The Effect of Health Belief Model‐Based Creative Drama Education on Health Locus of Control and Smoking Perception in Adolescents: A Randomized Controlled Trial

The aim of this study is to examine the effect of education given to eighth-grade adolescents in a primary school with health belief model (HBM)-based creative drama techniques on health locus of control (HLC) and smoking perception. This randomized controlled study was conducted between January and December 2019 in two primary schools in the Erzurum city center, Türkiye. The study included 80 eighth-grade students, who were randomly assigned to either the experimental group (n = 40) or the control group (n = 40) The experimental group received six sessions of creative drama training based on the HBM. Data collection instruments included the Multidimensional Health Locus of Control Scale (MHLC) and the Decisional Balance Scale for Children (DBSC). Pre- and post-test measurements were taken for both groups to assess changes in HLC and smoking perception. Statistical analyses were performed using repeated measures ANOVA to examine within-group changes over time and between-group differences, allowing us to understand the precise effect of the intervention across time points. Additionally, descriptive statistics were used to report means and standard deviations for all variables. No protocol registration number was available for this study at the time of its execution. The students in the experimental group showed a significant increase in the internal control sub-dimension of the HLC (t = -5.090, p < 0.001) and a decrease in the external control sub-dimension (U = -3.369, p < 0.001). For the Decisional Balance Scale, there was a significant decrease in the pros sub-dimension (t = -5.535, p < 0.001) and an increase in the cons sub-dimension (U = -3.934, p < 0.001). In the control group, only the pre-test mean score for the chance/fate sub-dimension was higher (p < 0.05). The repeated measures ANOVA confirmed significant within-group changes in the experimental group: an increase in internal locus of control and a decrease in external locus of control. Smoking perception also showed significant changes, with a decrease in the pros sub-dimension and an increase in the cons sub-dimension, validating the intervention's effectiveness. When creative drama practices are used together with the HBM, it caused a positive change in the HLC and the perception of cons toward smoking.