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Cited by 14Women's cancer prevention and managementCervical Cancer and HPV ResearchGlobal Cancer Incidence and Screening

Effectiveness of educational intervention on women’s participation to cervical cancer screening: a quasi-experimental study based on PEN-3 model

Open access
Seyrafi, Niloofar, Homayuni, Atefeh, Hosseini, Zahra, Aghamolaei, Teamur, Ghanbarnejad, Amin, Mouseli, Ali·2022·BMC Cancer
DOI 10.1186/s12885-022-10331-xPMC PMC9703409
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Abstract

Introduction: Cervical cancer is one of the most common cancer types among women in developing countries. Women’s behavior in the early detection of the disease is influenced by sociocultural factors. Thus, the present study aimed to determine the effect of an educational intervention based on PEN-3 model on women’s participation in cervical cancer screening. Methods: The present quasi-experimental study was conducted with 160 women participants visiting health care centers in Bandar Abbas in 2021. The sampling was as a multi-stage clustering, and the participants were divided into two groups, an intervention and a control (each with 80 participants). The data collection instrument was a researcher-made questionnaire based on the PEN-3 model constructs before and 3 months after an educational intervention (a training course). The intervention involved 30 online sessions of 15–20 minutes for the intervention group while the control group did not receive any training. Results: After the educational intervention, the mean scores of knowledge, attitude, enablers, nurturers and the Pap smear test behavior in the experimental group increased significantly compared to the control group (P < 0.05). The analysis of covariance results showed that by modulating the effect of pre-test score, there was a statistically significant difference between the intervention and control groups in the post-intervention behavior score. Conclusion: In the light of the present findings, it can be concluded that interventions based on the PEN-3 model with a focus on knowledge -raising, changing beliefs and identifying sociocultural and environmental factors that affect cervical cancer screening behavior can prevent cervical cancer in women.

AI snapshot

Written from the paper’s full text.

TL;DR

A quasi-experimental study in Bandar Abbas found that a PEN-3 model-based educational intervention increased women’s knowledge, attitude, enablers, and Pap smear screening behavior compared with a no-training control group. Nurturer scores rose in both groups, and ANCOVA showed no significant intervention effect on nurturers.

Key findings

  • Among 160 women (80 intervention, 80 control), post-intervention knowledge was higher in the intervention group (13.98 ± 0.111) than the control group (8.57 ± 2.12; p < 0.001), with ANCOVA F = 842.55, p < 0.001.
  • Attitude increased in the intervention group from 61.95 ± 3.78 to 63.16 ± 2.98, while it decreased in controls from 62.66 ± 4.18 to 54.15 ± 7.37; post-test between-group p < 0.001 (ANCOVA F = 102.67, p < 0.001).
  • Enablers increased in the intervention group from 39.55 ± 4.7 to 43.52 ± 3.94 and decreased in controls from 41.3 ± 4.53 to 33.3 ± 5.13; post-test p < 0.001 (ANCOVA F = 7197.76, p < 0.001).
  • Pap smear behavior increased in the intervention group from 54 (67.5%) to 79 (98.8%) versus controls from 48 (60.0%) to 52 (65.0%); post-test p < 0.001 (ANCOVA F = 65.4, p < 0.001). Nurturers increased in both groups, and ANCOVA found no significant group difference (F = 0.472, p = 0.493).

Methods

  • Quasi-experimental intervention with 160 women visiting healthcare centers in Bandar Abbas in 2021; multi-stage cluster sampling assigned four centers to intervention or control, with 80 participants per group.
  • Data were collected with a researcher-made PEN-3 questionnaire before and 3 months after intervention; reliability was Cronbach’s alpha 0.831 and ICC 0.89. The intervention comprised 30 online sessions of 15–20 minutes over 4 months via WhatsApp; controls received no training.
  • Analysis used SPSS24 with chi-square, independent- and paired-samples t-tests, ANCOVA, and logistic regression; significance was p < 0.05.

