Table 2.
Effect of educational interventions on screening behavior
| First author/city/year of publication | Study design | Intervention | Study population | Sample size | Mean age (SD) | Instrument | The most important findings |
|---|---|---|---|---|---|---|---|
| HajiKazemi, Tehran, 2006[69] | CT | Health counselling | Females attending premarital health counselling program | 600 | 21.82 (3.94) | QNR | After/before: Significant_difference in mean_score of awareness |
| Yeke Fallah, Ghazvin, 2007[70] | CT | Video and verbal training | Nursing and midwifery students of QUMS | 43 | 18 | QNR | After/before: Significant increase in mean K |
| Saatsaz, Amol, 2009[71] | CT | In-person education | Females high school teachers | 48 | NA | QNR | After/before: Significant improvement of P. about BSE, CBE, mammography |
| Hatefnia, Tehran, 2010[72] | RCT | HBM-based education | Females>35 years | 220 | NA | QNR | Intervention/control: Significant improvement in mean_score of K., HBM structures and mammography behavior |
| Moshfeghi, Arak, 2011[73] | RCT | Media and powerpoint | Physicians | 128 | NA | QNR | Significant_difference in mean_score of KAP after intervention in each group No significant_difference in KAP between two methods |
| Hajian, Tehran, 2011[74] | RCT | Health counseling | Females with BC_FH | 100 | 37.8 (11.7) | QNR | After/before: Significant_difference in mean K., HBM structures, BSE in intervention group Intervention/control (BSE: 82%/62%, P=0.021, CBE: 40%/18%, P=0.014, Mammography: 36%/30%, P=0.52) |
| Rahmati Najar Kolaie, Tehran, 2012[75] | CT | HBM-based education | Students living in the dormitory of TU | 99 | 21 (1.11) | QNR | After/before: Significant improvement of HBM structures |
| Farma, Zahedan, 2013[76] | CT | In-person education | Females guidance school teachers | 240 | 39.4 (7.4) | QNR | Intervention/control: Significant_difference in mean-score of KAP |
| Ghasemi, Shahrekord, 2014[77] | RCT | In-person education | Employee females in universities of Shahrekord | 50 | 33.5 (18) | QNR, C/L | After/before: Significant_difference in mean-scores of KAP, performing BSE |
| Khalili, Lavizan, 2014[78] | CT | HBM-based education | Females referred to HCCs | 144 | 34 (8.23) | QNR | After/before: Significant increase in mean K., HBM structures Intervention/control: Enhance the mean of K., HBM structures (P<0.001) |
| Torbaghan, Zahedan, 2014[79] | RCT | HBM-based education | Female employees of ZAUMS | 130 | Intervention 35.38 (8.01) Control 34.39 (8.98) |
QNR | Intervention/control: Significant_difference in mean-scores of awareness, perceived susceptibility, perceived benefits, perceived barriers, P |
| Rezaeian, Isfahan, 2014[80] | RCT | Health counselling | Females>40 years | 290 | 50.48 (6.81) | QNR | After/before: Significant. improvement means K., HBM structures Intervention/control: Significant_difference in HBM structures, health beliefs about BC and mammography Sc_Behavour |
| Sargazi, Zahedan, 2014[81] | RCT | TPB-based education | Females referred to the clinics | 140 | Intervention 31.6 (0.9) Control 32.6 (1.1) |
QNR | After/before: Significant increase scores of K., A., control of perceived behavior, behavioral intention, adopting Sc_Behavior in the intervention group |
| Haghighi, Birjand, 2015[82] | RCT | In-person education | Employee females of BU | 89 | 39.2 (7.3) | QNR | After/before: Significant increase in mean K., A. toward BSE and number of females who performed BSE |
| Absavaran, Zabol, 2015[83] | RCT | Lecture method/cell phone method | Nurses in Zabol hospitals | 105 | Intervention 29.3 (4.4) Intervention 28.3 (4.4) Controll 29.1 (4.7) |
QNR | After/before: Significant_difference in mean_score KAP in both intervention groups. Increase in A., P in mobile phone group was significantly more than in the lecture group |
| Taymoori, Sanandaj, 2015[84] | RCT | Health counselling | Females>50 years | 184 | 55.93 (7.80) | QNR | Intervention/control: Significant_difference in mean HBM and TPB structures and percent mammography |
