J Eval Clin Pract. 2026 Feb;32(1):e70387. doi: 10.1111/jep.70387.
ABSTRACT
RATIONALE: Breast cancer persists as a significant contributor to global morbidity and mortality. Although early detection through systematic screening plays a pivotal role in improving outcomes, women with limited literacy frequently exhibit reduced participation, primarily due to insufficient awareness and heightened apprehension.
AIMS: The purpose of this research was to evaluate whether an educational programme using audiovisual tools could improve breast cancer screening practices and decrease fear in women with low literacy levels.
METHODS: A randomised, double-blind study was carried out involving 120 women between 40 and 69 years old. Participants were assigned by chance to one of two groups: the intervention group (n = 60) or the control group (n = 60). The intervention entailed a 12-week structured programme, delivered once a week, which included the use of multimedia resources and breast models to provide training in breast self-examination, clinical breast examination, and mammography techniques. Outcomes were measured pre- and post-intervention using the Champion Breast Cancer Fear Scale and the Breast Cancer Screening Behaviour Questionnaire. Data were analysed using chi-square tests, mixed-model ANOVA, independent t-tests, and repeated-measures MANOVA.
RESULTS: Post-intervention, screening behaviours were markedly higher in the intervention versus control group- breast self-examination BSE 91.7% versus 33.3% (χ²(1) = 43.56, p < 0.001), clinical breast examination 95.0% vs. 6.7% (χ²(1) = 93.66, p < 0.001), and mammography 81.7% vs. 6.7% (χ²(1) = 68.43, p < 0.001). Breast cancer-related fear showed a significant time × group effect (mixed-model ANOVA), F(1,114) = 70.35, p < 0.001, ηp² = 0.38. Groups were equivalent at pre-test (t(118) = 0.46, p = 0.647). At post-test, fear scores were substantially lower in the intervention group (M = 12.38, SD = 3.05) than control (M = 23.78, SD = 10.91), Welch’s t(68.19) = -7.79, p < 0.001, Cohen’s d = 1.42, indicating a large effect.
CONCLUSION: Audiovisual education with breast model simulations effectively enhances screening behaviours and reduces fear among low-literacy populations. Implementing such programmes in rural areas can also support midwives and healthcare providers by improving patient engagement, facilitating education, and reducing barriers to early detection. These findings highlight the potential of audiovisual interventions as practical public health strategies to promote breast cancer awareness and screening in underserved communities.
TRIAL REGISTRATION: Clinical Trial ID: NCT06898229.
PMID:41709589 | DOI:10.1111/jep.70387
