Background
Methods
Data collection
School | Study participants | |||||
---|---|---|---|---|---|---|
Roll (SR) | 2-week follow-up (T1) | 6-month follow-up (T2) | ||||
School (English Education System Year) | n | n | % (SR) | n | % (of SR) | % (of T1) |
A (Year 11) | 175 | 124 | 70.9 | 104 | 59.4 | 83.9 |
B (Year 10) | 174 | 138 | 79.3 | 106 | 60.9 | 76.8 |
C (Year 12) | 44 | 28 | 63.6 | 12 | 27.3 | 42.9 |
D (Year 8) | 165 | 132 | 80.0 | - | - | - |
Total†
| 558 | 422 | 75.6 | 222 | 56.5 | 76.6 |
Intervention
Survey instrument
Cancer awareness
Individual-level explanatory variables
Analysis
Ethical considerations
Results
Sample
Total (n=422) | Intervention (n=290) | Control (n=132) | 6-month follow-up (n=222) | ||||||
---|---|---|---|---|---|---|---|---|---|
n | % | n | % | n | % | Significance†
| n | % | |
Gender
| |||||||||
Male | 221 | 52.4 | 162 | 55.9 | 59 | 44.7 | 127 | 57.2 | |
Female | 201 | 47.6 | 128 | 44.1 | 73 | 55.3 | p=0.033 | 95 | 42.8 |
Age
| |||||||||
11 | 1 | 0.2 | - | - | 1 | 0.8 | - | - | |
12 | 104 | 24.6 | - | - | 104 | 78.8 | - | - | |
13 | 23 | 5.5 | - | - | 23 | 17.4 | - | - | |
14 | 169 | 40.0 | 169 | 58.3 | - | - | 137 | 61.7 | |
15 | 80 | 19.0 | 80 | 27.6 | - | - | 64 | 28.8 | |
16 | 26 | 6.2 | 26 | 9.0 | - | - | 11 | 5.0 | |
17 | 4 | 0.9 | 4 | 1.4 | - | - | 2 | 0.9 | |
Missing | 15 | 3.6 | 11 | 3.8 | 4 | 3.0 | p<0.001 | 8 | 3.6 |
Ethnicity
| |||||||||
White | 386 | 91.5 | 261 | 90.0 | 125 | 94.7 | 200 | 90.1 | |
Other ethnic backgrounds | 30 | 7.1 | 23 | 7.9 | 7 | 5.3 | 17 | 7.7 | |
Missing | 6 | 1.4 | 6 | 2.1 | 0 | 0 | p=0.193 | 5 | 2.3 |
Knew someone with cancer
| |||||||||
Yes | 255 | 60.4 | 179 | 61.7 | 76 | 57.6 | 137 | 61.7 | |
No | 131 | 31.0 | 88 | 30.3 | 43 | 32.6 | 66 | 29.7 | |
Do not wish to answer | 36 | 8.5 | 23 | 7.9 | 13 | 9.8 | p=0.644 | 19 | 8.6 |
School (Region)
| |||||||||
A (Scottish Highlands) | 124 | 29.4 | 124 | 42.8 | - | - | 104 | 46.8 | |
B (South West England) | 138 | 32.7 | 138 | 47.6 | - | - | 106 | 47.7 | |
C (English East Midlands) | 28 | 6.6 | 28 | 9.7 | - | - | 12 | 5.4 | |
D (North West England) | 132 | 31.3 | - | - | 132 | 100.0 | p<0.001 | - | - |
Country
| |||||||||
Scotland | 124 | 29.4 | 124 | 42.8 | - | - | 104 | 46.8 | |
England | 298 | 70.6 | 166 | 57.2 | 132 | 100.0 | p<0.001 | 118 | 53.2 |
Recall of cancer warning signs
Cancer warning sign Yes % (n) | Intervention (n=290) | Control (n=132) | ||||||
---|---|---|---|---|---|---|---|---|
T0
| T1
| Change | Significance†
| T0
| T1
| Change | Significance†
| |
Pain |
13.1 (38)
|
54.1 (157)
|
41.0 (119)
|
p<0.001
| 15.2 (20) | 16.7 (22) | 1.5 (2) | p=0.832 |
Tiredness/Fatigue |
10.0 (29)
|
38.6 (112)
|
28.6 (83)
|
p<0.001
| 2.3 (3) | 3.0 (4) | 0.7 (1) | p=1.000 |
Change in appearance of mole |