| Sadeghi, Sirjan, 2015[85] | RCT | BASNEF model-based education | Females 20–40 years attending to HCCs | 200 | Intervention 35.86 (2.53) Control 36.12 (2.24) |
QNR | After/before: K. significantly increased in both groups. A., P., enabling factors increased in Intervention Intervention/control: Significant_difference in mean_scores of KAP, subjective norms, and enabling factors |
| Ghahremani, Shiraz, 2016[86] | RCT | Self-care education | Females referred to HCCs | 168 | Intervention 35.3 (7.5) Control 36.6 (8.5) |
QNR | Intervention/control: Significant_difference in mean_scores of TTM structures and BSE behavior (P<0.001) |
| Mirzaii, Mashhad, 2016[87] | RCT | SHEP-model-based education | All the health volunteers and females covered by two urban health centers | 120 | NA | QNR, C/L | Intervention/control: Significant_difference in mean_scores of A. and BSE (P<0.001) |
| Parsa, Hamedan, 2016[88] | RCT | Educational counselling | Females referred to HCCs | 150 | Intervention 47.64 (7.03) Control 46.6 (8.68) |
QNR, C/L | Intervention/control: Significant_difference in mean_scores of perceived benefits, perceived barriers, self-efficacy, health motivations, K. and BSE practice |
| Khiyali, Fasa, 2017[89] | RCT | HBM-based education | Healthy females | 92 | Intervention 30.39 (8.19) Control 28.23 (7.3) |
QNR | Intervention/control: Significant_difference in mean_scores of K., HBM structures and BSE behavior (P<0.001) |
| Nahidi, Abadeh, 2017[90] | RCT | HBM-based education | Females 30–39 years referred to HCCs | 144 | Intervention 38.5 Control 39.44 |
QNR | Intervention/control: Significant_difference in mean_scores of awareness., perceived susceptibility and performance Significant_difference in mean_score of performance in BSE (P<0.001) |
| Nasiriani, Yazd, 2017[91] | Randomized field-trial | Telephone counseling and education | Females with BC_FH | 90 | Intervention 45.8 (7.51) Control 46.77 (8) |
QNR | Intervention/control: Significant_difference in mammography performing (77.8%/24.4%) After/before: Significant_difference in mammography performing in the intervention group. No significant_difference in mammography performing in the control group |
| Savabi-Esfahani, Baharestan, 2017[92] | RCT | Role-playing, lecture | Females enrolled in community cultural centers | 314 | 45.53 (10.99) | QNR | After/before: Significant_difference in mean_scores of K. about BC and screening in both educational groups Role playgroup/lecture group: Mean_score of K. (94.5/88.8) |
| Shahbazi, Borujen, 2017[93] | RCT | Direct and indirect education | Nursing and midwifery personnel in Valiasr Hospital | 89 | 31.95 (6.57) | QNR | After/before: Significant. increase scores of K., in both groups, A. increased only indirect group Direct training versus indirect training: Significant_difference in K. and A. about BSE |
| Matlabi, Gonabad, 2018[94] | Randomized field-trial | In-person education | Married Females 20–49 years | 140 | 37.27 (6.69) | QNR | Intervention/control (immediately after: Action 21.4% versus 22.9%, P=0.001, maintenance 40% versus 24.3%, P=0.001, 3 months after: Action 25.7% versus 24.3%, P=0.001, maintenance 57.1% versus 24.3%, P=0.001) |
| Ghaffari, Isfahan, 2019[95] | RCT | HBM-based education | Health volunteers of HCCs | 480 | NA | QNR, C/L | Intervention/control: Immediately and two months after: Significant_difference in means of K., HBM structures related to BSE and mammography, BSE skill. No significant_difference in BSE behavior and mammography |
| Ghaffari, Karaj, 2018[96] | RCT | Education based on the integrated behavioral model | Females who were attended to HCCs | 138 | NA | QNR | Intervention/control: Immediately and two months after: Significant_difference in mean_score of K. and all structures except the perceived benefits of mammography and mammography behavior (P<0.001) |
