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Background <p>Cervical cancer represents a significant global health burden, particularly in low- and middle-income countries (LMICs), despite being largely preventable. The Health Action Process Approach (HAPA) distinguishes between motivational and volitional phases of behavior change; however, its application to cervical cancer prevention among Iranian teachers remains underexplored. This study evaluated whether an educational program informed by selected HAPA constructs (perceived severity, susceptibility, response efficacy, and self-efficacy) could improve cervical cancer self-care behaviors in this population. This study does not claim to test the full HAPA model but rather examines an intervention informed by HAPA constructs.</p> Methods <p>This quasi-experimental study utilized a two-group (intervention vs. control), pre-test/post-test/follow-up design involving 204 female primary school teachers in Ramsar, Iran. To minimize contamination, random allocation was performed at the school level (four schools per arm). The intervention group received four 90-minute weekly sessions grounded in HAPA constructs, while the control group received no intervention during the study period. Outcomes—comprising HAPA constructs (measured by a newly developed and psychometrically evaluated 25-item questionnaire) and self-care behaviors (10-item questionnaire)—were assessed at baseline (T1), immediate post-test (T2), and two-month follow-up (T3). Data were analyzed via repeated measures ANOVA with post-hoc Bonferroni corrections. Missing data (&lt; 5%) were handled using available case analysis following confirmation of the missing completely at random assumption (Little’s MCAR test: χ²=12.34, df = 18, <i>p</i> = 0.82).</p> Results <p>A total of 196 participants (96.1%) were retained at follow-up. The intervention group demonstrated significant improvements across all HAPA constructs and self-care behaviors from T1 to T2 (e.g., self-efficacy MD = 6.1, <i>p</i> &lt; 0.001, ηp²=0.35; self-care behaviors MD = 3.7, <i>p</i> &lt; 0.001, ηp²=0.41). These gains were maintained at T3 (all <i>p</i> &gt; 0.05 for T2 vs. T3 comparisons). In contrast, the control group exhibited no significant changes over time (all <i>p</i> &gt; 0.05).</p> Conclusions <p>A HAPA-informed educational intervention was effective in improving both motivational constructs and self-care behaviors related to cervical cancer prevention among female teachers, with effects sustained over two months. However, the study did not measure the full HAPA model (intention was omitted), and findings are limited to married teachers aged 30–50 years. Future studies should include longer follow-up periods (6–12 months), objective verification of Pap smear uptake through clinical records, and assessment of intention and volitional constructs.</p>

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Effectiveness of a HAPA-based educational intervention on cervical cancer preventive behaviors among female teachers: a quasi-experimental study

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年8月1日

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  • Arezoo Harsjian,
  • Ali Ramezankhani,
  • Sepideh Hajian,
  • Leili Rabiei

摘要

Background

Cervical cancer represents a significant global health burden, particularly in low- and middle-income countries (LMICs), despite being largely preventable. The Health Action Process Approach (HAPA) distinguishes between motivational and volitional phases of behavior change; however, its application to cervical cancer prevention among Iranian teachers remains underexplored. This study evaluated whether an educational program informed by selected HAPA constructs (perceived severity, susceptibility, response efficacy, and self-efficacy) could improve cervical cancer self-care behaviors in this population. This study does not claim to test the full HAPA model but rather examines an intervention informed by HAPA constructs.

Methods

This quasi-experimental study utilized a two-group (intervention vs. control), pre-test/post-test/follow-up design involving 204 female primary school teachers in Ramsar, Iran. To minimize contamination, random allocation was performed at the school level (four schools per arm). The intervention group received four 90-minute weekly sessions grounded in HAPA constructs, while the control group received no intervention during the study period. Outcomes—comprising HAPA constructs (measured by a newly developed and psychometrically evaluated 25-item questionnaire) and self-care behaviors (10-item questionnaire)—were assessed at baseline (T1), immediate post-test (T2), and two-month follow-up (T3). Data were analyzed via repeated measures ANOVA with post-hoc Bonferroni corrections. Missing data (< 5%) were handled using available case analysis following confirmation of the missing completely at random assumption (Little’s MCAR test: χ²=12.34, df = 18, p = 0.82).

Results

A total of 196 participants (96.1%) were retained at follow-up. The intervention group demonstrated significant improvements across all HAPA constructs and self-care behaviors from T1 to T2 (e.g., self-efficacy MD = 6.1, p < 0.001, ηp²=0.35; self-care behaviors MD = 3.7, p < 0.001, ηp²=0.41). These gains were maintained at T3 (all p > 0.05 for T2 vs. T3 comparisons). In contrast, the control group exhibited no significant changes over time (all p > 0.05).

Conclusions

A HAPA-informed educational intervention was effective in improving both motivational constructs and self-care behaviors related to cervical cancer prevention among female teachers, with effects sustained over two months. However, the study did not measure the full HAPA model (intention was omitted), and findings are limited to married teachers aged 30–50 years. Future studies should include longer follow-up periods (6–12 months), objective verification of Pap smear uptake through clinical records, and assessment of intention and volitional constructs.