Limitations

  • The authors state small sample size and limited generalizability, inability to hold face-to-face training during the Covid-19 pandemic, and limited communication with participants; online sessions also restricted women’s familiarity with treatment environments and services.
  • The text makes evident that sampling was convenience-based within selected centers and was restricted because people visited healthcare centers less during the pandemic.
  • The authors note that control-group participants may have received external encouragement or information from family, friends, health workers, community leaders, and mass media, which could explain increased nurturer scores in both groups.

Model-written summary. Check it against the paper before relying on it.

Integrity signals

Registry

Crossref · 10.1186/s12885-022-10331-x

Cites

27 of 27 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Claims the paper makes

17 of 37 cited sources checked · 7 supported · 1 flagged · accuracy not yet measured

  • Premisecitation

    Existing health education and promotion models do not consider culture at their core.

    “There are different models in health education and promotion to design, implement and evaluate preventive health programs, but none of them consider the culture of preventive behavior or health-promoting behavior at their core.”
    Quote in the paperSubstantial claim1 of 2 sources checked
    • cites [14] Shahbazi H, Ghofranipour F, Amiri P, Rajab A. Factors affecting self-care performance in adolescents with type i diabetes according to the PEN-3 cultural model. Int J Endocrinol Metab. 2018;16(4):e62582. source

      The Theoretical Framework (§2.1; page unavailable) says the PEN-3 health-promotion model is designed to put culture at the core of health-behavior determinants. That is a counterexample to the unqualified claim that no existing health education or promotion model does so. (LLM, conf=0.86)

      Checked by a reasoning model — may be wrong.

      Experimental — accuracy not yet measured
    • cites [15] Blackstone SR, Nwaozuru U, Iwelunmor J. Antenatal HIV testing in sub-Saharan Africa during the implementation of the millennium development goals: a systematic review using the PEN-3 cultural model. Int Quarterly Commun Health Educ. 2018;38(2):115–28. source
  • Premisecitation

    Few interventional studies have been conducted in Iran based on the PEN-3 model.

    “In Iran, few interventional studies have been conducted based on the PEN-3 model [11, 16].”
    Quote in the paperNot a substantial claim2 of 2 sources checked
    • cites [11] Parsa P, Aghababaii S, Rahmani S. Cervical cancer screening in postmenopausal women referring to Hamadan comprehensive health centers. Pajouhan Sci J. 2020;18(2):58–63. source

      The Methods in the paper’s Abstract describe a cross-sectional cervical-screening study in Hamadan, and its Conclusion recommends future interventions. Neither those passages nor searches for “PEN-3” and Iranian model-based intervention studies address how many PEN-3 interventions have been conducted in Iran. (LLM, conf=0.74)

      Experimental — accuracy not yet measured
    • cites [16] Naghibi A, Jamshidi P, Yazdani J, Rostami F. Identification of factors associated with breast cancer screening based on the PEN-3 model among female school teachers in Kermanshah. Iran J Health Educ Health Promot. 2016;4(1):58–64. source

      The Abstract describes this study as descriptive and cross-sectional and suggests that a future intervention using the PEN-3 model could be useful. Neither the Abstract nor the available References state how many PEN-3-based interventional studies have been conducted in Iran. Searches for the claim in English and Persian found no passage addressing that number. (LLM, conf=0.73)

      Experimental — accuracy not yet measured
  • Findingown data

    After controlling for pretest, the adjusted mean knowledge score differed significantly between the two groups in the post-test (F = 842.55, p < 0.001).

    “Table 6 showed that after eliminating the effect of pre-test on dependent variables and according to the estimated F-values, the adjusted mean scores of knowledge (f = 842.55, p < 0.001), attitude (f = 102.67, p < 0.001), enablers (f = 197.769, p < 0.001), and behavior (f = 65.4, p < 0.001), revealed significant differences between the two groups in the post-test.”
    Quote in the paperSubstantial claim
  • Findingown data

    After the intervention, there was a statistically significant difference between the intervention and control groups in all measured variables (p < 0.05).

    “However, after the intervention, a statistically significant difference was observed between the two groups in all variables (p<0.05).”
    Quote in the paperSubstantial claim
  • Findingown data

    Number of deliveries was not linearly correlated with behavior (p > 0.05).

