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Learn more: PMC Disclaimer | PMC Copyright Notice Invest Educ Enferm . 2026 Mar 30;44(1):e11. doi: 10.17533/udea.iee.v44n1e11 Search in PMC Search in PubMed View in NLM Catalog Add to search Show available content in en es pt Effect of a teaching intervention based on planned behavior theory on female nurses' preventive behaviors towards the osteoporosis. A quasi-experimental study or a randomized controlled trial El efecto de una intervención docente basada en la teoría del comportamiento planificado sobre los comportamientos preventivos de las enfermeras frente a la osteoporosis. Un estudio cuasiexperimental O efeito de uma intervenção pedagógica baseada na teoria do comportamento planejado nos comportamentos preventivos das enfermeiras em relação à osteoporose. Um estudo quase experimental. Ali Dehghani Ali Dehghani 4 Department of Community Health Nursing, School of Nursing, Jahrom University of Medical Sciences, Jahrom, Iran. Department of Community Health Nursing, School of Nursing, Jahrom University of Medical Sciences, Jahrom , Iran 5 Department of Nursing, School of Nursing and Midwifery, Shiraz University of Medical Sciences, Shiraz, Iran. Department of Nursing, School of Nursing and Midwifery, Shiraz University of Medical Sciences, Shiraz , Iran Find articles by Ali Dehghani 4, 5, 1 , Farzaneh Afrough Jahromi Farzaneh Afrough Jahromi 2 M.Sc. Email: [email protected] https://orcid.org/0000-0001-5237-9102, Email: [email protected] 4 Department of Community Health Nursing, School of Nursing, Jahrom University of Medical Sciences, Jahrom, Iran. Department of Community Health Nursing, School of Nursing, Jahrom University of Medical Sciences, Jahrom , Iran Find articles by Farzaneh Afrough Jahromi 2, 4 , Zohreh Badiyepeymaiejahromi Zohreh Badiyepeymaiejahromi 3 Ph.D. Associate professor. Email: [email protected]. https://orcid.org/0000-0001-6643-036X, Email: [email protected] 4 Department of Community Health Nursing, School of Nursing, Jahrom University of Medical Sciences, Jahrom, Iran. Department of Community Health Nursing, School of Nursing, Jahrom University of Medical Sciences, Jahrom , Iran Find articles by Zohreh Badiyepeymaiejahromi 3, 4 Author information Article notes Copyright and License information 2 M.Sc. Email: [email protected] https://orcid.org/0000-0001-5237-9102, Email: [email protected] 3 Ph.D. Associate professor. Email: [email protected]. https://orcid.org/0000-0001-6643-036X, Email: [email protected] 4 Department of Community Health Nursing, School of Nursing, Jahrom University of Medical Sciences, Jahrom, Iran. Department of Community Health Nursing, School of Nursing, Jahrom University of Medical Sciences, Jahrom , Iran 5 Department of Nursing, School of Nursing and Midwifery, Shiraz University of Medical Sciences, Shiraz, Iran. Department of Nursing, School of Nursing and Midwifery, Shiraz University of Medical Sciences, Shiraz , Iran 1 Ph.D. Professor. Email: [email protected] ; [email protected]. Corresponding Author. https://orcid.org/0000-0002-1768-1856 Received 2025 Sep 23; Accepted 2026 Feb 13; Collection date 2026 Jan-Apr. This is an open-access article distributed under the terms of the Creative Commons Attribution License PMC Copyright notice PMCID: PMC13078826 PMID: 41980252 Abstract Objective. Examine the effect of a teaching intervention based on planned behavior theory on female nurses' preventive behaviors toward osteoporosis. Methods. In this quasi-experimental study, 100 female nurses working at two hospitals affiliated with Jahrom University of Medical Sciences in southern Iran were place in the intervention and control groups. Data were collected using a questionnaire that included demographic information and constructs of planned behavior theory. Data were collected in three phases: pretest, posttest one month after the teaching intervention, and posttest two months after the teaching intervention. Four sessions of 45-60 min training program were held within the period of a month for the experimental group at classrooms equipped with a video projector and whiteboard. No intervention was given to the control group. Results. The findings showed that the intervention and control groups were similar in terms of demographic variables before the intervention. There were significant differences in the means of attitude, abstract