14.8 (43)
|
35.5 (103)
|
20.7 (60)
|
p<0.001
| 12.1 (16) | 7.6 (10) | -4.5 (-6) | p=0.180 |
Weight loss |
5.5 (16)
|
24.8 (72)
|
19.3 (56)
|
p<0.001
| 8.3 (11) | 5.3 (7) | -3.0 (-4) | p=0.388 |
Lump |
66.9 (194)
|
82.4 (239)
|
15.5 (45)
|
p<0.001
| 62.1 (82) | 65.9 (87) | 3.8 (5) | p=0.424 |
Bleeding |
10.0 (29)
|
24.5 (71)
|
14.5 (42)
|
p<0.001
|
4.5 (6)
|
13.6 (18)
|
9.1 (12)
|
p=0.008
|
Bowel/Bladder Habits |
1.4 (4)
|
10.3 (30)
|
8.9 (26)
|
p<0.001
| 2.3 (3) | 5.3 (7) | 3.0 (4) | p=0.344 |
Cough |
8.6 (25)
|
16.6 (48)
|
8.0 (23)
|
p<0.001
| 9.8 (13) | 16.7 (22) | 6.9 (9) | p=0.078 |
Headache/Migraine |
11.7 (34)
|
19.3 (56)
|
7.6 (22)
|
p=0.003
|
3.8 (5)
|
9.8 (13)
|
6.0 (8)
|
p=0.039
|
Stomach ache |
1.4 (4)
|
9.0 (26)
|
7.6 (22)
|
p<0.001
| 0 (0) | 0.8 (1) | 0.8 (1) |
‡
|
Weight gain | 0 (0) | 7.6 (22) | 7.6 (22) |
‡
| 1.5 (2) | 1.5 (2) | 0.0 (0) | p=1.000 |
Sore throat |
0.7 (2)
|
6.6 (19)
|
5.9 (17)
|
p<0.001
| 0.8 (1) | 3.8 (5) | 3.0 (4) | p=0.219 |
Bruising |
1.4 (4)
|
6.6 (19)
|
5.2 (15)
|
p=0.001
| 1.5 (2) | 2.3 (3) | 0.8 (1) | p=1.000 |
Nausea/Sickness |
9.7 (28)
|
14.1 (41)
|
4.4 (13)
|
p=0.002
| 10.6 (14) | 8.3 (11) | -2.3 (-3) | p=0.607 |
Spots/rashes | 2.4 (7) | 4.5 (13) | 2.1 (6) | p=0.210 | 3.8 (5) | 6.8 (9) | 3.0 (4) | p=0.424 |
Difficulty swallowing | 0 (0) | 2.1 (6) | 2.1 (6) |
‡
| 2.3 (3) | 1.5 (2) | -0.8 (-1) | p=1.000 |
Dizziness | 1.0 (3) | 2.8 (8) | 1.8 (5) | p=0.180 | 3.0 (4) | 3.0 (4) | 0 (0) | p=1.000 |
Sore that doesn't heal | 1.4 (4) | 3.1 (9) | 1.7 (5) | p=0.227 | 1.5 (2) | 0.8 (1) | -0.7 (-1) | p=1.000 |
Loss of appetite | 0 (0) | 0.7 (2) | 0.7 (2) |
‡
| 2.3 (3) | 3.0 (4) | 0.7 (1) | p=1.000 |
Infection | 1.0 (3) | 1.0 (3) | 0 (0) | p=1.000 | 0 (0) | 0 (0) | 0 (0) |
‡
|
Cramps | 1.0 (3) | 0.7 (2) | -0.3 (-1) | p=1.000 | 0 (0) | 1.5 (2) | 1.5 (2) |
‡
|
Feeling weak | 1.7 (5) | 1.0 (3) | -0.7 (-2) | p=0.687 | 2.3 (3) | 3.0 (4) | 0.7 (1) | p=1.000 |
Blurred vision | 1.0 (3) | 0.3 (1) | -0.7 (-2) | p=0.625 |
0.8 (1)
|
5.3 (7)
|
4.5 (6)
|
p=0.031
|
Flu symptoms | 1.7 (5) | 0.7 (2) | -1.0 (-3) | p=0.250 | 0 (0) | 0 (0) | 0 (0) |
‡
|
Tumour/Growth | 4.8 (14) | 3.4 (10) | -1.4 (-4) | p=0.454 | 0 (0) | 0 (0) | 0 (0) |
‡
|
Generally unwell | 5.5 (16) | 3.4 (10) | -2.1 (-6) | p=0.286 | 9.8 (13) | 8.3 (11) | -1.5 (-2) | p=0.804 |
Breathing problems |
4.1 (12)
|
0.3 (1)
|
-3.8 (-11)
|
p=0.003
| 1.5 (2) | 4.5 (6) | 3.0 (4) | p=0.219 |
Hair loss |
12.4 (36)
|
7.2 (21)
|
-5.2 (-15)
|
p=0.024
|
18.9 (25)
|
29.5 (39)
|
10.6 (14)
|
p=0.024
|
Don't know |
23.8 (69)
|
11.4 (33)
|
-12.4 (-36)
|
p<0.001
|
28.8 (38)
|
18.9 (25)
|
-9.9 (-13)
|
p=0.011
|
Recognition of cancer warning signs
Cancer warning sign Yes % (n) | Intervention (n=290) | Control (n=132) | ||||||
---|---|---|---|---|---|---|---|---|
