Social Media-Based Education on Cancer Screening Awareness in Women: A Randomized Controlled Trial

This study was conducted as a two-arm, parallel-group randomized controlled trial to evaluate the effect of a Social Ecological Model-based social media educational program on women's knowledge and attitudes regarding cancer screenings and their self-reported digital health literacy.

The study included 132 women aged 30-70 years who had not previously undergone breast, cervical, or colorectal cancer screening and who met the other eligibility criteria. Participants completed baseline assessments before group assignment and were allocated in a 1:1 ratio to the experimental group or the active comparator group.

The experimental group received a structured educational program through closed WhatsApp and Instagram groups. During the eight-week program, 53 visual educational posters were shared. The content addressed breast, cervical, and colorectal cancer epidemiology, risk factors, symptoms, screening methods, national screening recommendations, healthy lifestyle behaviors, access to screening services, and digital health literacy. Following the scheduled poster-sharing period, four short reinforcement videos were provided. The intervention therefore comprised a total of 57 educational materials.

The active comparator group received two standardized online educational sessions via Zoom, delivered one week apart. Each session lasted approximately 45-60 minutes. The sessions covered breast, cervical, and colorectal cancer screenings, digital health literacy, and the use of digital health services such as e-Nabız and the Central Physician Appointment System (MHRS). Participants were allowed to ask questions during the sessions but did not receive the repeated social media content or continuous group interaction provided to the experimental group.

The three co-primary outcomes were cancer screening knowledge, attitudes toward cancer screening, and self-reported digital health literacy. The outcomes were assessed using validated Turkish measurement instruments at baseline and four weeks after completion of the assigned educational program.

The educational intervention was developed with reference to the individual, interpersonal, institutional/organizational, community, and policy levels of the Social Ecological Model. However, all outcome measures were collected at the individual level. Actual cancer screening participation, health service utilization, and outcomes at the interpersonal, organizational, community, or policy levels were not measured.

The study was approved by the Istanbul Medipol University Non-Interventional Clinical Research Ethics Committee (Approval Number: E-10840098-202.3.02-7880). Written informed consent was obtained from all participants.

Inclusion criteria

• Female
• Aged 30-70 years
• Applied to Medipol Mega University Hospital in Istanbul between June and August 2025
• Had not previously undergone breast, cervical, or colorectal cancer screening
• Actively used both WhatsApp and Instagram
• Had access to a digital device and internet connection that enabled participation in the educational program
• Voluntarily agreed to participate and provided written informed consent

Exclusion criteria

• Previous diagnosis of any type of cancer
• Previous participation in any breast, cervical, or colorectal cancer screening procedure