norms, behavioral intent, and preventive behavior in the intervention group compared to the control group one and two months after the teaching intervention ( p <0.05). However, the mean perceived control of behavior did not differ significantly between the intervention and control groups ( p =0.15). In the control group, the means of attitude, abstract norms, behavioral intent, and behavior did not differ significantly regarding osteoporosis prevention one and two months after the intervention compared to before the teaching intervention ( p >0.05). The intervention had small effects on attitudes (Partial eta squared: η²p = 0.025 to 0.047), moderate effects on perceived behavioral control (η²p = 0.038 to0.054) and behavioral intention (η²p = 0.116 to 0.126), large effects on abstract norms (η²p = 0.282 to 0.295), and very large effects on behavior (η²p = 0.365 to 0.498). Conclusion. According to the results of this study, planned behavior theory may influence the preventive behavior of osteoporosis in female nurses. Therefore, this theory could serve as a framework for designing and conducting teaching interventions to prevent osteoporosis and promote health in women. Descriptors: osteoporosis; health behavior; education, nursing; theory of planned behavior; nurses. Resumen Objetivo. Examinar el efecto de una intervención docente basada en la teoría del comportamiento planificado sobre los comportamientos preventivos de las enfermeras frente a la osteoporosis. Métodos. En este estudio cuasi-experimental, 100 enfermeras que trabajaban en dos hospitales afiliados a la Universidad de Ciencias Médicas de Jahrom (sur de Irán), fueron asignadas aleatoriamente al grupo de intervención o al grupo de control. La intervención educativa consistió en cuatro sesiones de un programa de entrenamiento de 45-60 minutos de duración durante un mes para el grupo experimental. No se realizó ninguna intervención con el grupo de control. Los datos se recopilaron mediante un cuestionario que incluía información demográfica y preguntas sobre los constructos de la teoría del comportamiento planificado. Los datos se recopilaron en tres fases: basal, un mes y dos meses después de la intervención educativa. Resultados. Los hallazgos mostraron que los grupos de intervención y control eran similares en términos de variables demográficas antes de la intervención. Se observaron diferencias significativas en las medias de actitud, normas abstractas, intención conductual y comportamiento preventivo en el grupo de intervención en comparación con el grupo de control uno y dos meses después de la intervención educativa ( p <0.05). Sin embargo, la media del control percibido del comportamiento no difirió significativamente entre los dos grupos de studio ( p =0.15). En el grupo de control, las medias de actitud, normas abstractas, intención de comportamiento y comportamiento no difirieron significativamente en cuanto a la prevención de la osteoporosis uno y dos meses después de la intervención (p>0.05). La intervención tuvo efectos pequeños en las actitudes (Partial eta squared: η²p =0.025 a 0.047), efectos moderados en el control conductual percibido (η²p=0.038 a 0.054) y en la intención conductual (η²p=0.116 a 0.126), efectos grandes en las normas abstractas (η²p=0.282 a 0.295), y efectos muy grandes en el comportamiento (η²p=0.365 a 0.498). Conclusión. Según los resultados de este estudio, la teoría del comportamiento planificado puede influir en el comportamiento preventivo ante la osteoporosis en las enfermeras. Por lo tanto, esta teoría podría servir como marco para diseñar y llevar a cabo intervenciones docentes para prevenir la osteoporosis y promover la salud en las mujeres. Descriptores: osteoporosis, conductas relacionadas con la salud, educación en enfermería, teoría del comportamiento planificado, enfermeras y enfermeros Resumo Objetivo. Examinar o efeito de uma intervenção pedagógica baseada na teoria do comportamento planejado nos comportamentos preventivos de enfermeiras em relação à osteoporose. Métodos. Neste estudo quase experimental, 100 enfermeiras que trabalham em dois hospitais afiliados à Universidade de Ciências Médicas de Jahrom, no sul do Irã, foram colocadas nos grupos de intervenção e controle. Os dados foram coletados por meio de um questionário que incluía informações demográficas e conceitos da teoria do comportamento