

About the article

Received: 2017-06-27

Accepted: 2017-07-16

Published Online: 2017-11-23

Compliance with ethical standards

Conflict of interests: All other authors had no conflicts of interest to be declared.

Informed consent: Informed consent was obtained from all individual participants included in the study.

Ethical approval: All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. This study was approved by the Ethical Committee of Shahid Beheshti University of medical sciences (code:116).

Authors’ contributions: MGh and BA helped in study design. SR and AL helped in analysis and interpretation of data. AA and BA drafted the manuscript. SR and MGh helped in critical revision of the manuscript.

Citation Information: International Journal of Adolescent Medicine and Health, 20170106, ISSN (Online) 2191-0278, DOI: https://doi.org/10.1515/ijamh-2017-0106.

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