    “However, there were no linear correlation between the variables of occupation status, deliveries and educational level with the behavior (p > 0.05) and there was independence between these variables.”
    Quote in the paperNot a substantial claim
  • May combine two claims. 19
  • Classified as probably not a substantial claim. 11
  • The quote only partly states this claim. 2

  • May combine two claims.

    Study design and conductcitation

    The sample size was estimated using a standard deviation of 1.5 from a similar study, an effect size of 0.7, a power of 80%, and a 5% standard error, yielding 160 after adding 10% for attrition.

    “In a similar study [18], the standard deviation of the behavior score (Pap smear) was equal to 1.5. with a standard error of 5%, an effect size of 0.7 and a power of 80%, the sample size was estimated using the following formula:”
    • Also stated in: § Sample size and sampling procedure · plain
      “To compensate for the attrition rate, 10% was added to the sample size, and finally the sample size was estimated at 160.”
    Quote in the paperSubstantial claim1 of 1 sources checked
    • cites [18] Naghibi A, Rostami F, Masomi F, Cherati JY. Application of the perceptual factors, enabling and reinforcing model on pap Smaear screening in Iranian northern woman; 2016. source

      The Materials and Methods section describes a cross-sectional study of 416 women and its Pap-smear questionnaire, but gives no standard deviation for the behavior score. Searches for 1.5 and the stated sample-size parameters found no passage reporting a behavior-score standard deviation of 1.5, an effect size of 0.7, 80% power, or a 160-person estimate with attrition. Page numbers are unavailable in our copy. (LLM, conf=0.76)

      Experimental — accuracy not yet measured

  • Classified as probably not a substantial claim.

    Premisecitation

    The PEN-3 model focuses on culture in preventive behavior or health promotion at its core.

    “One health education and promotion model that focuses on culture in preventive behavior or health promotion at its core is the PEN-3 model.”
    Quote in the paperSubstantial claim1 of 1 sources checked
    • cites [14] Shahbazi H, Ghofranipour F, Amiri P, Rajab A. Factors affecting self-care performance in adolescents with type i diabetes according to the PEN-3 cultural model. Int J Endocrinol Metab. 2018;16(4):e62582. source

  • Classified as probably not a substantial claim.

    Premisecitation

    The Pap test is an effective screening program for early detection and prevention of cervical cancer.

    “The Pap test is an effective screening program to this aim [2].”
    Quote in the paperSubstantial claim1 of 1 sources checked
    • cites [2] Bedell SL, Goldstein LS, Goldstein AR, Goldstein AT. Cervical cancer screening: past, present, and future. Sex Med Rev. 2020;8(1):28–37. source

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    According to the National Cervical Cancer Program in Iran, screening should be done for all women after marriage, with women under 21 having a Pap smear test after 3 years of their first intercourse and women over 21 after 1 year of their first intercourse.

    “According to the National Cervical Cancer Program in Iran, screening should be done for all women after marriage, so women under 21 should have a Pap smear test after 3 years of their first intercourse and women over 21 after 1 year of their first intercourse [6].”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites [6] Eghbal SB, Karimy M, Kasmaei P, Roshan ZA, Valipour R, Attari SM. Evaluating the effect of an educational program on increasing cervical cancer screening behavior among rural women in Guilan, Iran. BMC Women's Health. 2020;20(1):1–9. source

      The Background says Pap smears are conducted every three years for women who are or have been sexually active. It does not state the Iranian national program’s rules for starting screening after marriage or the claimed one- and three-year intervals after first intercourse; searches for those age-specific rules found no supporting passage. (LLM, conf=0.72)

      Experimental — accuracy not yet measured

  • May combine two claims.

    Premisecitation

    Women face many cultural, emotional, functional, social, religious, geographical and economic barriers to receiving Pap smear services, including lack of knowledge, lack of doctor's advice, stress, embarrassment, high cost, busy work, lack of privacy, fear of positive test result, and aggressiveness of follow-up procedures.