planejado. Os dados foram coletados em três fases: pré-teste, pós-teste um mês após a intervenção de ensino e pós-teste dois meses após a intervenção de ensino. Quatro sessões de um programa de treinamento de 45 a 60 minutos foram realizadas no período de um mês para o grupo experimental em salas de aula equipadas com um projetor de vídeo e quadro branco. Nenhuma intervenção foi realizada no grupo controle. Resultados. Os resultados mostraram que os grupos de intervenção e controle eram semelhantes em termos de variáveis demográficas antes da intervenção. Houve diferenças significativas nas médias de atitude, normas abstratas, intenção comportamental e comportamento preventivo no grupo de intervenção em comparação com o grupo controle um e dois meses após a intervenção de ensino ( p <0.05). No entanto, a média do controle percebido do comportamento não diferiu significativamente entre os grupos de intervenção e controle ( p =0.15). No grupo controle, as médias de atitude, normas abstratas, intenção comportamental e comportamento não diferiram significativamente em relação à prevenção da osteoporose um e dois meses após a intervenção em comparação com antes da intervenção de ensino ( p >0.05). A intervenção teve pequenos efeitos nas atitudes (eta quadrado parcial: η²p=0.025 a 0.047), efeitos moderados no controle comportamental percebido (η²p=0.038 a 0.054) e na intenção comportamental (η²p=0.116 a 0.126), efeitos grandes nas normas abstratas (η²p=0.282 a 0.295) e efeitos muito grandes no comportamento (η²p=0.365 a 0.498). Conclusão. De acordo com os resultados deste estudo, a teoria do comportamento planejado pode influenciar o comportamento preventivo da osteoporose em enfermeiras. Portanto, essa teoria poderia servir como uma estrutura para projetar e conduzir intervenções de ensino para prevenir a osteoporose e promover a saúde nas mulheres. Descritores: osteoporose, comportamentos relacionados com a saúde, educação em enfermagem, teoria do comportamento planejado, enfermeiras e enfermeiros Introduction Osteoporosis is a systemic disease. It causes decreased bone mass and bone destruction. 1 This disease is the most common among bone metabolic diseases. It results in bone fragility. 2 Osteoporosis is defined by reduced height, kyphosis, fractures, and respiratory disorders in older age groups. 3 Osteoporosis is affected by various factors, including environmental, genetic, and lifestyle factors. 4 It is clear that as life expectancy and life span increase, so does the prevalence of osteoporosis and related fractures. 5 Women are undeniably exposed to osteoporosis eight times more than men. 6 The number of osteoporosis-related fractures in the European Union is projected to rise from 4.3 million in 2019 to 5.3 million in 2034. 1 Osteoporosis affects 10-30% of women over 40 years old and 10% of men in seven developed countries in Asia and Oceania. 5 A study in Iran reported the following: 32% of women had osteoporosis, 51% had low bone density, and 32% had osteoporosis in the lumbar region, 21% in the vertebrae, 21% in the neck of the femur, and 21% in the hip joint. 7 According to a systematic review in Iran, prevalence of osteoporosis has been reported 38% in women and 25% in men. 8 Osteoporosis has significant effects on psychosocial functions including anxiety, depression, low independence in activity of daily living, and low self-esteem. Preventing this complication is important. 9 , 10 Various occupations affect health differently. Nursing is recognized as one of the high risk occupation with physical, psychological, and social tensions. 11 Nursing is inseparable of healthcare and includes health promotion, disease prevention and care of patients with physical and psychological disorders. Nurses have responsibility to response to problems in patients, people, families and groups. 12 Nurses’ health is at risk more than the general population. The World Health Organization in a study on stressful occupations reported that out of 130 occupations, nurses rank 27 in terms of health problems. 4 Studies have shown that nurses suffer from diseases such as musculoskeletal, cardiovascular, respiratory, infectious, and psychological diseases. These diseases are more common in female nurses than male ones. 13 Night shift could be the main factor for decreasing vitamin D resulting osteoporosis as they work in an environment without sunshine. Prospective studies have shown that working night shift more than 20 years is associated with increasing risk of hip and wrist factures. 