# Efficacy of digital educational intervention using I-Change model in promoting preventive behaviors for cervical cancer among Iranian women: A randomized controlled trial

## TL;DR

A digital education app based on the I-Change model improved cervical cancer prevention behaviors more effectively than a digital booklet among Iranian women.

## Contribution

Demonstrates the superior effectiveness of a mobile app over a digital booklet for promoting cervical cancer prevention behaviors.

## Key findings

- The app group showed significant improvements in knowledge, perceived risk, and self-efficacy.
- Preventive behaviors were highest in the app group (67.12%) compared to the booklet group (38.57%).
- The app was more effective in sustaining behavioral changes over 12 weeks.

## Abstract

Cervical cancer (CC) is a major health concern for women, yet stigma and embarrassment often prevent preventive care. Digital health education offers a private, accessible way to learn about CC prevention. This study evaluated the effectiveness of a digital educational intervention based on the I-Change model in promoting preventive behaviors among Iranian women.

A randomized controlled trial (RCT) was conducted with 210 women (18–49 years) from Ramsar, Iran. Participants were assigned to three groups: two intervention groups (mobile app and digital booklet) and a control group. The "Evaluation of Preventive Behaviors Against CC (PERCICA)" questionnaire assessed outcomes. The intervention included a pre-test, digital education, and follow-ups immediately and at 12 weeks post-intervention. Data were analyzed using t-tests, analysis of Variance (ANOVA), analysis of covariance (ANCOVA), and repeated measures ANOVA.

The app group showed significant improvements in knowledge, perceived risk, self-efficacy, cognitive barriers, and social support (P<0.05). Preventive behaviors (e.g., condom use, Pap tests, genital exams) were highest in the app group (67.12%, 95% CI: [29.32±2.35]), followed by the booklet group (38.57%, 95% CI: [9.55±2.17]).

The app was more effective in sustaining behavioral changes and promoting CC prevention than the booklet, highlighting the value of tailored digital education for sensitive health topics.

ClinicalTrials.gov IRCT20181205041861N3. Registered V2.0 on 26 October 2021 with the IRCTID, V1.0. https://irct.behdasht.gov.ir/trial/57157.