Validation of a questionnaire to evaluate the attitude towards primary prevention advice from the European code against cancer

Study protocol of a randomized controlled trial to improve cancer prevention behaviors in adolescents and adults using a web-based intervention supplemented with SMS

Background

The overall number of cancer cases is increasing and, therefore, strengthening cancer prevention has become a priority. The institutions responsible for its control establish guidelines for primary prevention. These include recommendations, such as: not smoking, following a healthy diet, doing daily physical exercise or avoiding overweight. Adolescence is a period of adoption and/or consolidation of health behaviors, and both school- and family-based interventions have proven effective to improve them. Furthermore, online and mobile phone educational interventions are encouraging. Consequently, the main aim of this study is to assess the efficacy of an intervention in which these requirements (school, family, the Internet and SMS) are combined to prevent behavioral cancer risk.

Methods

This protocol describes the design and implementation of a complex online program that includes a randomized controlled trial put into practice in two countries: Spain and Mexico. Adolescents and adults of their environment (relatives and teachers) who voluntarily participate will be randomly assigned to the experimental group or to the control group once they have completed the online pre-test. The experimental group members will have free access to a tailor-made and interactive website (http://www.alertagrumete.com). During the academic year, this website will be periodically updated with different school and leisure activities related to the avoidance of risk behaviors. To encourage participation, the program includes a competition that gives rewards to the winners. SMS are also sent to students to stimulate the adoption of healthy behaviors and as a reminder of participation. Finished the intervention, an online post-test is performed in both groups and the impact on the risk behaviors is therefore assessed.

Discussion

The program is pioneer, since it combines many components which have already proven effective in previous researches. Moreover, it aims to compare efficacy in two countries with different socio-economic levels to find out if these approaches are equally effective in countries with a lower income level. However, the vertiginous evolution of the Internet and mobile phones may make this tool less attractive for adolescents, who may prefer social networks and other mobile phone applications which are nowadays massively used by their peers.

Trial registration

ISRCTN27988779

Impact of a primary care intervention on smoking, drinking, diet, weight, sun exposure, and work risk in families with cancer experience

BACKGROUND

Modifying multiple behavior risks is a promising approach to reduce cancer risk. Primary prevention advices of the European Code against Cancer were included in an educational intervention (EI) using social cognitive theories for motivating families with cancer experiences to adopt six cancer prevention behaviors.

METHODS

A randomized clinical controlled trial recruited 3,031 patients from Primary Care among cancer patients' relatives. The experimental group (EG) received four EI, one EI every six months, focused on tobacco, alcohol, diet, weight, sun and work, and based on social cognitive models. The impact of the first three EI was calculated measuring at baseline and 18 months later: (a) The percentage of people with each risk behavior; (b) The score reached in a Total Cancer Behavioral Risk (TCBR) indicator; (c) The Odds Ratios at the post-test.

RESULTS

Five risk behaviors decreased significantly more (p<0.01) in the EG than in the CG: Smoking (OR=0.662), drinking (OR=0.504), diet (OR=0.542), weight (OR=0.698), and sun (OR=0.389). The TCBR indicator also decreased an average of nearly 5 points (28.42 vs. 23.82), significantly more (p<0.001) in the EG.

CONCLUSION

Families with cancer experiences changed five cancer risk behaviors when approached in Primary Care with interventions based on social cognitive models.

Psychosocial factors associated with cancer behavioural risk in relatives of cancer patients

The European Code against Cancer includes some primary cancer prevention behaviours, which can be studied in the framework of psychosocial models of human behaviour as the ASE model (attitude-social influence-efficacy model). The objective of this study was to detect the factors that better explain cancer behavioural risk in relatives of cancer patients. A convenience sample of 3031 people was selected in primary care centres. A three-step multivariate analysis was carried out by means of a multiple linear regression, introducing cancer behavioural risk as the dependent variable and the following covariables: psychosocial factors in the ASE model, sociodemographic variables and the family history of cancer. At least five difficulties and four needs were perceived in following the preventive advice by 25% of patients. The main difficulties were tobacco and alcohol addiction and the demands of a social life. Principal needs were access to cessation programmes, family support, and being controlled and pressured by health workers. The highest risk profile is to be a young man with a low sociocultural level. The ASE determinants were the best predictors of cancer behavioural risk, so programmes that forget these predictors may not achieve any impact and may waste resources.