14 , 15 Preventive strategies of osteoporosis include increasing bone density and minimizing trend of bone decreasing through health education and promotion. 16 Osteoporosis is preventable, as it is latent and not diagnosed until late stage. 3 Health education is central for any health activity. It is fundamental for health promotion. 17 Value and effectiveness of health education plans depend on proper using of theories. 18 Theories help health education planners to think beyond personal issues during need assessment and developing plan. 19 One of the related theories is planned behavior theory which could be effective in predicting health behaviors. According to this theory, the most important predictor of behavior management is intent for behavior, which consists of motivational factors affecting behavior. It is directed by three factors of 1. Attitude to behavior 2. Mental norms 3. Perceived control of behavior. These three factors predict intent of behavior. 20 Attitude reflects positive or negative evaluation of behavior. Mental norms refer to perceived pressure for doing or not doing. Perceived control of behavior is perception about easy or difficulty of performing behavior. Behavior intent indicates severity of will for performing behavior. 21 This theory has been employed in predicting and explaining various spectrum of behavior including diet behavior in students and adults, 16 , 22 physical activity, 23 banks, 24 construct industry, 25 preventive behavior in chronic conditions. 26 , 27 Studies showed that planned behavior theory result in maternal care, encouraging normal vaginal delivery. 26 , 28 This theory also results in improving osteoporosis behaviors in studies in female teachers 29 and on patients with type 2 diabetes. 27 Chronic conditions and osteoporosis are increasing in women, particularly nurses. Osteoporosis is preventable, and health education through planned behavior theory could predict and change health behavior. This study was conducted to examine the effect of teaching intervention based on planned behavior on preventive behaviors of osteoporosis in female nurses. Methods Type of study and sample. This is a quasi-experimental study, which was conducted on female nurses working at two Motahari and Seyed-shohada hospitals affiliated to Jahrom University of Medial Sciences (South of Iran) in month of 2024 to month of 2025. Sample size was calculated 50 in each group and 100 in total based on Altman Normogram 30 considering Standard difference= 0.85, confidence interval 95% and power 90%. 31 Inclusion criteria were female nurses aged 30 to 59 years, having at least one-year clinical working experience, not taking part in other experimental studies on osteoporosis, not taking part in workshop or teaching class about osteoporosis over past six months, not taking corticosteroid or other medications affecting osteoporosis, and not having osteoporosis. Exclusion criteria were not attending in the teaching sessions, being absentee more than two sessions, and not having willingness to continue the study. For recruitment, we obtained a list of female nurses from the nursing offices at Seyed-shohada (interventions group) and Motahari (control group) hospitals. Those who were eligible were then extracted from the primary list. Finally, 50 nurses from each hospital were selected using simple random sampling. The control group was selected from another hospital to minimize contamination bias. Data Collection Tools. In this study, data were collected using demographic and constructs of planned behavior theory questionnaires (attitude, abstract norms, perceived control of behavior, behavioral intent, and behavior). Data collection tool includes six demographic and background questions and a questionnaire consisting five parts: (i) attitude measurement : 15 questions, range of score 15 - 75 ; (ii) mental norms measurement : 8 questions, range of score 8 - 40; (iii) perceived control of behavior measurement : 6 questions, range of score 6 - 30; (iv) behavioral intent measurement: 8 questions, range of score 8 - 40; and (v) 8 questions related to behavior as once per day, twice or more per day, once per week, twice or more per week, and never with a range of score 8 - 40. Higher score in all dimensions indicates better behavior. Validity and reliability of this questionnaire have been reported in a study by Jalili et al . 