Enhancing Hepatitis B and C Prevention Among People Who Use Drugs: Evaluating an Educational Intervention at a Drop-In Center in Southwest Iran based on Protection Motivation Theory.

BACKGROUND: Substance abuse, particularly injection drug use, remains a significant public health challenge in Iran, where an estimated 2 million people use illicit drugs daily. Injection drug users are at high risk for bloodborne infections such as hepatitis B and C, which contribute substantially to morbidity and mortality in this population. Understanding individual factors that influence risky behaviors through frameworks like the Protection Motivation Theory (PMT) is essential for effective prevention. This study aimed to assess the impact of a PMT-based educational intervention on reducing hepatitis B and C risk behaviors among addicts attending Drop-In Centers (DICs) in Iran. METHOD: A quasi-experimental study was conducted on 101 injection drug users registered with the Drop-in Center (DIC) in southwest Iran. Participants were selected via census sampling and randomly assigned to intervention (n = 50) and control (n = 51) groups. Data were collected using a validated, researcher-designed questionnaire based on PMT, measuring constructs including knowledge, attitude, perceived vulnerability and severity, self-efficacy, maladaptive rewards, response costs, and protective behaviors. The intervention consisted of eight educational sessions over two months, designed to target these PMT constructs through lectures, discussions, role-playing, and problem-solving. Pre- and post-intervention questionnaires were administered to both groups, and data were analyzed using paired and independent t-tests, chi-square, and McNemar's tests via SPSS version 27. RESULTS: At baseline, there was no significant difference between the intervention and control groups in mean scores of knowledge, attitude, perceived vulnerability, perceived severity, perceived self-efficacy, perceived maladaptive rewards, perceived response costs, and behavior (p > 0.05). However, after the intervention, a significant difference was observed in the constructs of the model in the intervention group compared to the control group (p < 0.001), with large between-group effect sizes ranging from d = 1.45 to 6.36, indicating a substantial impact of the intervention on all PMT constructs. CONCLUSION: The PMT-based educational intervention significantly improved hepatitis B and C preventive behaviors among injecting drug users. These findings suggest that theory-driven, low-cost educational programs grounded in behavioral science can be effectively integrated into harm reduction services among high-risk, marginalized populations. Future studies should assess long-term sustainability, replicate results in diverse and larger settings, and validate outcomes using objective behavioral measures to support broader implementation and policy integration.