| Masoudiyekta, Dezful, 2018[97] | RCT | HBM-based education | Females 20–59 years referred to HCCs | 226 | 39.75 (9.05) | QNR | Intervention/control: Significant increase rate of BSE and mammography, mean_scores of K. and HBM structures three months after (P<0.001). No significant_difference in the score of CBE |
| Mirmoammadi, Hamadan, 2018[98] | RCT | HBM-based consultation | Females>40 years attending Hamadan HCCs | 150 | Intervention 64.47 (7.3) Control 60.46 (8.8) |
QNR | Intervention/control (significant_difference in mammography: 49.3%/20%, CBE: 52%/28%, mean_scores of K., HBM constructs except for susceptibility and severity) |
| Naserian, Mahshahr, 2018[99] | RCT | Short messages and group training | Females 40–60 years referred to HCCs | 210 | Intervention 48.1 (5.8) Intervention 48.7 (5.8) |
QNR | After/before: Significant. increase in mean_score K. In each group (P=0.001), no significant increase between groups (P=0.061) Group training was better in BSE (P<0.001) SMS group was better in CBE (P=0.02) |
| Mashhod, Tehran, 2018[100] | RCT | HBM-based education | Females referred to HCCs | 94 | Intervention 35 Control 32.5 |
QNR | After/before: Significant_difference in mean_scores of HBM structures except for perceived benefits in the experimental group Intervention/control: Significant_difference in mean_scores o K., HBM structures except for perceived benefits, BSE performance |
| Fathollahi-Dehkordi, Isfahan, 2018[101] | RCT | Health counselling | Females>20 years with BC_FH | 107 | Intervention 36.04 (10.90) Control 35.58 (10.22) |
QNR | Intervention/control: Significant_differencein screening practice. Time factor and time-group interaction affected K.and HBM structures significantly Most females in the action stage of CBE vesrsus in the contemplation stage (P<0.001) |
| Alizadeh Sabeg, Abish Ahmad, 2019[102] | RCT | Health counselling | Females 40–69 years | 60 | Intervention 47.6 (5.7) Control 48.2 (5.8) |
QNR | Intervention/control: Significant_difference in mean_scores of total K. and K. about symptoms, risk factors, age-related and lifetime risk, BC screening, frequency of BSE 2 months after |
| Termeh Zonouzy, Tehran, 2019[103] | RCT | Intervention based on fear appeals using the EPPM model | Females>40 years with no BC_FH | 600 | 53.2 (9.45) | QNR | After/before: Significant_difference in mean_scores of A., behavioral intention in the intervention group Intervention/control: Significant_difference in mean_scores of A., behavioral intention |
| Rokhforouz, Rafsanjan, 2019[104] | RCT | In-person education | Health volunteers working in HCCs in Rafsanjan | 92 | 46.84 (10.67) | QNR, C/L | Intervention/control: Significant_differencef in movement in the stages of change, mean scores of HBM structures except for perceived barriers |
| Molaei-Zardanjani, Isfahan, 2019[105] | RCT | Individual and peer education | Females referred to selected HCCs | 100 | NA | QNR | After/before: Significant improvement in A. toward behavior, subjective norms, perceived behavioral control, intention behavior in both groups Mean_score of A. in the individual education group was higher (P<0.05) Mean_score of subjective norms in the peer education group was higher (P<0.05) No significant_difference in mean_scores of perceived behavioral control constructs and behavioral intention between groups (P>0.05) |
CT=Computed tomography; RCT=Randomised clinical trial; HBM=Health belief model; TPB=Theory of planned behavior; BASNEF=Beliefs, attitudes, subjective norms, and enabling factors; SHEP=Systematic comprehensive health education and promotion; EPPM=Extended parallel process model; HCC=Health Care Center; BU=Birjand University; BC_FH=Family history of breast cancer; ZAUMS=Zahedan University of Medical Sciences; TU=Tehran University; QUMS=Qazvin University of Medical Sciences; NA=Not available; QNR=Questionnaire; C/L=Checklist; BSE=Breast self-examination; CBE=Clinical breast examination; KAP=Knowledge/attitude/practice; BC=Breast cancer; TTM=Transtheoretical model; SMS=Short Message Service