Evaluation of a PEN-3-based educational intervention to promote fecal immunochemical test uptake in a rural Iranian population: a quasi-experimental pre-post study.

Authors

Zohreh Fathian-Dastgerdi, Hadi Mousavi-Nejad, Mohammad Javad Tarrahi

Published in

BMC public health. Volume 26. Issue 1. Aug 18, 2026. Epub Aug 18, 2026.

Abstract

Colorectal cancer (CRC) is a major public health concern worldwide, and participation in screening programs remains inadequate in many rural and underserved populations. This study assessed the effectiveness of a culturally tailored educational intervention based on the PEN-3 model in improving uptake of the fecal immunochemical test (FIT) among adults in rural Iran.
A community-based quasi-experimental pre-post study was conducted in Daran, Isfahan Province, Iran, in 2022. A total of 388 adults aged 50-70 years were recruited using stratified random sampling from two comprehensive health centers. The intervention was developed according to the PEN-3 model and addressed individual perceptions, family support, and community-level enabling factors. Data were collected before and three months after the intervention using a validated 51-item questionnaire assessing knowledge, perceived susceptibility, perceived severity, perceived barriers, response efficacy, and self-efficacy. Paired t-tests and chi-square tests were used for statistical analysis.
Among the 365 participants who completed the study, 134 individuals (36.7%) underwent FIT screening within three months after the intervention. Significant improvements were observed in knowledge, perceived susceptibility, and self-efficacy (all p < 0.001). Women demonstrated higher screening uptake than men (46.1% vs. 27.8%, p < 0.05), and FIT participation was inversely associated with educational level.
The findings suggest that FIT uptake and several PEN-3-related psychosocial constructs improved following implementation of the educational intervention. However, the absence of a control group limits causal inference. Further controlled studies are needed to confirm the effectiveness and long-term impact of culturally tailored educational interventions for colorectal cancer screening.

PMID:
43015721
Bibliographic data and abstract were imported from PubMed on 12 Nov 2026.

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