Mobile app versus lecture for HPV prevention: A field trial with a planned behavior approach

Abstract

The most common sexually transmitted infection worldwide is Human Papillomavirus (HPV). Despite the high prevalence of HPV and its extensive consequences, awareness and knowledge among those affected, as well as the general public, are limited. Therefore, this study aimed to determine the effect of Theory of Planned Behavior (TPB)- based education delivered through two methods, lecture and mobile application, on the awareness and attitude of women of reproductive age attending comprehensive health service centers in Dezful city toward the prevention of cervical cancer and HPV during 2024–2025. This three-arm cluster-randomized trial was conducted among women of reproductive age attending comprehensive health service centers in Dezful, Iran, from 2024 to 2025. Three health service centers were randomly assigned to the control, lecture-based education, and mobile application-based education groups (40 participants per group; n  = 120). Participants were assessed at baseline (T 0 ), immediately after the intervention (T 1 ), and two months after the intervention (T 2 ). The prespecified primary outcomes were HPV-related awareness and TPB-related outcomes. Data were analyzed using appropriate nonparametric tests and generalized estimating equations (GEE). At T 1 and T 2 , significant differences were observed in awareness, attitude, subjective norms, perceived behavioral control, willingness to receive the HPV vaccine, and TPB total in the intervention groups compared to the control group ( P  < 0.05), unlike at T 0 . In pairwise comparisons, the mobile application intervention group showed a significant increase in all measure outcomes compared to the other groups after the intervention ( P  < 0.05). Generalized Estimating Equations (GEE) analysis, adjusting for baseline values, revealed that the mobile app intervention significantly improved attitude (β = 0.438, 95% CI: 0.204 to 0.671; P  < 0.001) but was associated with decreased behavioral intention over time (β = −0.350, 95% CI: −0.616 to − 0.084; P  = 0.010) compared to controls. The lecture group showed lower perceived behavioral control (β = −0.288, 95% CI: −0.546 to − 0.029; P  = 0.029) and total TPB scores (β = −0.700, 95% CI: −1.134 to − 0.266; P  = 0.002) relative to controls. The educational intervention based on the TPB, delivered through both lecture and mobile application methods, significantly improved HPV-related awareness and TPB-related outcomes among women. However, mobile application-based education achieved greater improvements in several outcomes. Therefore, modern electronic educational methods may serve as a valuable complement to conventional educational approaches for promoting HPV prevention and health education.