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Randomized Controlled Trial
. 2025 Jun 2;25(1):2048.
doi: 10.1186/s12889-025-23313-y.

The effect of simulation-based breast health education on breast cancer awareness and breast self-examination skills of Afghan refugee women: a randomized controlled trial

Nilgün Kuru Alici  1   2 , Ayşe Arikan Dönmez  3 , Okşan Aktaş  3 , Zeybek Zeytun  4   3
Affiliations
Randomized Controlled Trial

The effect of simulation-based breast health education on breast cancer awareness and breast self-examination skills of Afghan refugee women: a randomized controlled trial

Nilgün Kuru Alici et al. BMC Public Health. .

Abstract

Objectives: The aim of this study was to examine the effects of simulation-based breast health education on Afghan women's awareness of breast cancer, including knowledge of its risk factors, signs, and symptoms, as well as to improve their breast self-examination skills.

Study design: This study was a pre-test, post-test, parallel-arm randomized controlled trial.

Methods: The study sample consisted of 46 Afghan women, with 23 participants assigned to each of the intervention and control groups using block randomization. This study was conducted at the Social Development and Aid Mobilization (SGDD-ASAM) in Ankara, Türkiye. The intervention group received simulation-based breast health training. Each session of breast health education was 180 min. The simulation used a one-to-one show-and-do technique, which took approximately 120 min. Data were collected using the Breast Cancer Awareness Measure and the Breast Self-Examination Skill Assessment Form. The data were analyzed with the IBM SPSS 26 program. Descriptive statistics were used to evaluate the study data, including mean, standard deviation, percentage, and frequency distribution. The Shapiro-Wilk normality test was applied for further analysis. The Chi-Square (X2) Test was used to compare outcomes between groups. The significance level of p < 0.05 was considered.

Results: After the simulation-based training, there was a significant increase in confidence, skills, and behavior awareness among participants in the intervention group compared to the control group (p < 0.001). While there was no change in the control group, awareness of breast cancer, knowledge, and skills in the intervention group were predominantly rated as sufficient.

Conclusions: The simulation-based breast health education intervention for Afghan refugee women was found to be a practical and innovative approach to raising breast cancer awareness and providing breast self-examination skills. This intervention may play a significant role in identifying at-risk individuals and raising their awareness. If sustained, this could potentially increase future screening participation and early detection, ultimately contributing to improved patient outcomes. It is recommended that policymakers and health professionals prioritize the integration of simulation-based health education into prevention and health promotion strategies targeting disadvantaged populations, such as refugees and migrants, to improve early diagnosis and advance health equity.

Trial registration: Clinical Trials Number is NCT06051331. Registration date is 22.11.2023.

Keywords: Afghan women; Breast cancer awareness; Breast self-examination; Health education; Simulation-based education.

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Conflict of interest statement

Declarations. Ethics approval and consent to participate: The study was reviewed and approved by the Hacettepe University Social Sciences and Humanities Research Ethics Committee in Türkiye (No: E-66777842–300-00003075359). The researchers explained the purpose of the study and obtained written informed consent from all participants prior to data collection. Participants were informed that they could withdraw from the study at any time without providing a reason. It was also clearly stated that no payments would be made to them during the study, nor would they be required to make any payments. For illiterate participants, a sworn translator read the entire consent form aloud in their native language. Upon confirming their understanding and voluntary agreement to participate, they provided consent by signing or marking the form in the presence of both the translator and an impartial witness. The study was conducted in accordance with the principles of the Declaration of Helsinki, ensuring ethical standards in research involving human participants, including respect for autonomy, beneficence, and confidentiality. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests.

Figures

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Flow chart
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Fig. 2
The breast examination simulator
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