32 For psychometrics of the questionnaire in Iran, after developing the questionnaire based on literature, it was given to 10 experts in health education and promotion. It was revised based on feedbacks from the experts. Then it was given to 20 women to complete. After 10 days, it was given to compete again. The reliability was obtained 0.79 using α of Cronbach and the content validity index was 0.72. Phases of this study. This study included three phases of pretest, planning and implementing teaching interventions based on planned behavior theory, and post-test one and two months after the teaching intervention: (i) Pretest phase. After obtaining consent from both control and interventions groups, and ensuring confidentiality of information, pretest was completed for both groups. After completing, pretest questionnaires were collected. Then teaching intervention was carried out including four teaching sessions based on planned behavior theory in the intervention group; (ii) Intervention’s phase. Teaching sessions were held in four 45 - 60 minute sessions by the investigator in a conference room for the intervention group. 32 , 33 Teaching tools were whiteboard, PowerPoint and pamphlet. For each session, behavioral objectives were identified, and various methods were employed including lecture, group discussion, and personal consultation. First session was held to change attitude in female nurses about osteoporosis, proper assessment of preventive behavior of osteoporosis. Second session was held to increase perceived pressure from the society and relatives about preventive behavior of osteoporosis. Third session was about specific ideas on what a person should perform in preventing osteoporosis. Forth session was about their intent in selecting preventive behavior of osteoporosis. 32 , 33 Before each session, teaching contents of previous session were reviewed. Teaching pamphlet was provided to female nurses. The control group did not receive any teaching: (iii) Post intervention phase. Follow up of nurses' behavior was carried out through telephone contact, texting, and consultation for two months after the intervention. Both groups completed the questionnaire of constructs of planned behavior theory one and two months after the teaching intervention. Data analysis. Data were analyzed using the SPSS 21. Shapiro-Wilk test was used to examine normality of data. Friedman test was used for comparison of preventive behavior of osteoporosis in the intervention and control groups, and Wilcoxon test was used for the two comparisons. Mann-Whitney U test was used to compare between the control and intervention groups. Significance was considered at 0.05. Results In this study, 100 female nurses took part in the intervention group (50 subjects) and control groups (50 subjects). Most nurses were under 40 years old in the intervention group (76%) and control group (72%). Results of analysis showed that there were not significant differences between the intervention and control groups in terms of demographic variables ( Table 1 ). Table 1. Comparison of Demographic variables in intervention and control groups . Variables Intervention group ( n =50) Control group ( n =50) Statistics χ 2 p -value Frequency Percent Frequency Percent Age in years Under 40 38 76 36 72 0.208 0.65 ≥ 40 12 24 14 28 Marital status Single 9 18 6 12 0.706 0.40 married 41 82 44 88 Education Bachelor 39 78 42 84 0.585 0.44 Master 11 22 8 16 History of osteoporosis No 35 70 38 76 0.457 0.50 Yes 15 30 12 24 Work history in years 0 - 10 17 34 9 18 3.44 0.18 11 - 20 18 36 24 48 ≥ 21 15 30 17 34 Open in a new tab Results of Friedman test showed that means of attitude, abstract norms, behavioral intent, and behavior about preventive behavior of osteoporosis differed significantly one and two months after the teaching intervention compared to before the intervention ( p <0.05) ( Table 2 ). In the control group, means of attitude, abstract norms, behavioral intent, and behavior about preventive behavior of osteoporosis were not significantly different one and two months after the teaching intervention compared to before the intervention ( p >0.05). Results of Mann-Whitney U showed that means of