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

Study Hypotheses H1: Using educational animated videos about breast cancer has a positive effect on participants' knowledge about breast cancer and the importance of screening programs.

H2: Using an informative educational booklet about breast cancer has a positive effect on participants' knowledge about breast cancer and the importance of screening programs.

H3: Using an educational animated video about breast cancer increases participants' participation rates in breast cancer screening programs.

H4: Using an informative educational booklet on breast cancer increases the participation rate of female participants in breast cancer screening programs.

H5: Using an educational animation video on breast cancer and screening programs increases women's knowledge about breast cancer and their participation rate in screening programs more than using an educational booklet.

Educational intervention and evaluation In a study examining the content of YouTube videos as a source of information for breast examination, it was found that although the quality of these videos was quite good, they were not sufficiently reliable in terms of the reliability of health information and the quality of information (Bu Bshait and Almaqhawi, 2024). Therefore, a new educational video will be developed from scratch. The video will provide high reliability, accuracy, and fluency based on evidence-based guidelines and will be aligned with the guidelines of the World Health Organization (WHO, 2024), the Palestinian Ministry of Health (MOH, 2024), the Royal College of Obstetricians and Gynaecologists (RCOG, 2011), and the American College of Obstetricians and Gynecologists (ACOG, 2017).

• An animated video and educational booklet containing the same information about breast cancer and screening will be developed.
• The script, characters, and story will be prepared in accordance with the information and objectives.
• The opinions of experts will be sought.
• If any changes are made to the animated video and educational booklet based on expert opinions, they will be revised accordingly.
• A pilot study will be conducted to test the data collection tools.
• If necessary, based on feedback received after the pilot study, changes will be made to the animated video, educational booklet, and Breast Cancer and Screening Program Information Test, and their final versions will be finalized.

Women participating in the study will be randomly selected and their written consent will be obtained via Google forms before the study begins. They will then be divided into two groups on the WhatsApp platform, and the "Introductory Information Form" and "Breast Cancer and Screening Program Information Test" will be sent online prior to the first follow-up intervention. Subsequently, animated videos and educational booklets will be distributed to both groups randomly. The Breast Cancer and Screening Program Knowledge Test will be sent to the women again one month and three months after the intervention for follow-up and evaluation purposes. This study aims to determine the short- and long-term effectiveness of the animated video and educational booklet on women's knowledge and behavior regarding breast cancer and screening.

Data collection tools used in the study The data collection tools will include an "Identification Information Form," a "Breast Cancer and Screening Program Information Test," an "Animation Video," and an "Educational Booklet."

1. The Information Form will include questions about women's demographic information, health status, and family history of breast cancer.
2. The Breast Cancer and Screening Program Information Test will include: 1) Information and awareness about breast cancer risk factors, symptoms, primary prevention, and secondary prevention; 2) Information on performing self-breast examination (SBE), undergoing clinical breast examination (CBE), and having a mammogram according to the screening program; 3) Questions to assess women's behaviors regarding performing SBE, undergoing CBE, and having a mammogram.
3. Animated Video; 1) Information on breast cancer risk factors, symptoms and signs, primary prevention, and secondary prevention; 2) A scenario will be prepared based on information about performing a Self-Breast Examination (SBE), undergoing a Clinical Breast Examination (CBE), and having a mammogram according to the screening program, and an animated video will be created.
4. Educational Booklet; 1) Information on breast cancer risk factors, symptoms, primary prevention, and secondary prevention; 2) An educational booklet will be created containing information on performing a Self-Breast Examination (SBE), undergoing a Clinical Breast Examination (CBE), and having a mammogram according to the screening program.

The "Information Form," "Breast Cancer and Screening Program Information Test," "Animation Video," and "Educational Booklet" will be written in Turkish and Arabic and, after their linguistic validity has been checked, will be sent to experts (breast disease specialists, midwives, and academics) their content validity will be determined, and the final version of the data collection tools will be created based on the experts' opinions. The questions in the "Information Form," "Breast Cancer and Screening Program Knowledge Test" will be evaluated according to criteria such as relevance to the subject, clarity of questions, fluency of expression, and suitability for general culture. All suggestions will be considered, and if necessary, changes will be made to the "Informative Information Form," "Breast Cancer and Screening Program Knowledge Test," "Animation Video," and "Educational Booklet." After the pilot study is conducted with 14 women (who will not be included in the study), the internal consistency of the questionnaire will be evaluated using Cronbach's alpha coefficient, and if the values are between 0.70 and 0.95, these results will be considered sufficient.