JMIR Publications

ABSTRACT

Background:

Breast cancer is the most frequently diagnosed cancer in Indonesia, and most patients present at an advanced stage. Fear of the disease is itself a barrier to education, because images of advanced breast cancer deter engagement with early-detection information. Marker-based augmented reality (AR) on a personal smartphone can render three-dimensional anatomy and disease progression in a learner-controlled, stylized, privately viewable form. Most AR health education evidence comes from health-professional trainees and university students in high-income settings. It reports knowledge outcomes almost exclusively, leaving its value for community health learning largely untested.

Objective:

This pilot study aimed to obtain preliminary estimates of the effect of smartphone-delivered, marker-based AR education, relative to conventional education, on knowledge, attitude, and practice related to early breast cancer detection among community-dwelling Indonesian women.

Methods:

In this 2-group pretest-posttest pilot study with site-level allocation, conducted between February and May 2026, 80 women were selected from the membership lists of 2 branches of a young women's community organization in Jakarta; 1 branch was allocated to AR education (n=40) and the other to conventional education (n=40). In the AR group, nurses delivered the session using a web-based AR platform on participants' own smartphones and 24 printed cards, 13 of which carried a marker that launched a three-dimensional model or an AR quiz. The control group received the same content, over the same duration and from the same facilitators, as a lecture with slide presentation. Knowledge, attitude, and practice were measured immediately before and after a single session using a questionnaire adapted and translated from a breast cancer screening scale. Generalized estimating equations (GEE), adjusted for occupation (the only baseline characteristic that differed between groups), estimated group-by-time interactions. Feasibility was assessed by recruitment and retention, and acceptability by a single recommendation item.

Results:

Knowledge, attitude, and total scores improved significantly over time in both groups (all P<.001), whereas practice scores did not change (β=0.47; P=.28). The group-by-time interaction was significant only for knowledge (β=3.83, 95% CI 1.08-6.56; P=.006) and not for attitude (β=0.37; P=.85), practice (β=0.33; P=.62), or the total score (β=4.53; P=.13). All 80 participants completed both assessments, and all participants who used the AR resource, including control participants who tried it after their post-test, would recommend AR for early-detection education.

Conclusions:

In this pilot study, nurse-facilitated AR education was associated with a greater immediate gain in knowledge than conventional nurse-delivered education, but not with greater gains in attitude or self-reported practice. AR is therefore best used as a complementary tool within nurse-led breast health education rather than as a standalone intervention. Because allocation was by site and outcomes were measured immediately after a single session, these estimates are preliminary. Procedures were feasible and the resource was acceptable and nurse-observed assessment of breast self-examination skill. Clinical Trial: Indonesia Clinical Research Registry INA-5F1C287; http://ina-crr.kemkes.go.id