attitude, abstract norms, behavioral intent, and behavior were not significantly different between the control and intervention groups before the intervention ( p >0.05). One and two months after the intervention, there were significantly differences in means of attitude, abstract norms, behavioral intent, and behavior between the control and intervention groups ( p <0.001). One and two months after the intervention, means of attitude, abstract norms, behavioral intent and behavior were significantly greater in the intervention group compare to the control group. Table 2. Comparison of means of preventive behavior of osteoporosis between the intervention and control groups before, 1 month and 2 months after the intervention . Construct Time Intervention Group Control Group Statistics p -value * Mean SD Mean SD Attitude Before the intervention 60.12 5.76 54.94 12.46 -1.38 0.166 One month after the intervention 74.98 0.14 53.10 13.55 -5.76 < 0.001 Two months after the intervention 67.10 2.47 54.58 15.55 -4.05 < 0.001 Statistics 87.96 0.484 p -value ** < 0.001 0.785 Abstract Norms Before the intervention 27.64 4.04 28.96 4.28 -1.75 0.08 One month after the intervention 39.88 0.33 28.76 8.16 -8.56 < 0.001 Two months after the intervention 33.78 1.90 28.92 6.98 -3.95 < 0.001 Statistics 89.55 3.35 p -value ** < 0.001 0.187 Behavior control Before the intervention 15.88 4.20 16.68 3.29 -0.942 0.346 One month after the intervention 15.90 3.89 15.54 3.43 -0.135 0.893 Two months after the intervention 15.62 4.22 15.60 3.30 -0.031 0.975 Statistics 89.55 3.82 p -value ** 0.053 0.148 Behavioral Intent Before the intervention 28.12 4.67 28.04 5.35 -1.23 0.218 One month after the intervention 39.64 0.75 28.18 4.89 -1.24 0.046 Two months after the intervention 34.08 1.88 28.38 8.28 2.77 0.006 Statistics 85.84 2.90 p -value ** < 0.001 0.299 Behavior Before the intervention 21.86 2.20 22.54 3.32 -1.58 0.113 One month after the intervention 32.62 2.95 23.94 3.79 -7.85 < 0.001 Two months after the intervention 25.90 3.14 22.68 4.07 -4.19 < 0.001 Statistics 86.58 3.34 p -value ** < 0.001 0.188 Open in a new tab *Mann-Whitney U, ** Friedman In the intervention group, results of Wilcoxon test showed that means of attitude, abstract norms, behavioral intent, and behavior increased significantly one month after the intervention compared to before the intervention and two months after the intervention compared to before the intervention ( p <0.001). Mean of attitude in nurses decreased significantly two months after the intervention compared to before the intervention ( Table 3 ). Table 3. Comparison of means constructs of regarding preventive behavior of osteoporosis in the intervention group before, 1 month and 2 months after the intervention. Time Construct One month after the intervention--Two months after the intervention Before the intervention-Two months after the intervention Before the intervention-One month after the intervention Attitude Statistics 1.14 -1.86 -0.72 p -value * < 0.001 < 0.001 < 0.001 Abstract Norms Statistics 1.09 -1.88 -0.790 p -value * < 0.001 < 0.001 < 0.001 behavioral intent Statistics 0.690 -1.83 1.14 p -value * < 0.001 < 0.001 < 0.001 Behavior Statistics 1.100 -1.84 -0.740 p -value * < 0.001 < 0.001 < 0.001 Open in a new tab *Wilcoxon test A mixed-design ANOVA was conducted to examine the effects of time (Factor) and group on attitude, abstract norms, perceived behavioral control, behavioral intention, and behavior scores. For attitude scores, neither the main effect of time (F (1.86, 182.54) = 2.53, p =0.086, partial η² =0.025) nor the interaction between time and group (F (1.86, 182.54) =4.85, p =0.010, partial η² =0.047) reached practical significance, indicating a small effect of the intervention on attitudes. Significant main effects of time and significant time × group interactions were observed for abstract norms, perceived behavioral control, behavioral intention, and behavior scores (all p <0.05). For abstract norms, large effect sizes were found for both time (partial η² =0.282) and the interaction (partial η² =0.295). Behavioral intention showed moderate effects for time (partial η² =0.116) and the interaction (partial η² =0.126), while perceived behavioral control demonstrated small-to-moderate effects (partial η² =0.054 and 0.0038, respectively). The strongest effects were observed for behavior