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Previously submitted to: JMIR mHealth and uHealth (no longer under consideration since Oct 09, 2019)

Date Submitted: Sep 8, 2019
Open Peer Review Period: Sep 8, 2019 - Oct 9, 2019
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Development and Evaluation of Culturally Tailored Mobile Phone-Based Application to Promote Breast Cancer Preventive Behaviors among the Iranian Women: A randomized controlled trial

  • Maryam Khazaee-Pool; 
  • Tahereh Pashaei; 
  • Koen Ponnet; 



Despite the first rank of breast cancer incidence diagnosed in Iranian women, they have one of the lowest rates of breast cancer preventive behaviors. So that these behaviors have not been applied as routine care for healthy Iranian women. To improve preventive behaviors, a reliable and practical approach is needed. This study aimed to develop and test the culturally tailored mobile Phone-based application to promote breast cancer preventive behaviors called ASSISTS among Iranian women.


This study explores the impact of ASSISTS mobile application on changes to study Iranian women’ preventive behaviors toward breast cancer and recommends suggestions for how the intervention can be enhanced for varied dissemination and performance in the Iranian community.


Applying a randomized controlled trial design, 140 Iranian women aged 40 years and above were recruited and randomly appointed to either the intervention group (n=70) to receive culturally and personally tailored multilevel messages by a smartphone application accompanied by the routine health care facilities and control group (n=70) to receive just a routine health care. Outcome measures included attitude, stimulus, self-efficacy, information seeking, stress management, self-care, and social support, readiness for performing breast cancer preventive behaviors. The feasibility and acceptability of the ASSISTS mobile application intervention were also assessed.


Significant intervention effects were observed for objectively measured knowledge and self-reported variables of ASSISTS scale (all P<.05). The intervention group indicated significantly more change on scores of knowledge of preventive behaviors procedures and self-care (P=.01). The ASSISTS app group indicated significantly more readiness for breast exams use after the intervention compared with the booklet group. Furthermore, the intervention group evaluated consent with the intervention (P=.001) and increase of knowledge on breast cancer preventive behaviors (P=.001) more significant than the booklet group. About 68.2% ASSISTS app participants assessed this app as self-explanatory (44/70), fun (64/70, 66.5%), and interesting (63/70, 88.8%).


An ASSISTS smartphone app-based intervention was a practical, useful, and suitable intervention means to improve breast cancer preventive behaviors in Iranian women. A flexible, directly tailored method that depends on current technical progress can gain underserved and hard-to-employee populations that bear unequal cancer loads.


Please cite as:

Khazaee-Pool M, Pashaei T, Ponnet K

Development and Evaluation of Culturally Tailored Mobile Phone-Based Application to Promote Breast Cancer Preventive Behaviors among the Iranian Women: A randomized controlled trial

JMIR Preprints. 08/09/2019:16183

DOI: 10.2196/preprints.16183


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