Cancer is a leading cause of death globally; in this case, breast cancer has been widely considered (1). The incidence rate has slowly risen in advanced countries in current decades; this rate has quickly risen in developing countries (2). The risk factors that increase the chance of developing breast cancer can be categorized in unchangeable factors, like sex, age, delay in menarche or menopause, and family history of breast cancer (3, 4), and changeable factors, like obesity (5), high intake of fat foods (6), low level of regular exercise (7), alcohol drinking (6, 8), smoking (9), and facing a high level of stress (7). These changeable lifestyle factors are important risk factors for developing breast cancer (5). As such, changing one’s lifestyle may prevent breast cancer and reduce the risk of getting breast cancer to a large extent (8–13). For instance, it has been detected that routine exercises prevent too much weight gain and therefore decrease the risk of developing breast cancer (14).
It has been accepted that the easiest and effective ways to control and decrease breast cancer development and mortality are prevention and screening programs, which are at this moment in progress in Iran. Screening performances counting self and clinical breast exams and mammography are also defined to be useful for early detection and decreased mortality as a result of breast cancer (15, 16). However, procedures for application these modalities are not the same and differ in many countries (17–19). However, most Iranian women do not perform breast cancer screening behaviors because screening is not refunded by the government, with a risk that women who postpone screening may die earlier (19, 20). A study conducted in 2013 in Iran further revealed that 25% of women postponed the next check-up for more than three months (21), and despite having suitable awareness and beliefs, few health staffs applied breast cancer preventive behaviors and screening (22). Inappropriately the data for clinical breast exams does not record, but it has been expected that at best, 10% of Iranian females existing in the city might perform annual clinical breast check-ups (23).
Additionally, the information for diagnostic mammography between Iranian women differs from 1.3–30% (24, 25). Because only a few Iranian females considered doing breast exams, concentrating on the enhancement of healthy lifestyles might be vital to generate helpful healthcare approaches and increase health results (26, 27). It is essential to develop the subsequent health of women by performing health promotion modifications.
One of the most effective approaches to enhance breast cancer preventive behaviors (BCPBs) are using media campaigns (e.g., via billboards, radios, and television campaigns), while informing the women (28–32). The most important results of household surveys about using information technology by the Statistics Center of Iran show that the number of Iranian women who have a phone in is 27.3 million, and 15.2 million have computers, and 21.6 million of them access the internet. However, the rate of mobile users is 85% for men and 76.4% for women. Based on the statistic, 60.4% of women access to the internet. About 89.6% of Iranian users who use one of the information technology tools (e.g., mobile, computer) rate in the age group of 15–24 years and this amount of use for people in the age group of 25–49 years reported about 94.9%. Meanwhile, based on the age index of mobile use, the penetration rate of mobile users in the age group of 50–74 years is about 82.2%, and in the age group of 75 years and more is 50%. These figures show that the 25-49-year-old age group has the highest mobile users (33).
Mobile apps make innovative chances to regular behavioral aims, deliver healthy lifestyle advising, and enable self-controlling of targeted behavior of women (34). Mobile apps have become progressively related to health maintenance and effectively combined with interventions that mark healthy food, regular exercise, and controlling weight (35). Furthermore, mobile apps apply a tracking system to increase adherence by automated signal or announcement or graphic growth by checking devices for reminders and systematic interplays. The benefits of applying apps contain affordability, availability, and appropriate delivery to numerous areas and several peoples (35, 36). At-risk women of breast cancer look for apps to find breast cancer prevention-related information, discuss subjects with peers, and look for advice from experts to monitor their self-care decision making (37, 38). However, the bazaar for health care mobile apps is significantly disorganized because many of them are planned for very particular backgrounds, and they fail theoretic content. A literature review on quality evaluation for mobile apps is different (37, 39). Therefore, the design of quality and document-based mobile app to enhance breast cancer preventive behaviors in women is necessary.
Model-based intervention supports planners in recognizing theoretic structures to consider in an intervention to extract behavioral modification (40, 41). Furthermore, the theoretic basis offers an approach to smartphone preventive behavior intervention improvement (42). The Template for Intervention Description and Replication (TIDieR) guideline suggested the applying of theoretic frameworks in planning preventive interventions (43). Above all, model-informed design eases the process of an intervention (44, 45). Evidence from literature review and meta-analysis is applied as a base to generate suggestions for smartphone app design. The literature review is the source standard in integrating data in health care systems (46). Furthermore, a meta-analytic method is recognized as the most influential document due to its methodological precision (47).
On the other hand, considering the views and experiences of users in designing and developing mobile-based educational software helps to increase the effectiveness and practicality of the educational app. So that, by exploring users' experience about the mobile app, investigators and app designers can well develop future m-health interventions to be both practical and admitted by finale-users. The user-focused plan is a well-accepted strategy to improve a smartphone app. This plan is purposefully valuable due to its penetrations on users and their context of performance (48). The benefits of the user-centered plan involve the increase of freedom, capability, helpful, sensitive experience, and a feeling of connection for users (49). The user-centered plan emphasizes on target audience via an iterative plan method that employs users in building a concept, design, and improvement of a mobile app (50, 51). User contribution enhances demand and user-friendliness (52). The target group can choose personalized data about their favored method, which is vital to expand the adequacy and efficiency of interventions (49). User-based design procedures can support identifying the priority of possible users for content, template, and structure on a smartphone app, thus causing in a singularly useful plan. In conclusion, with probable advantages of little cost, high accessibility, and proper adherence, the current study aimed to develop an m-BCPBP app framework to facilitate breast cancer preventive behaviors among at-risk women applying for a model, literature review, and user-based method by the qualitative study.