scores, with very large effect sizes for time (partial η² =.0498) and the time × group interaction (partial η² =0.365), indicating that the educational intervention produced substantial improvements in behavior over time, with differential effects between groups ( Table 4 ). Table 4. The effects of time (Factor) and group on attitude, abstract norms, perceived behavioral control, behavioral intention, and behavior scores. Origen Type III sum of squares Degrees of freedom Quadratic mean F p-value Partial eta squared Factor = Attitude Score Factor 694.820 1.863 373.037 2.530 0.086 0.025 Factor*Group 1332.847 1.863 715.583 4.852 0.01 0.047 Error (Factor) 26919.000 182.535 147.473 - - - Factor = Abstract Norms Score Factor 1677.807 1.671 1003.855 38.421 <0.001 0.282 Factor*Group 1794.607 1.671 1073.738 41.095 <0.001 0.295 Error (Factor) 4279.587 163.794 26.128 - - - Factor = Behavior Control Score Factor 25.820 1.650 15.644 5.585 0.007 0.054 Factor*Group 17.780 1.650 10.773 3.846 0.031 0.038 Error (Factor) 453.067 161.742 2.801 Factor = Behavioral Intent Score Factor 576.060 1.259 457.460 12.916 .000 0.116 Factor*Group 631.687 1.259 501.634 14.163 .000 0.126 Error (Factor) 4370.920 123.407 35.419 Factor = Behavior Score Factor 1908.487 1.995 956.577 97.366 .000 0.498 Factor*Group 1105.260 1.995 553.981 56.387 .000 0.365 Error (Factor) 1920.920 195.522 9.825 Open in a new tab Discussion This study showed that planned behavior theory affected preventive behaviors of osteoporosis in nurses. According to the results, teaching plan increased significantly attitude in the interventions group. In the control group, mean of attitude about preventive behavior of osteoporosis was not significantly different one and two months after the intervention. Previous studies have shown that intervention plan could improve preventive behavior of osteoporosis in patients; however, less research has been conducted on female nurses. In most studies, positive results have been reported about the effect of teaching interventions based on planned behavior theory. Shakeri Neghad et al . 23 and Pakyar et al . 34 found that teaching intervention based on planned behavior theory affected attitude positively. These results are consistent with our study. In a study by Shah Mohammadi et al ., 35 examined the effect of teaching intervention based on planned behavior theory on preventing osteoporosis in mothers of high school students in Tehran, and Jalili et al . 32 examined the effect of planned behavior theory on preventing osteoporosis in women at healthcare centers. According to the results of these studies, mean of attitude changed significantly after the teaching intervention. According to the results of this study, teaching plan increased abstract norms significantly in women in the intervention group. In the control group, mean of abstract norms about preventive behavior of osteoporosis was not significantly different one and two months after the intervention. Consistent with the results of this study, in a study by Jangi et al . 35 , lecture and SMS based on planned behavior theory improved diet behavior in preventing osteoporosis in high school students. According to the results of these studies, planning and teaching over 9 months at school showed significant differences two months after the intervention. In another study by Pakyar et al . 34 on middle-aged people, teaching intervention was effective on abstract norms, which is consistent with the results of our study. Shah Mohammadi et al . 33 and Jalili et al . 32 found that mean of abstract norms changed significantly after the intervention. On the other hand, in a study by Jihooni et al ., 36 effect of teaching intervention based on planned behavior theory results in improving mean of abstract norms in menopause women. Possible reasons of increasing in the intervention group are attending of physicians, authorities and family members in teaching sessions. According to the results of this study, teaching plan did not increase significantly perceived control of behavior in women in the intervention and control groups. Consistent with the results of this study, Jalili et al . 32 examined effect of planned behavior theory on preventing osteoporosis in women at healthcare centers. According to the results of this study, after the intervention mean of perceived control of behavior did not change significantly, which is consistent with the results of this study. Results of this study are contradict with Pakyar et al ., 34 ShahMohammadi et al ., 33 Ates et al . 