BMJ Open. 2026 Aug 10;16(8):e103814. doi: 10.1136/bmjopen-2025-103814.
ABSTRACT
OBJECTIVES: The low uptake of cervical cancer screening (CCS) in rural areas is mainly related to the lack of awareness regarding cervical cancer. Using educational interventions has been shown to substantially improve knowledge and attitude towards cervical cancer, which are important determinants of undergoing CCS. The aim of this study was to analyse the impact of different educational intervention methods on knowledge, attitudes and willingness to undergo CCS among women in rural Indonesia.
DESIGN: A quasi-experimental study with a non-equivalent control group design.
SETTING: The study was conducted in North Tobelo, a rural district in North Halmahera Regency.
PARTICIPANTS: Sample size was calculated using Power and Sample Size Calculations software (V.3.1.2). 150 women were recruited via convenience sampling from 12 Integrated Health Service Posts, cluster-randomised into three arms: control (n=50), flipchart (n=50) and video (n=50). A per-protocol approach was applied; all participants completed pre-intervention and post-intervention assessments within a single visit with no loss to follow-up. Continuous outcomes were analysed using the Kruskal-Wallis and Wilcoxon tests; categorical outcomes using χ² or Fisher’s exact tests with Bonferroni correction. Non-parametric analysis of covariance (Quade’s method) controlled for baseline scores, age at first sexual intercourse and household income, with partial eta-squared reported as the effect size.
INTERVENTIONS: All study arms received identical educational content presented in simple Indonesian language and avoiding the use of medical terminology. The educational content included cervical cancer epidemiology, aetiology, risk factors, clinical symptoms, prevention methods, various CCS methods, visual inspection with acetic acid screening procedures, benefits and side effects of getting human papillomavirus vaccination and CCS, as well as a brief explanation regarding cervical cancer treatment. Knowledge, attitude and willingness were assessed using a structured pre-intervention and post-intervention questionnaire comprising both dichotomous items and Likert-scale questions.
RESULTS: Although knowledge improved significantly in all intervention groups (p<0.001), only the video group showed a significant improvement in attitude after the intervention (p=0.016). The median change scores of knowledge and attitude were only significantly higher in the video group when compared with the control group (p=0.041 and p=0.013, respectively), but not significantly different in other pairwise comparisons. Moreover, the proportion of participants who were willing to undergo CCS after the intervention was also increased significantly in the video group when compared with the control group (52% vs 22%; p=0.006) and flipchart group (52% vs 24%; p=0.012).
CONCLUSIONS: In conclusion, the video-based educational intervention demonstrated the greatest improvements in knowledge, attitude, and willngness to undergo CCS compared to other methods.
PMID:42575548 | DOI:10.1136/bmjopen-2025-103814