T0
| T1
| Change | Significance†
| T0
| T1
| Change | Significance†
| |
Unexplained pain |
51.4 (147)
|
88.5 (253)
|
37.1 (106)
|
p<0.001
|
37.4 (49)
|
48.1 (63)
|
10.7 (14)
|
p=0.024
|
Unexplained weight loss |
45.1 (129)
|
79.0 (226)
|
33.9 (97)
|
p<0.001
|
32.8 (43)
|
42.7 (56)
|
9.9 (13)
|
p=0.041
|
Sore that does not heal |
28.2 (80)
|
57.0 (162)
|
28.8 (82)
|
p<0.001
| 17.4 (23) | 23.5 (31) | 6.1 (8) | p=0.169 |
Cough or hoarseness |
39.0 (112)
|
66.6 (191)
|
27.6 (79)
|
p<0.001
|
19.7 (26)
|
31.1 (41)
|
11.4 (15)
|
p=0.024
|
Unexplained bleeding |
52.8 (151)
|
78.7 (225)
|
25.9 (74)
|
p<0.001
| 40.2 (53) | 48.5 (64) | 8.3 (11) | p=0.117 |
Difficulty swallowing |
38.9 (111)
|
60.0 (171)
|
21.1 (60)
|
p<0.001
| 32.6 (43) | 36.4 (48) | 3.8 (5) | p=0.511 |
Change in bowel/bladder habits |
54.4 (155)
|
74.4 (212)
|
20.0 (57)
|
p<0.001
| 56.8 (75) | 50.8 (67) | -6.0 (-8) | p=0.256 |
Change in appearance of a mole |
64.9 (185)
|
84.2 (240)
|
19.3 (55)
|
p<0.001
| 49.2 (65) | 46.2 (61) | -3.0 (-4) | p=0.585 |
Lump or swelling | 93.4 (268) | 94.1 (270) | 0.7 (2) | p=0.851 | 80.2 (105) | 84.7 (111) | 4.5 (6) | p=0.210 |
Awareness of relationship between cancer and age
Awareness of common cancers
Childhood
TYA
Women
Men
Anticipated delay
Barriers to help-seeking
Barrier Yes % (n) | Intervention (n=290) | Control (n=132) | ||||||
---|---|---|---|---|---|---|---|---|
T0
| T1
| Change | Significance†
| T0
| T1
| Change | Significance†
| |
Emotional barriers
| ||||||||
Not confident to talk about symptoms |
53.0 (151)
|
44.6 (127)
|
-8.4 (-24)
|
p=0.021
| 50.0 (65) | 43.8 (57) | -6.2 (-8) | p=0.280 |
Worried about what the doctor might find |
70.2 (200)
|
63.2 (180)
|
-7.0 (-20)
|
p=0.021
| 73.5 (97) | 70.5 (93) | -3.0 (-4) | p=0.523 |
Too scared | 56.8 (162) | 51.9 (148) | -4.9 (-14) | p=0.165 | 49.6 (65) | 43.5 (57) | -6.1 (-8) | p=0.229 |
Too embarrassed | 56.8 (163) | 55.7 (160) | -1.1 (-3) | p=0.818 | 51.5 (67) | 52.3 (68) | 0.8 (1) | p=1.000 |
Practical barriers
| ||||||||
Other things to worry about |
22.2 (63)
|
29.6 (84)
|
7.4 (21)
|
p=0.010
| 12.4 (16) | 17.1 (22) | 4.7 (6) | p=0.180 |
Too busy | 24.9 (71) | 27.7 (79) | 2.8 (8) | p=0.389 | 17.1 (22) | 14.7 (19) | -2.4 (-3) | p=0.607 |
Difficult to arrange transport | 16.4 (47) | 12.2 (35) | -4.2 (-12) | p=0.111 | 14.7 (19) | 13.2 (17) | -1.5 (-2) | p=0.839 |
Service barriers
| ||||||||
Difficult to make an appointment | 23.1 (66) | 24.1 (69) | 1.0 (3) | p=0.795 | 15.4 (20) | 16.9 (22) | 1.5 (2) | p=0.832 |
Worried about wasting the doctor’s time | 34.1 (98) | 33.8 (97) | -0.3 (-1) | p=1.000 | 29.2 (38) | 29.2 (38) | 0 (0) | p=1.000 |
Difficult to talk to doctor | 35.0 (100) | 31.5 (90) | -3.5 (-10) | p=0.282 | 34.6 (45) | 31.5 (41) | -3.1 (-4) | p=0.618 |