Effect of a PEN-3 Model-Based Motivational Training Programme on Breast Cancer Screening Behaviours Among Female School Teachers

Ahmed, Bekhal Saber; Abdulla, Salih Ahmed

doi:10.31557/APJCP.2026.27.9.3385

Effect of a PEN-3 Model-Based Motivational Training Programme on Breast Cancer Screening Behaviours Among Female School Teachers

Document Type : Research Articles

Authors

Bekhal Saber Ahmed ¹
Salih Ahmed Abdulla ¹^{, 2}

¹ Department of Nursing, Hawler Medical University, Kurdistan Region, Iraq.

² Nursing Department, Faculty of Nursing, Tishk International University, Kurdistan Region, Iraq.

10.31557/APJCP.2026.27.9.3385

Abstract

Background: Breast cancer remains a leading cause of morbidity and mortality among women globally, with limited organized screening programs in low- and middle-income countries such as Iraq. Culturally appropriate educational interventions are needed to improve screening behaviors. Objective: This study aimed to evaluate the effect of a PEN-3 model–based motivational training program on breast cancer screening behaviors among female school teachers in Erbil city, Iraq. Methods: A cluster quasi-experimental controlled study was conducted among 136 female teachers from 18 public girls’ high schools. Schools were allocated at the cluster level to either an intervention group (n = 68) or a control group (n = 68). The intervention group received four structured motivational training sessions based on the PEN-3 model, while the control group received no intervention. Data were collected at baseline and two months post-intervention using a researcher-developed questionnaire based on the PEN-3 model, for which content validity and reliability were assessed in this study. Data were analyzed using descriptive statistics and non-parametric tests, including the Wilcoxon signed-rank test, Mann–Whitney U test, and chi-square test. Result: At two months post-intervention, the intervention group showed significant improvements in median scores of perception, enablers, and nurturers compared with the control group (all p < 0.001), with large effect sizes. The proportion of participants performing breast self-examination increased from 8.8% at baseline to 100% post-intervention in the intervention group, compared to 0% in the control group (p < 0.001). Similarly, clinical breast examination (69.1% vs. 0%) and mammography uptake (39.7% vs. 0%) were significantly higher in the intervention group. Conclusion: The PEN-3 model–based motivational training programme appears effective in improving breast cancer screening behaviors among female school teachers in the short term. Culturally tailored educational interventions may play an important role in promoting early detection practices in similar settings.

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