Journal Article

The effect of Fogg model-based virtual education on health literacy and stages of behavior change in cervical cancer screening: study protocol for a randomized controlled trial

Mousavi-Nejad, Saba, Mohammadzadeh, Zeinab, Mehrabi, Esmat, Rezaei, Elham, Nourizadeh, Roghaiyeh

2026

Overview

Background Cervical cancer imposes a significant burden on women in low- and middle-income countries (LMICs), where participation rates in screening programs are suboptimal. Identifying effective intervention strategies to increase screening participation is critical, particularly in these communities. This study aims to determine the effect of Fogg model-based virtual education on cervical cancer health literacy and stages of behavior change related to cervical cancer screening. Methods This is a two-arm, parallel-group, randomized controlled trial with blinded outcome assessor and data analyst. Eighty women aged 21–65 years will be recruited from one-fifth of Tabriz’s health centers, selected on the basis of socioeconomic diversity, and randomized at a 1:1 ratio via restricted block randomization and sealed opaque envelopes for allocation concealment. The intervention group will receive virtual education based on the Fogg behavior model for 4 weeks (twice weekly) via the Iranian messaging platform Eitaa, which uses multimedia content (videos, audio, infographics, text messages, and quizzes) about cervical cancer and its screening. The content includes spark messages (to increase motivation and reduce psychological barriers), facilitator messages (to simplify practical barriers), and trigger messages (to prompt action). Data analysis will use ANCOVA for continuous variables and ordinal regression for stages of change. Discussion If the results of this study demonstrate positive effects, the intervention could increase screening participation, reduce the disease burden, and be scalable and adaptable for other LMICs, serving as a foundation for national digital prevention programs for diseases such as cervical cancer. Trial registration This trial was prospectively registered on the Iranian Registry of Clinical Trials. Iranian Registry of Clinical Trials, IRCT20171007036615N14, 21/10/2025. It was updated once due to an error in registering the expected date for recruitment, with the update dated 23/10/2025. https://irct.behdasht.gov.ir/trial/86293

• Publisher: BioMed Central,BioMed Central Ltd,Springer Nature B.V,BMC
• Subject: Adult / Aged / Analysis / Anxiety / Behavior / Biomedicine / Cancer / Cervical cancer / Cervical cancer health literacy / Clinical trials / Consent / Counseling / Decision making / Diagnosis / Distance education / Distance learning / Early Detection of Cancer - methods / Early Detection of Cancer - psychology / Female / Fogg behavior model / Health Behavior / Health education / Health facilities / Health Knowledge, Attitudes, Practice / Health Literacy / Health Sciences / Human papillomavirus / Humans / Information management / Intervention / Iran / Medical diagnosis / Medical personnel / Medical screening / Medicine / Medicine & Public Health / Middle Aged / Middle schools / Motivation / Multicenter Studies as Topic / Oncology, Experimental / Online education / Pap smear / Patient Education as Topic - methods / Randomized Controlled Trials as Topic / Risk factors / Self-efficacy / Social networks / Socioeconomic factors / Statistics for Life Sciences / Study Protocol / Text Messaging / Training / Uterine cervical neoplasms / Uterine Cervical Neoplasms - diagnosis / Uterine Cervical Neoplasms - prevention & control / Uterine Cervical Neoplasms - psychology / Womens health / Young Adult