Educational Program Increases Vulvar Self-Examination Rates in Randomized Trial

A structured educational intervention based on the Health Belief Model significantly boosted women’s vulvar health awareness, health literacy, and self-examination practices, according to a randomized controlled trial published in BMC Women’s Health. The investigation assessed whether combining theoretical teaching with hands-on anatomical model practice could influence health beliefs and foster proactive screening behaviors among women attending primary healthcare settings.

The study was conducted across six family health centres located in Ankara, Türkiye, between August and October 2025. Researchers randomized a total of 206 women into two study arms, ultimately completing analyses on 203 participants, comprising 100 individuals in the intervention group and 103 individuals in the control group. The trial was registered retrospectively on ClinicalTrials.gov under the identifier NCT07621315.

Participants allocated to the active intervention arm took part in a dedicated 45-minute educational session anchored in the Health Belief Model. This session integrated formal theoretical instruction with practical exercises utilizing anatomical models to clarify self-examination techniques. Conversely, women assigned to the control cohort received routine clinical counselling alongside standard educational print materials distributed at the health centres.

Investigators tracked outcomes from baseline to a one-month follow-up evaluation. The primary outcome domain focused on health beliefs, quantified through five distinct subscales of the Champion Health Belief Model Scale. Secondary outcome measures included changes in vulvar health awareness scores, knowledge-based vulvar health literacy scores, and self-reported rates of vulvar self-examination practice.

In the intervention cohort, vulvar health awareness scores rose markedly from a baseline mean of 11.54 ± 3.10 to 16.63 ± 2.65 at one month. Statistical evaluation confirmed a significant group-by-time interaction effect for this awareness metric, characterized by an F-statistic of F(1,201) = 181.348, a partial eta squared of 0.474, and a significance level of p < 0.001.

Knowledge-based vulvar health literacy also improved substantially among intervention participants, rising from 12.70 ± 3.74 at baseline to 19.21 ± 3.16 following the educational session. Repeated-measures analysis demonstrated a significant group-by-time interaction for health literacy as well, yielding F(1,201) = 176.696, partial eta squared of 0.468, and p < 0.001, reflecting gains over the control cohort.

Engagement in self-examination practices exhibited a prominent shift among women who received the educational intervention. The proportion of participants reporting self-examination of the vulva rose from 11.0 percent before the intervention to 73.0 percent at the one-month evaluation, representing a statistically significant increase (p < 0.001). In contrast, the control group showed no significant shift over the same timeframe, recording a p-value of 1.000.

Analysis of the Champion Health Belief Model subscales revealed mixed interaction effects across specific perceptual dimensions. Significant group-by-time interactions occurred for perceived benefits (F(1,201) = 9.007; p = 0.003; partial eta squared = 0.043) and self-efficacy or confidence (F(1,201) = 58.943; p < 0.001; partial eta squared = 0.227). However, the intervention produced no significant interaction effects regarding perceived susceptibility (p = 0.721), perceived seriousness (p = 0.530), or perceived barriers (p = 0.387).

To evaluate these outcomes, the research team employed a mixed-design repeated-measures analysis of variance alongside group comparison tests and McNemar’s test. These analytical methods allowed the investigators to evaluate changes across both study arms from baseline measurements through the one-month post-intervention follow-up point. By tracking both groups systematically across time, the analytical framework captured how targeted educational instruction influenced participants compared to the standard counseling and printed materials provided at the family health centres.

The trial design also reflected specific methodological boundaries, notably its reliance on self-reported practices and a focused one-month evaluation interval following the educational session. While the single 45-minute structured session combining anatomical model practice with theoretical instruction produced marked shifts in knowledge-based literacy, awareness scores, perceived benefits, and confidence, other perceptual dimensions remained unchanged across the study window. Specifically, perceived susceptibility, perceived seriousness, and perceived barriers did not exhibit statistically significant group-by-time interaction effects between the two cohorts.

Overall, the randomized trial demonstrated that integrating hands-on anatomical model practice with theoretical instruction under the Health Belief Model framework generated substantial short-term improvements in vulvar health literacy, awareness, and reported examination habits among participants attending primary care facilities in Ankara. At the same time, the stability observed in susceptibility, seriousness, and barrier scores underscores how distinct belief domains respond differently to focused educational sessions.

Subject of Research: Effectiveness of a Health Belief Model educational intervention on vulvar health awareness and self-examination practices

Article Title: Effectiveness of a health belief model-based self-examination of the vulva education program on women’s vulvar health awareness, health literacy, health beliefs, and self-examination practice: a randomized controlled trial

Article References: Aşır, Ö. A., Ceylan, S., Bektaş, A. Ö., & Çifci, Ş. (2026). Effectiveness of a health belief model-based self-examination of the vulva education program on women’s vulvar health awareness, health literacy, health beliefs, and self-examination practice: a randomized controlled trial. BMC Women's Health. https://doi.org/10.1186/s12905-026-05098-3

Image Credits: AI Generated

DOI: 10.1186/s12905-026-05098-3

Keywords: vulvar health awareness, vulvar self-examination, Health Belief Model, health literacy, randomized controlled trial, women's health, Champion Health Belief Model Scale, family health centres, Ankara, self-efficacy, perceived benefits, primary care, preventive health, patient education, anatomical models, clinical trials