The Effect of Animation Video and Training Booklet Designed on Breast Cancer

Aim of the Study This study aims to evaluate the effect of an animated video and educational booklet developed to inform Palestinian women aged 40-69 about breast cancer and screening programs on their level of knowledge about breast cancer and screening methods. The breast cancer screening program in Palestine includes monthly self-examination, clinical breast examination, and mammography. This study will be conducted in two phases. In the first phase, the animated video and educational booklet will be developed, and in the second phase, the level of knowledge and participation in screening programs will be evaluated after the educational intervention. Type of research: This is a randomized controlled experimental study. The study will be conducted with two intervention groups. Women who receive education through the animated video will form Intervention Group I, while women who receive education through the educational booklet will form Intervention Group II. The study will evaluate the effectiveness of the intervention in increasing the knowledge of women who received education through an animated video and an educational booklet about breast cancer, performing self-breast examinations, undergoing clinical breast examinations, and participating in breast cancer screening programs that include mammograms. This study will be conducted on Palestinian women and will target women with different levels of education. This study is based on a randomized controlled trial design and will compare the pre-, interim, and post-test results for women in both groups (animation video group and educational booklet group) in terms of breast cancer, breast cancer screening program information, and behavior change. It will be evaluated whether animation videos or educational booklets are more effective in increasing knowledge and behavior. Location and Timing of the Study: The study will be conducted in the West Bank of Palestine between September 2025 and December 2026. Research Population and Sample: The research population will consist of women aged 40-69 living in the West Bank of Palestine. Since this study was designed as a randomized controlled trial, a power analysis was conducted to determine the number of participants to be included in each group. In this context, the G\*Power (3.1.19.7) program was used to calculate the sample size. Using Cohen's standard effect sizes, the power analysis determined that a total of 128 participants (64 in each group) were needed to achieve 80% power at an effect size of 0.5, a 0.05 error rate, and a 0.95 confidence interval. Participants were volunteers who could read and write Arabic, were between 40 and 69 years of age, did not have breast cancer, and did not have a history of benign breast diseases such as breast cysts, fibroadenoma, or hyperplasia, no family history of breast cancer, no history of self-breast examination, no participation in breast cancer screening programs, and who own a smartphone or laptop computer. Women who meet the inclusion criteria will be divided into two groups: Intervention Group I, which will be trained using an animated video, and Intervention Group II, which will be trained using an educational booklet, using a simple random allocation method. To enhance the reliability of the study and ensure an equal distribution of the sample between the two groups, a program that generates random numbers will be used, and the sample will be randomly selected via the www.randomizer.org website. Women will be divided into two groups (in a 1:1 ratio). Women diagnosed with breast cancer during the study, women working in the healthcare sector (doctors, midwives, or nurses), pregnant and breastfeeding women, and women who do not watch the animated video or read the educational booklet within one week of receiving the educational materials will be excluded. Research Context Palestinians have been living under constant Israeli occupation and attacks since 1948, and the situation has worsened since the war began on October 7, 2023. The recent war has led to further restrictions and deliberate obstruction of access to health centers and hospitals by Israeli occupiers (Ali et al., 2025). Therefore, the universe will consist of women who come to the Murabitat Charity Association in the Palestinian Governorate of Qalqilya. The sample will be selected from women who meet the inclusion criteria. To facilitate the research and better reach women, an animated video will be published on the YouTube platform (as a private video), meaning only those with the link will be able to watch it, and it will not appear in search results. The educational booklet will be sent via a WhatsApp group in PDF format and will be password-protected, so only those with the password will be able to view it. Data collection tools will be managed online via WhatsApp or Zoom, ensuring accessibility and security under local political and logistical constraints.

Sex

Female

Minimum age

40 Years

Maximum age

69 Years

Inclusion Criteria:

* who could read and write Arabic,
* women between 40 and 69 years of age,
* who own a smartphone or laptop computer.

Exclusion Criteria:

* Did not have breast cancer, and did not have a history of benign breast diseases such as breast cysts, fibroadenoma, or hyperplasia, no family history of breast cancer, no history of self-breast examination, no participation in breast cancer screening programs

• BACKGROUNDAcharya, A., Ashrafian, H., Cunningham, D., Ruwende, J., Darzi, A., & Judah, G. (2022). Evaluating the impact of a novel behavioural science informed animation upon breast cancer screening uptake: protocol for a randomised controlled trial. BMC Public Health, 22(1). https://doi.org/10.1186/s12889-022-13781-x Al Eker O, Imam A, Elissa K. Unveiling health disparities in Palestine: a qualitative study of stakeholders' perspectives. Int J Equity Health. 2025 Apr 16;24(1):102. doi: 10.1186/s12939-025-02449-8. PMID: 40241084; PMCID: PMC12001633. Ali, D. O., Shaheen, A., & Badrasawi, M. (2025, April 22). Impact of the Israeli Occupation on Palestinian Women Health, Narrative review. https://journals.najah.edu/journal/pmpj/first-online/article/2499/ Alkhaldi M, Coghlan R, Miller S, Basuoni AA, Tanous O, Asi YM. State Accountability for the Good Health of Palestinians Has Failed: What Can the Global Health Community Do Next? Health Hum Rights. 2022 Jun;24(1):77-84. PMID: 35747282; PMCID: PMC9212828. Al-Tell, M., Natour, N., & Younes, D. (2019). Barriers to Breast Cancer Screening among Palestinian Women in Nablus Region, North-ern West Bank. Palestinian Medical and Pharmaceutical Journal (Pal. Med. Pharm. J.), 5(2). https://doi.org/10.59049/2790-0231.1061 American College of Obstetricians and Gynecologists. (2017). Breast cancer risk assessment and screening in average-risk women (Practice Bulletin No. 179). Obstetrics & Gynecology, 130(5), e1-e16. https://doi.org/10.1097/AOG.0000000000002158 (Erişim Tarihi 20.6.2025) Bekdemir Ak, Ö. (2024). Meme kanseri taramasında farkındalık ve davranış oluşturmaya yönelik hazırlanan video ve cep telefonu uygulamasının etkinliğinin değerlendirilmesi. İstanbul Üniversitesi-Cerrahpaşa Lisansüstü Enstitüsü, Doktora Tezi. Bu Bshait MS, Almaqhawi A. Quality Assessment of YouTube Videos As Information Source for Breast Self-Examination. Cureus. 2024 Sep 26;16(9):e70227. doi: 10.7759/cureus.70227. PMID: 39463531; PMCID: PMC11512166. Elshami, M