    “Among the reasons for not adhering to this test are lack of knowledge about the need for Pap smear, lack of doctor’s advice, stress, embarrassment caused by the test, high cost, busy work, lack of privacy, fear of the positive test result, aggressiveness of the follow-up procedures (if the test turns positive) [11–13].”
    Quote in the paperSubstantial claim2 of 3 sources checked
    • cites [11] Parsa P, Aghababaii S, Rahmani S. Cervical cancer screening in postmenopausal women referring to Hamadan comprehensive health centers. Pajouhan Sci J. 2020;18(2):58–63. source

      The Abstract (page not provided) reports Pap smear screening rates among postmenopausal women and recommends improving awareness, but it does not identify reasons women did not adhere to screening. Searches for the listed barriers, including embarrassment and lack of knowledge, found no passage linking them to nonadherence in our copy. (LLM, conf=0.74)

      Experimental — accuracy not yet measured
    • cites [12] Hajializadeh K, Ahadi H, Jomehri F, Rahgozar M. The role of health Beliefsin predicting Barriersto cervical Cancer screening. J Kerman Univ Med Sci. 2014;21(5):416–25.

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

    • cites [13] Lemp JM, De Neve J-W, Bussmann H, Chen S, Manne-Goehler J, Theilmann M, et al. Lifetime prevalence of cervical cancer screening in 55 low-and middle-income countries. JAMA. 2020;324(15):1532–42. source

      The Discussion (page not provided) suggests that cultural and societal values influence access to screening and mentions free screening as a possible contributor to higher uptake. The Limitations section also notes low awareness of screening recommendations and that screening is generally perceived as uncomfortable. The paper does not establish the citing sentence’s detailed list of reasons for not obtaining a Pap smear, including lack of doctor’s advice, busy work, lack of privacy, fear of a positive result, or aggressive follow-up procedures. (LLM, conf=0.83)

      Experimental — accuracy not yet measured

  • May combine two claims.

    Premisecitation

    There is a 10-20 year delay between the pre-cancerous stage and cervical cancer, providing time to diagnose and treat the cancer earlier and avoid progression.

    “Because there is 10–20 years delay between the pre-cancerous stage and cervical cancer, there is a whale of time to diagnose and treat the cancer earlier and avoid its progression (pre-invasive period).”
    Quote in the paperSubstantial claim1 of 2 sources checked
    • cites [4] Hossaini F, Tahmasebi R, Noroozi A. Comparing the effects of individual and group training methods based on health belief model on the belief and practice of Bushehr women regarding pap smear test. J Health. 2017;7:668–79.

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

    • cites [5] Khiyali Z, Asadi R, Ghasemi A, Khani JA. The effect of educational intervention base on health belief model on performing pap smears in women of Fasa city. Iran J Health Educ Health Promot. 2017;5(4):304–10. source

      The Abstract (page unavailable) says Pap smears aid early detection and can delay progression of cervical disorders. It does not state that the interval from a precancerous stage to cervical cancer is 10–20 years; searches for that interval and the pre-invasive period found no supporting passage in our copy. (LLM, conf=0.84)

      Experimental — accuracy not yet measured

  • May combine two claims.

    Premisecitation

    Attitude is a predisposing factor for the onset and persistence of healthy behaviors and is correlated with behavior.

    “Because attitude is a predisposing factor for the onset and persistence of healthy behaviors and is correlated with behavior, a positive attitude can be a strength in promoting screening behavior [15, 16, 18].”
    Quote in the paperSubstantial claim2 of 3 sources checked
    • cites [15] Blackstone SR, Nwaozuru U, Iwelunmor J. Antenatal HIV testing in sub-Saharan Africa during the implementation of the millennium development goals: a systematic review using the PEN-3 cultural model. Int Quarterly Commun Health Educ. 2018;38(2):115–28. source
    • cites [16] Naghibi A, Jamshidi P, Yazdani J, Rostami F. Identification of factors associated with breast cancer screening based on the PEN-3 model among female school teachers in Kermanshah. Iran J Health Educ Health Promot. 2016;4(1):58–64. source

      The Abstract (page not provided) identifies belief in early tumor detection as a factor affecting breast-cancer screening among female school teachers. That supports a narrower connection between a belief and screening behavior, but the copy does not establish that attitude generally predisposes the onset and persistence of healthy behaviors or is correlated with behavior. (LLM, conf=0.70)

