Effectiveness of two educational interventions based on the theory of planned behavior on oral cancer self-examination in adults: a randomized controlled trial.

BACKGROUND: The theory of planned behavior (TPB) is recognized as an effective theory for behavior change. The aim of the present study was to investigate the impact of two TPB-based educational interventions on oral self-examination (OSE) behavior and the related TPB constructs among adults in Tehran, Iran, in 2022. METHODS: This randomized controlled trial involved 400 healthy individuals recruited from 20 urban comprehensive health centers in the southern part of Tehran, Iran. The health centers were randomly assigned to two control (PowerPoint) and intervention (WhatsApp) groups (200 individuals in each group). In the control group (the recipient of the routine care), participants received a 20-minute lecture through a PowerPoint presentation and a pamphlet. In the intervention group (the recipient of an additional intervention alongside the routine care), participants were educated through messages and images on WhatsApp along with having monthly group discussions. Data was collected at baseline, as well as at 1- and 3-month follow-ups using a structured questionnaire. The outcomes assessed included OSE behavior and the related TPB constructs: intention, attitude, subjective norm, and perceived behavioral control. Linear and logistic generalized estimating equations (GEE) regression models were used to evaluate the impact of the interventions with STATA version 17. RESULTS: Of the total participants, 151 (37.75%) were men. The mean ± standard deviation (SD) of ages in the PowerPoint and WhatsApp groups were 39.89 ± 13.72 and 39.45 ± 13.90, respectively. OSE and the related TPB constructs showed significant differences between the groups at the 1-month post-intervention assessment. The effect of PowerPoint was more significant in the short-term (one month), while both methods showed similar effectiveness after three months, specifically in relation to OSE and the TPB constructs. At the 3-month post-intervention assessment, there were significant increases in OSE (OR = 28.63), intention (ß = 1.47), attitude (ß = 0.66), subjective norm (ß = 2.82), and perceived behavioral control (ß = 1.19) in both groups (p < 0.001). CONCLUSIONS: The present study provides evidence of the effectiveness of both educational interventions in improving OSE and the TPB constructs after three months. Therefore, both TPB-based educational methods can be recommended for designing and implementing interventions aimed at preventing oral cancer. TRIAL REGISTRATION: The trial protocol was registered in the Iranian Registry of Clinical Trials (IRCT) on 04/03/2022 (registration number: IRCT20220221054086N1).

Effects of educational interventions based on the theory of planned behavior on oral cancer-related knowledge and tobacco smoking in adults: a cluster randomized controlled trial.

BACKGROUND: The theory of planned behavior (TPB) is an effective model for facilitating behavioral change. The aim of the present study was to evaluate the impact of TPB-based educational interventions on oral cancer-related knowledge and tobacco smoking behavior in an Iranian adult population in 2022. METHODS: In this randomized controlled trial, a total of 400 healthy individuals were enrolled. The study was implemented in 20 urban health centers in the south of Tehran, Iran. The health centers were randomly allocated into two intervention groups. In group PowerPoint (PP), the participants received education through a 20-minute PowerPoint presentation complemented by a pamphlet. Group WhatsApp (WA) was educated via WhatsApp messages and images. Data was collected using a structured questionnaire at baseline, and at one- and three-month follow-ups. The outcomes were evaluated in terms of knowledge, tobacco smoking behavior, and the related model constructs i.e. intention, attitude, subjective norm, and perceived behavioral control. Generalized estimating equations (GEE) regression models were applied to assess the effect of interventions on repeated measurements of the outcomes. All analyses were conducted using STATA Software Version 17. RESULTS: Out of all the participants, 249 (62%) were women. The mean and standard deviation (SD) of age were 39.67 and 13.80 years. Overall, group PP had a significantly higher score of knowledge compared to group WA (ß = 0.43, p = 0.005). No significant differences were found between the groups with regard to tobacco smoking and the related TPB constructs, except for attitude with a higher score in group PP compared to group WA (ß = 0.50, p = 0.004). At the three-month follow-up, both interventions had significant effects on increasing knowledge (ß = 4.41), decreasing tobacco smoking (OR = 0.54), and increasing intention (ß = 1.11), attitude (ß = 1.22), subjective norm (ß = 1.37), and perceived behavioral control (ß = 1.08) (P < 0.001). CONCLUSIONS: Both interventions were effective in improving knowledge, tobacco smoking, and the TPB constructs after three months. Therefore, the application of both methods could be considered in the design and implementation of oral cancer prevention programs. TRIAL REGISTRATION: The trial protocol was registered in the Iranian Registry of Clinical Trials (IRCT) on 04/03/2022 (registration number: IRCT20220221054086N1).

Delayed diagnosis of oral cancer in Iran: challenge for prevention.

