From screen to screening: a randomized controlled trial on mHealth vs. traditional training on knowledge, attitudes, practice, self-efficacy, and adherence intention to pap smear.

BACKGROUND

Cervical cancer (CC) is a significant global health concern, particularly in low- and middle-income countries, where screening participation remains low. This study aimed to compare the effectiveness of two educational interventions, a mobile application-based program (mHealth) and face-to-face training (F2F), in improving knowledge, attitudes, self-efficacy, practices, and Adherence Intention to Pap smear testing among women in Saveh, Iran.

METHODS

This study was a parallel-group randomized controlled trial (RCT) conducted between 2023 and 2024. The participants were randomly assigned to three groups: (A) control, (B) F2F training, and (C) mHealth-based education (via the PapTest smartphone app). Data were collected at four time points: baseline (pretest), immediately postintervention, four weeks postintervention, and twelve weeks postintervention. The primary outcomes were measured via two validated instruments: the Cervical Cancer Screening Self-Efficacy Scale and the Self-Efficacy Scale for Pap Smear Screening Participation (SES-PSSP). Statistical analyses, including correlation tests, chi-square tests, ANOVAs, and Kruskal‒Wallis tests were performed via SPSS version 24.

RESULTS

The intervention phase results revealed significant differences over time and across groups in terms of knowledge, attitudes, self-efficacy, and practices (P < 0.05). Notably, knowledge levels differed significantly among the three groups at one month and three months postintervention (P < 0.05). Additionally, practice scores at the three-month follow-up were significantly different across the groups. However, the attitudes and self-efficacy scores were significantly different at baseline, necessitating an adjustment for preintervention variability. Post adjustment analyses confirmed significant within-group and between-group differences in these variables over time. In contrast, Adherence Intention to Pap smear retesting did not significantly differ across the groups at different time points (P > 0.05).

CONCLUSION

Both mHealth-based education and F2F training significantly improved knowledge, attitudes, self-efficacy, and practices related to Pap smear screening. However, the mobile app intervention demonstrated greater and more sustained improvements than did face-to-face training. Given their accessibility, cost-effectiveness, and scalability, mHealth interventions represent a promising strategy for enhancing cervical cancer screening Adherence Intention. Future research should explore longer follow-up periods and hybrid education models to optimize screening participation and Adherence Intention in diverse populations.

TRIAL REGISTRATION: Iranian Clinical Trial Register (IRCT20231130060228N1). Registration date: 2024-02-19, 1402/11/30. URL: https://irct.behdasht.gov.ir/trial/74165 .