      Experimental — accuracy not yet measured
    • cites [18] Naghibi A, Rostami F, Masomi F, Cherati JY. Application of the perceptual factors, enabling and reinforcing model on pap Smaear screening in Iranian northern woman; 2016. source

      The Results and Discussion (sections 3–4; page unavailable) link positive and negative perceptions with Pap-smear screening behavior, supporting the narrower point that beliefs relate to this behavior. The paper does not state that attitude predisposes the onset and persistence of healthy behaviors generally or report a correlation between attitude and behavior. (LLM, conf=0.78)

      Experimental — accuracy not yet measured

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Interpretationcitation

    The finding of increased knowledge after the intervention is consistent with prior studies.

    “This finding is similar to a body of research conducted by Pirzadeh and Amidi Mazaheri [19], Adamu et al. [20], Gana et al. [21], Karimy et al. [22], Williams et al. [23] and Jeihooni et al. [24] and Jeihooni et al. [25].”
    Quote in the paperNot a substantial claim1 of 3 sources checked
    • cites [19] Pirzadeh A, Mazaheri MA. The effect of education on women's practice based on the health belief model about pap smear test. Int J Prev Med. 2012;3(8):585.
    • cites [20] Adamu A, Abiola A, Ibrahim M. The effect of health education on the knowledge, attitude, and uptake of free pap smear among female teachers in Birnin-Kebbi, North-Western Nigeria. Niger J Clin Pract. 2012;15(3):326–32. source
    • cites [21] Gana GJ, Oche MO, Ango JT, Kaoje AU, Awosan KJ, Raji IA. Educational intervention on knowledge of cervical cancer and uptake of Pap smear test among market women in Niger State, Nigeria. J Public Health Africa. 2017;8(2):575. source

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Interpretationcitation

    The nurturers finding is consistent with some studies and inconsistent with another.

    “This finding is consistent with a body of research by Williams et al. [23], Jeihooni et al. and Abedi et al. [24, 27], yet inconsistent with the results of the study by Mirtz et al. [28].”
    Quote in the paperNot a substantial claim1 of 3 sources checked
    • cites [23] Williams M, Moneyham L, Kempf M, Chamot E, Scarinci I. Structural and sociocultural factors associated with cervical cancer screening among HIV-infected African American women in Alabama. AIDS Patient Care STDs. 2015;29(1):13–9. source
    • cites [24] Jeihooni AK, Kashfi SM, Hatami M, Avand A, Bazrafshan M. The effect of educational program based on PRECEDE model in promoting prostate cancer screening in a sample of Iranian men. J Cancer Educ. 2019;34(1):161–72. source
    • cites [27] Abedi M, Borhani M, Rahimzadeh H, Mehri A, Hoseini ZS. The role of education in promoting self-care behaviors in patients with hypertension: an application of the PRECEDE model. J Educ Commun Health. 2020;7:303–10. source

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Interpretationcitation

    The enablers finding was consistent with some studies and inconsistent with another.

    “This finding was consistent with the results of studies conducted by Williams et al. [23], Jeihooni et al. [24], Dizagi et al. [26] and inconsistent with the results of the study conducted by Abedi et al. [27].”
    Quote in the paperNot a substantial claim2 of 3 sources checked
    • cites [23] Williams M, Moneyham L, Kempf M, Chamot E, Scarinci I. Structural and sociocultural factors associated with cervical cancer screening among HIV-infected African American women in Alabama. AIDS Patient Care STDs. 2015;29(1):13–9. source
    • cites [24] Jeihooni AK, Kashfi SM, Hatami M, Avand A, Bazrafshan M. The effect of educational program based on PRECEDE model in promoting prostate cancer screening in a sample of Iranian men. J Cancer Educ. 2019;34(1):161–72. source
    • cites [26] Dizaji MB, Taghdisi MH, Solhi M, Hoseini SM, Shafieyan Z, Qorbani M, et al. Effects of educational intervention based on PRECEDE model on self care behaviors and control in patients with type 2 diabetes in 2012. J Diabetes Metab Disord. 2014;13(1):1–6. source

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Interpretationcitation

    The behavior finding was in line with some studies and inconsistent with another.