PURPOSE: The aim of this study was to investigate the diagnostic delay and its determinants among oral cancer patients in Tehran, Iran. MATERIALS AND METHODS: This study was conducted between September 2004 and September 2006 in three university hospitals, and included 100 consecutive patients with primary oral squamous cell carcinoma (international classification of disease, ICD-10 sites C01 to C06). Data were obtained through questionnaire interviews and medical records of the patients were reviewed to obtain information on the date of diagnosis, primary tumour site and the stage of the tumour at the time of diagnosis. Statistical analysis was performed by t test, ANOVA and logistic regression. RESULTS: The mean diagnostic delay was 7.2 months (SD 7.5, range 1 to 36 and median 4). The most important determinants of longer diagnostic delay were being single (OR = 4.8; 95% CI = 1.5 to 14.8; P < 0.05) and being at advanced tumour stages (OR = 5.3; 95% CI = 1.8 to 15.6; P < 0.01). The mean patient and professional delays were 5.3 months (SD 6.1 and median 2) and 2.1 months (SD 2.1 and median 1), respectively. Patients at advanced tumour stages were more likely to have longer patient and professional delays than those at early stages (OR = 5.6; 95% CI = 1.8 to 17.3 and OR = 3.4; 95% CI = 1.2 to 9.4, respectively; P < 0.05). Living alone was also a determinant of longer patient and professional delays (OR = 7.1; 95% CI = 2.0 to 24.7, OR = 3.5; 95% CI = 1.2 to 10.3, respectively; P < 0.05). CONCLUSIONS: Developing preventive programmes that focus on the enhancement of public and professional awareness about oral cancer is essential to promote earlier diagnosis in Iran.

Survival after lip cancer diagnosis.

The purpose of this study was to analyze the 5-year survival rates of 82 patients with lip cancer attending 5 university hospitals during 1999-2003 in Tehran, Iran. We used information from patient records, telephone calls, and death register files of the Iran Ministry of Health to ascertain the patients' vital status. Associations between survival and the variables of sex, age, stage of the tumor at the time of diagnosis, treatment modality, and tumor histopathologic type were analyzed with Kaplan-Meier, log-rank, and Cox regression methods. Of all patients, 70 (85%) were men, with a median age of 62 years (mean, 58.6 years [SD, 15 years]; range, 27-85 years) at the time of diagnosis. The median follow-up time of the patients was 57 months (mean, 56.4 months [SD, 28 months]; range, 0-112 months). The 1- to 5-year overall survival rate was 91% to 62%. The tumor stage at the time of diagnosis and the treatment modality were associated with survival (P < 0.05) in both univariate and multivariable analyses. Patients who underwent surgery and had lower stage tumors at the time of diagnosis showed higher survival rates. No differences in patient survival were found regarding sex, age, and histopathologic type of tumors. These findings indicate that although lip tumors are curable, early detection, diagnosis, and treatment lead to even higher rates of survival. Importance of the early detection of lip cancer should be emphasized in all health care and cancer prevention campaigns directed to the public and professionals.

Survival after diagnosis of cancer of the oral cavity.

In this retrospective study we analysed the survival in 470 patients with oral cancer. Patients who attended five university hospitals in Tehran, Iran, during the period 1996-2002 were included. Data were obtained from a combination of sources including patients' records, telephone calls, and deaths registered by the Ministry of Health. Survival curves were generated using Kaplan-Maier curves. Univariate and multivariate analyses of the relations between survival and age, sex, site of primary tumour, stage, and histopathological type were made using the log-rank test and Cox's regression analysis. Sex and age were not associated with survival. Treatment and stage of tumour at the time of diagnosis were related to survival. The overall survival rates were higher in patients with stages I or II cancer than those in stages III (OR=2.8, 95% CI=1.8 to 4.4) or IV (OR=4.6, 95% CI=3.1 to 6.8) at the time of diagnosis. Patients treated with radiotherapy had lower survival than those who had been operated on and had radiotherapy or operation alone (OR=2.8, 95% CI=1.7 to 4.5). There was no difference in survival depending on the histological type of tumour. To achieve higher survival, early detection and diagnosis of oral cancers should be emphasised in oral health programmes to improve public awareness and preventive activities among dentists in Iran.

Malignant oral tumors in iran: ten-year analysis on patient and tumor characteristics of 1042 patients in Tehran.

This study analyzed characteristics of oral cancer patients from Tehran, Iran, and their tumors. Data came from the patient records of 30 major hospitals in Tehran. Patients (n = 1042), diagnosed with invasive oral cancer in 1993-2003, were classified by primary tumor site according to ICD-10 (C00-C10). Data were analyzed separately for lip, oral cavity and salivary gland tumors. Statistical evaluation included chi and t-test. Of all cases, 59% were male. Age for all cases ranged from 6-103 years, mean age was 58.8 years (SD 16; median 62); 89% were older than 40. Tumor site breakdown was 65% oral cavity, 21% major salivary glands and 14% lip. A clear gender difference (P < 0.001) appeared regarding the primary tumor sites: women dominated in oral cavity cancers and men in lip cancers. The most common cancer site was the tongue (32%), accounting for 50% of the oral cavity cancers. Histologically, 88% of all oral cavity and lip cancers were squamous cell carcinomas, 10% of those were in age /= age 65. At the time of diagnosis, 59% of oral cavity cancers and 29% of lip cancers were at stage III or IV (P < 0.001). The results emphasize an urgent need for a national program focusing on early detection of oral cancers, including educational information addressed to oral health professionals.