Cervical cancer remains a global health challenge with substantial disparities between countries. High-quality colposcopy is essential for cervical cancer prevention, yet training opportunities remain inadequate worldwide. We developed the Intelligent Digital Education Tool for Colposcopy (iDECO) to address training gaps and evaluated the effect across diverse international settings.

Six pre-post interventional training programmes were conducted in China, Mexico, and Mongolia from December 2024 to May 2025. A total of 369 trainees from 87 centers participated in a 3-week online training programme using iDECO, a bilingual web-based platform featuring authentic colposcopy cases, gamified learning pathways, and personalized analytics. The primary outcomes included colposcopy competence in general assessment, colposcopic findings, diagnostic accuracy, and management decisions. The secondary outcomes focused on participant feedback and satisfaction.

Of 369 participants who completed pretests, 333 (90.24%) completed post-training assessments. Significant improvements were observed across all competency domains. Diagnostic accuracy increased with an odds ratio (OR) of 1.72 (95% CI: 1.60–1.86) with the greatest gains in high-grade lesion identification [OR = 2.27 (95% CI: 1.94–2.64)]. Squamocolumnar junction visibility and transformation zone type assessments improved with ORs of 1.41 (95% CI: 1.31–1.51) and 1.87 (95% CI: 1.73–2.01), respectively. Biopsy decision-making accuracy also showed significant improvement [OR = 2.09 (95% CI: 1.91–2.29)]. International participants showed lower baseline performance but achieved the greatest improvements. Greater than 85% of participants rated the training highly satisfactory and 83.56% preferred intelligent training over traditional methods.

iDECO-based training significantly improved colposcopy competence across diverse international settings with high user satisfaction. These findings support the potential for worldwide implementation of intelligent digital training tools to address colposcopy training gaps and contribute to the elimination of cervical cancer.

To describe temporal changes associated with deployment of an optical character recognition (OCR)-enabled One-Identity (One-ID) digital platform for rural cervical cancer screening, focusing on over-screening rates, CIN2+ detection, colposcopy follow-up, and CIN2+ management.

A multi-county pre-post observational study was conducted in six rural counties in Shanxi, Yunnan, and Sichuan Provinces (2021–2024), encompassing 153,978 encounters. The digital platform integrates OCR identity capture, deterministic One-ID linkage, and real-time duplicate alerts. Over-screening proportions before and after digital deployment were compared, changes in CIN2+ detection rate were evaluated, and colposcopy follow-up and CIN2+ management were assessed. Differences were tested with χ² or Fisher’s exact tests.

Among 153,978 encounters, the proportion of over-screening decreased from 12.64% in 2023 to 0.17% in 2024 with an absolute reduction of 12.17% (95% CI: 11.94–12.40; P < 0.001). The share of women receiving a first screening within the preceding 3 y increased from 78.3% to 88.2% (P < 0.001). Colposcopy completion improved from 64.1% to 84.9%. The CIN2+ detection rate rose from 0.35% (2021–2023 pooled) to 0.67% in 2024 (P < 0.001) and CIN2+ management completion increased from 56.0% to 76.2% (95% CI: 13.3–27.2; P < 0.001). These improvements were consistent across age groups, counties, and screening strategies.

The OCR-enabled One-ID platform substantially reduced over-screening, increased CIN2+ detection rate, and strengthened case follow-up/management, particularly where baseline tracking was weak, supporting scalable digital reinforcement of rural screening programmes.