    “This finding was in line with the results of the studies conducted by Jeihooni et al. [24], Pirzadeh and Amidi Mazaheri [19], Romli et al. [30], Daryani et al. [31], yet inconsistent with the results of the study conducted by Adamu et al. [20].”
    Quote in the paperNot a substantial claim1 of 3 sources checked
    • cites [24] Jeihooni AK, Kashfi SM, Hatami M, Avand A, Bazrafshan M. The effect of educational program based on PRECEDE model in promoting prostate cancer screening in a sample of Iranian men. J Cancer Educ. 2019;34(1):161–72. source
    • cites [19] Pirzadeh A, Mazaheri MA. The effect of education on women's practice based on the health belief model about pap smear test. Int J Prev Med. 2012;3(8):585.
    • cites [30] Romli R, Sa’adiah Shahabudin NS, Mokhtar N. Effectiveness of a health education program to improve knowledge and attitude towards cervical cancer and pap smear: a controlled community trial in Malaysia. Asian Pac J Cancer Prev. 2020;21(3):853. source

  • May combine two claims.

    Findingown data

    In the intervention group, the mean behavior score increased from 0.662 to 1, which was statistically significant (p < 0.001).

    “In the intervention group, the mean behavior score increased from 0.662 to 1, which was statistically significant (p < 0.001).”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    There was a significant difference between the mean age of participants with Yes and No responses to Pap smear behavior (p < 0.0001), with younger participants more likely to perform cervical cancer screening.

    “The results indicated that there was a significant difference between the mean age of participants with Yes and No responses (p < 0.0001) and according to the mean ranks, the mean age of participants with No response is higher than the mean age of participants with Yes response. In other words, younger participants are more likely to perform cervical cancer screening.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    In the logistic regression, knowledge and nurturers were significantly associated with behavior (p < 0.05), while attitude and enabling factors were not (p > 0.05).

    “The results of Table 7 showed that attitude and enabling factors with a significance level greater than 0.05 should be removed from the model. According to the significance level of knowledge and nurturers, which is less than 0.05, these variables should be present in the model.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    The mean knowledge score increased after the intervention, and there was a statistically significant difference between the two groups in knowledge (p < 0.001).

    “The results showed that the mean scores of knowledge increased after the intervention, and a statistically significant difference was found between the two groups in terms of the knowledge before and after the intervention (p<0.001).”
    Quote in the paperSubstantial claim

  • Classified as probably not a substantial claim. May combine two claims.

    Premisecitation

    An early detection and prevention of cancer is essential in controlling the disease and increasing patient survival.

    “An early detection and prevention of cancer is essential in controlling the disease and increasing patient survival [4].”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [4] Hossaini F, Tahmasebi R, Noroozi A. Comparing the effects of individual and group training methods based on health belief model on the belief and practice of Bushehr women regarding pap smear test. J Health. 2017;7:668–79.

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • May combine two claims.

    Interpretationown data

    The educational intervention had an effect on knowledge, attitude, enablers, and behavior in the participants of the intervention group.

    “The findings showed the effect of the intervention on the mentioned variables in the participants of the intervention group.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Study design and conductown data

    The researcher-made questionnaire was validated by a panel of experts and had internal consistency (Cronbach's alpha = 0.831) and test-retest reliability (ICC = 0.89).

    “A panel of experts was formed to validate the questionnaire.”
    • Also stated in: § Instrumentation · hedged
      “The internal consistency of the questionnaire was estimated using Cronbach’s alpha, which was estimated at 0.831 and the ICC was 0.89.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Premisecitation

    In Iran, 49.9% of women had taken the Pap test in their lifetime, while the rate in other countries was reported to be 85-93%.

    “for an instance, 49.9% of women had taken this test in their lifetime [9], while the rate in other countries was reported to be 85–93% [10].”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [9] Shabgard BMM, Khajehvand A. The effect of educational intervention based on BASNEF model on life style of Cancer in female in Rasht. Med J Mashhad Univ Med Sci. 2020;63(2):2499–507.

