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Participants were randomly allocated in study groups by the balance block randomization method. Data were collected using a socio-demographic and pregnancy outcomes checklist as well as self-devised questionnaire assessing the constructs of the HAPA model before and three months after the educational intervention. The framework of the educational intervention was based on the constructs of the HAPA and included three one-hour training sessions through lectures, group discussions, \u2018question and answer\u2019 sessions, and the use of educational tools. Data were analyzed using analysis of covariance (ANCOVA) and SPSS software.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Results<\/jats:title>\n                <jats:p>Pregnancy outcomes including optimal weight gain during pregnancy (<jats:italic>p<\/jats:italic>\u2009=\u20090.47), neonate\u2019s birth weight (<jats:italic>p<\/jats:italic>\u2009=\u20090.58), gestational age at delivery (<jats:italic>p<\/jats:italic>\u2009=\u20090.83), type of delivery (<jats:italic>p<\/jats:italic>\u2009=\u20090.48) gestational anemia (<jats:italic>p<\/jats:italic>\u2009=\u20090.22), diabetes (<jats:italic>p<\/jats:italic>\u2009=\u20090.59) and hypertension (<jats:italic>p<\/jats:italic>\u2009=\u20090.29) were not significantly different in the intervention and control groups. The results showed that the educational intervention produced a significant increase in the total score (24 points) in the intervention group. Improvement of scores in the intervention group compared to the control was observed in all of the model constructs except outcome expectation (0.68 decrease). The educational intervention in the present study had a large measure of effect in total (SMD: 2.69, partial eta<jats:sup>2<\/jats:sup>: 0.664).<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Conclusion<\/jats:title>\n                <jats:p>A nutritional education intervention based on the HAPA model for malnourished pregnant women increased behavioral intention and planning for action to have better nutritional behavior. However, the intervention did not change the pregnancy outcomes significantly.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Practice implications<\/jats:title>\n                <jats:p>Nutritional education based on the HAPA model can be used to improve nutritional behaviors of malnourished pregnant women.<\/jats:p>\n              <\/jats:sec>","DOI":"10.1186\/s12884-024-06276-7","type":"journal-article","created":{"date-parts":[[2024,1,25]],"date-time":"2024-01-25T08:02:30Z","timestamp":1706169750000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":8,"title":["The effect of nutritional education based on the health action process approach (HAPA) on the pregnancy outcomes among malnourished pregnant mothers"],"prefix":"10.1186","volume":"24","author":[{"given":"Atieh","family":"Razzazi","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mark D.","family":"Griffiths","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zainab","family":"Alimoradi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2024,1,25]]},"reference":[{"issue":"5","key":"6276_CR1","doi-asserted-by":"publisher","first-page":"737","DOI":"10.1016\/j.jada.2006.02.006","volume":"106","author":"U N\u00f6thlings","year":"2006","unstructured":"N\u00f6thlings U, Murphy SP, Sharma S, Hankin JH, Kolonel LN. 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The study protocol was prospectively registered in the Iranian clinical Trial Registration system (ID: IRCT20180218038789N5 registered prospectively in 2020-12-24). After obtaining the necessary permits, the individuals were invited to participate in the research. Written informed consent was obtained from all participants. Some of the participants in the present study were illiterate. In this group, all the explanations related to the goals of the project and the freedom to participate in the research were explained orally to them and their consent to participate in the research was obtained, orally. In addition, in this group, the goals of the project and the freedom to participate in the study were explained to their spouses who were literate and a written informed consent was obtained from their spouses.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethical approval and consent to participate"}},{"value":"Not applicable.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"The authors declare no competing interests.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"83"}}