From screen to screening: a randomized controlled trial on mHealth vs. traditional training on knowledge, attitudes,...

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.

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.

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).

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.

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