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

    • cites [10] Nazari S, Keshavarz Z, Afrakhte M, Riazi H. Barriers to cervical Cancer screening in HIV positive women: a systematic review of recent studies in the world. Iran J Epidemiol. 2019;15(1):87–94.

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims. The quote only partly states this claim.

    Interpretationreasoning

    The increase in nurturers in both groups may be due to participants' curiosity and the control group receiving encouragement.

    “Recording the information of the participants (in both the control and intervention groups) in the form of a questionnaire (pre-test), led to the curiosity and inquiry of the participants from the officials of the health care centers, and these officials are obliged to guide and inform the participants. This led to informing women about the services provided by health care centers, which they may”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Study design and conductreasoning

    The study had limitations including a small sample size, limited generalizability of findings to the whole population, failure to hold face-to-face training during the Covid-19 pandemic, and limited communication with people.

    “There are certain limitations in the present study including the small sample size and, thus, the limited generalizability of findings to the whole population, failure to hold face-to-face training in the Covid-19 pandemic and the limited communication with people.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Pirzadeh and Amidi Mazaheri found that education increased women's knowledge of the Pap smear test in the intervention group.

    “The findings reported by Pirzadeh and Amidi Mazaheri [19] also confirm that education increased women’s knowledge of the Pap smear test in the intervention group.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [19] Pirzadeh A, Mazaheri MA. The effect of education on women's practice based on the health belief model about pap smear test. Int J Prev Med. 2012;3(8):585.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    Adamu et al. found that the mean knowledge score of cervical cancer was low in both intervention and control groups, and after the intervention, a significant increase was observed in the knowledge score of the intervention group.

    “The findings reported by Adamu et al. [20] on the effect of health education on knowledge, attitude and practice of Pap smear test among female teachers showed the mean knowledge score of cervical cancer was low in both intervention and control groups. After the intervention, a significant increase was observed in the knowledge score of the intervention group.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [20] Adamu A, Abiola A, Ibrahim M. The effect of health education on the knowledge, attitude, and uptake of free pap smear among female teachers in Birnin-Kebbi, North-Western Nigeria. Niger J Clin Pract. 2012;15(3):326–32. source

  • The quote only partly states this claim.

    Interpretationown data

    The educational intervention did not have an effect on nurturers.

    “Therefore, it can be concluded that the educational intervention did not have any effect on any of these variables.”
    Quote in the paperSubstantial claim
24 of 24

  • The paper relies on this without support.

    Self-reported Pap smear behavior (a single question 'Have you ever done the pap test?') accurately reflects actual participation in cervical cancer screening.

    “The only behavior question “Have you ever done the pap test?” was to be answered as Yes (1 point) or No (0 point). A Yes answer was interpreted as showing the behavior and the No answer as the lack of behavior.”

  • The paper relies on this without support.

    The control group did not receive any other cervical cancer screening education or exposure that could affect their behavior during the study period.

    “The control group did not receive have any training or educational content. They were only contacted for doing the survey.”

  • The paper relies on this without support.

    The 3-month follow-up period is sufficient to detect a change in Pap smear behavior.

    “Three months after the end of the training intervention, the data were collected again in both control and intervention groups.”

  • The paper relies on this without support.

    The online educational intervention via WhatsApp was delivered as intended and participants engaged with the content sufficiently to produce the observed effects.

    “A group was formed in WhatsApp for the women in the intervention group. For a month, the daily educational content related to each of the model constructs was posted in the group.”

  • The paper relies on this without support.

    The sample of women visiting healthcare centers in Bandar Abbas is representative of the broader population of women in Iran for the purpose of generalizing the intervention effect.

    “The research population consisted of all women visiting healthcare centers in Bandar Abbas.”

  • The authors state this as an assumption.

    The study was pioneering in adopting the PEN-3 model to prevent cervical cancer in Iran and Bandar Abbas.

    “One strength of the study is that it was pioneering in adopting the PEN-3 model to prevent cervical cancer in Iran and Bandar Abbas.”

  • The paper relies on this without support.

    Enablers are the prerequisite for behavioral change and can be motivating.

    “Enablers are considered to be the prerequisite for behavioral change, and can be motivating.”