22 and Şanlıtürk et al . 37 In a study by Pakyar et al . 34 it was found that teaching intervention was effective on perceived control of behavior. In studies by Shah Mohammadi et al . 33 mean of perceived control of behavior changed significantly after teaching intervention. Ates et al . 22 examined behavioral intent for healthy diet in Turkish teachers based on planned behavior theory. They found that mental norm is the most effective factor on behavioral intent for healthy diet. Şanlıtürk et al . 37 examined the effect of a teaching plan based on planned behavior on asthma management and medication compliance. They found that asthma management and medication compliance increased after teaching planned behavior in the intervention group. This difference in results could be related to difference in research population. If people have necessary resources, self-esteem and adequate ability, they perform specific behavior. Limitations like personality, mental status and working condition could affect preventive behavior of osteoporosis. 32 On the other hand, this difference could be related to limitations of theory including lack of focusing on change behavior, gap of perceived control of behavior and real control of behavior. 38 According to the results of this study, teaching plan resulted in significant increase in behavioral intent in the intervention group. Results of this study are consistent with results of studies by ShahMohammadi et al . 33 , Jalili et al ., 32 Pinar et al ., 39 Pakyar et al . 32 and Andriyaningtiyas et al . 40 According to the results of this study, teaching plan resulted in significant increase in preventive behavior in the intervention group. Results of this study are consistent with results of studies by Jihooni et al . 36 in menopause women, Dehghankar et al . 16 in health volunteers and Abdelrhamn et al . 29 in female teachers. Abdelrhamn et al . 29 found improving in knowledge, performance and planned behavior of in Egyptian female teachers about prevention of osteoporosis. But a study by Ahmadi Tabatabai 41 ,teaching interventions based on planned behavior theory was not effective on physical activity, which is not consistent with results of our study. This difference could be related to age of staff 40 - 60 years as age affects type of physical activity. While age of most nurses was under 40 years in our study. One of the strengths of this study is that it was the first-time planned behavior theory was conducted on preventive behaviors of osteoporosis in female nurses. In the control group, constructs of preventive behavior of osteoporosis did not change. On the other hand, using theories of behavior increases the effect of health education programs. Given the nature of nursing and its risk, considering osteoporosis as a common disease in female nurses was another strength of this study. There were some limitations in this study. Given self-report of collected data, there was possible inaccuracy in recording data, which was decreased through explaining and ensuring participants about confidentiality of personal information. Another limitation of this study was quasi-experimental design and selecting groups from two hospitals to decrease contamination bias. Conclusion. According to the results of this study, planned behavior theory could affect preventive behavior of osteoporosis in female nurses. Results of this study could be employed as a basis for future interventions, particularly in of nurses' role in health education. This study could be used as a framework for designing and conducting teaching interventions for preventing osteoporosis and health promotion in women. Ethical considerations. This study was conducted according to the Helsinki declaration 5 and all considerations related to design of this study. This study was approved at the Ethics Committee at Jahrom University of Medical Sciences (IR. JUMS. REC.1402,035). Informed consent was obtained from the participants. Nurses were stated that participation is voluntary. Questionnaires were anonymous, and collected data were confidential. After the intervention, file of teaching plan was provided to the control group. 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