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

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.