  • The paper relies on this without support.

    Nurturers can lead to continued behavior and give ongoing rewards for maintaining behavior.

    “Nurturers can lead to continued behavior and give ongoing rewards for maintaining behavior.”
8 of 8

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

Each contradiction between two passages listed here was confirmed by an independent check.

  • Attitude scale minimum is inconsistent with its scoring

    Minor

    The questionnaire has 16 attitude questions, each scored from 1 to 5. Its minimum total is therefore 16, not 12.

    Reported 12 · recomputed 16

  • Intervention-group bachelor percentage is incorrect

    Minor

    Table 2 lists 11 participants with a bachelor's degree in the intervention group of 80. That is 13.75%, not 11.8%.

    Reported 11.8 · recomputed 13.75

  • Two different F-values are reported for enablers

    Minor

    Table 6 gives the group F-value for enablers as 7197.76, while the accompanying description gives it as 197.769. Both are presented as the same adjusted comparison.

  • Nurturers result is called significant despite p = 0.493

    Minor

    The paper sets significance at p < 0.05, but describes the adjusted nurturers comparison with p = 0.493 as a significant difference.

4 of 4

Cites

Flagged first, then by citations

Research works printed but not linked: 4

  1. Hossaini F, Tahmasebi R, Noroozi A. Comparing the effects of individual and group training methods based on health belief model on the belief and practice of Bushehr women regarding pap smear test. J Health. 2017;7:668–79.
  2. Shabgard BMM, Khajehvand A. The effect of educational intervention based on BASNEF model on life style of Cancer in female in Rasht. Med J Mashhad Univ Med Sci. 2020;63(2):2499–507.
  3. Nazari S, Keshavarz Z, Afrakhte M, Riazi H. Barriers to cervical Cancer screening in HIV positive women: a systematic review of recent studies in the world. Iran J Epidemiol. 2019;15(1):87–94.
  4. Hajializadeh K, Ahadi H, Jomehri F, Rahgozar M. The role of health Beliefsin predicting Barriersto cervical Cancer screening. J Kerman Univ Med Sci. 2014;21(5):416–25.

Cited by

Sorted by citations

Related

Authors
Seyrafi, N., Homayuni, A., Hosseini, Z., Aghamolaei, T., Ghanbarnejad, A., & Mouseli, A.
Affiliations
Hormozgan University of Medical Sciences (IR)
Corresponding author
Hosseini, Zahra
ORCID
Venue
BMC Cancer
Publisher
Springer Science and Business Media LLC
Published
2022-11-28
Volume
22
Issue
1
Pages
1226-1226
ISSN
1471-2407 (ISSN-L)
DOI
10.1186/s12885-022-10331-x
PMC
PMC9703409
OpenAlex
W4310212435
Semantic Scholar
915b8d7e26f3fff62a2148ac8ae213324861d20b
Cited by
14
References
26
Citations by year
2026: 2 · 2025: 4 · 2024: 5 · 2023: 3
FWCI
2.42
Type
journal article
Language
en
Open access
Licence
Locations
  • BMC Cancer (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • PubMed Central (submittedVersion, cc-by)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
Funders
Hormozgan University of Medical Sciences
Topics
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Women's cancer prevention and management
  • Health Sciences › Medicine › Epidemiology › Cervical Cancer and HPV Research
  • Health Sciences › Medicine › Oncology › Global Cancer Incidence and Screening
Keywords
cervical cancer screening, PEN-3 model, educational intervention, women's health behavior, Pap smear screening, health knowledge and attitudes, socio-cultural barriers, online health education, cervical cancer prevention
MeSH terms
Uterine Cervical Neoplasms, Female, Humans, Vaginal Smears, Cluster Analysis, Early Detection of Cancer, Papanicolaou Test

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Claims read by deepseek-v4.1-flash under definition version 3 (extract-v3) on 2026-10-16.

Classified by jev-1.13-20260917 (gold-guideline-v0.2) on 2026-10-16.

Cited sources are checked by gpt-6-sol.

Statistics and arithmetic are recomputed, not judged.

Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.

What counts as a claim ›How we measure confidence ›How we check this ›

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