Evaluation of mass media campaign of early cancer diagnosis, targeting older adults in Northern Ireland: a cross-sectional study.

BACKGROUND: Cancer Research UK ran a mass-media campaign for 6 weeks from Sept 1, 2022, to Sept 13, 2022, targeted to people aged 50 years and older and from a lower social-grade (C2DE) in Northern Ireland. The campaign was developed to target barriers to help-seeking for the target audience. With this evaluation, we aimed to compare reported barriers and self-reported help-seeking before and after the campaign to assess changes potentially related to the campaign. METHODS: We ran cross-sectional surveys that collected data from independent participants before the campaign (wave 1; n=1262; July 18-Aug 31, 2022) and after the campaign (wave 2; n=1250; Oct 3-Nov 3, 2022; N=2512). A recruitment agency recruited participants to be representative of Northern Ireland by age, gender, and social grade (Office for National Statistics, 2011; quota sampling). After wave 2, age range was 16-94 years (mean 51 years) and gender breakdown was 46% male (n=1152), 54% female (n=1356), and <1% other (n=3). Participants gave written informed consent, and the survey was administered using Computer Assisted Personal Interviewing (CAPI) at waves 1 and 2, and Computer Assisted Telephone Interviewing (CATI) at wave 1. Ethics approval was given by Queens University Belfast. Data were analysed in SPSS. FINDINGS: 78% of the targeted audience (354/451) reported remembering the TV campaign. Of people who reported no symptoms, more reported "nothing would put them off or delay seeking medical attention" at wave 2 (447 [41%] of 1084 participants) than at wave 1 (221 [24%] of 936 participants), and this difference was significant (t(939.796)=2·243, p=0·025; 95% CI 0·083 to 1·244). Participants who reported experiencing a symptom (wave 1 n=186; wave 2 103) were less likely to report that they did not seek help from their GP or doctor in wave 2 (n=63 [61%]) than in wave 1 (n=157 [85%]); however, this difference was not significant (t(214.167)=1·133, p=0·258, 95% CI -0·051 to 0·188). INTERPRETATION: Decreases in barriers reported "nothing putting them off seeking help" and decreases in not seeking help from a GP or doctor to help seeking for actual symptoms experienced suggests this campaign might have resulted in some positive shifts in self-reported help-seeking behaviours for actual symptoms. However, these findings should be interpreted in light of the limitations of this research. Although this was a large sample, additional consideration should be given to the use of independent samples (rather than repeated surveys with the same population), self-reported data, and different data collection methods. FUNDING: Community Foundation for Northern Ireland through the Department of Health Cancer Charities Fund.

Potential impact of health communications to raise awareness of the relative risk of age and cancer: a qualitative study.

BACKGROUND: The Cancer Research UK Cancer Awareness Measure Survey (2022) found older age as a risk factor for cancer to be low (around 2-4% across UK nations). However, 89 in 100 cancers are in those aged 50 years and older, and the majority of health-communications are targeted to these higher risk groups. This research aimed to understand the potential impact on health behaviours of communicating messages on relative increased risk of cancer with older age on participant's capability, motivation, and opportunity (COM-B model) in relation to positive early diagnosis health behaviours (body vigilance, intention to take part in cancer screening, preventative measures). METHODS: In this qualitative study, we conducted 60 min semi-structured paired-depth interviews of people aged 25-74 years from across the UK (20 pairs; n=40; age: mean 58·5 years, range 25-74; 19 [47%] men and 21 [53%] women; 27 [67%] White and 13 [33%] from Black or Asian minority ethnic groups). Participants were recruited via a recruitment agency and provided with an incentive of £60 for their time. To assess potential longer-term impact, participants filled a survey 2 weeks later on their views on the messages tested, and on self-reported actions taken as a result of the messages tested. The three different messages tested were rotated. Data were analysed using rapid thematic techniques, two moderators reviewed the data, and a framework analysis style assessed themes against capability, opportunity, and motivation (COM-B model). FINDINGS: Message 2 was the most preferred, as it was clear and easy to understand. Results suggested that including this messaging in health campaigns could encourage some positive early diagnosis heath behaviours. The post survey identified self-reported behaviour changes in nine (23%) of the 40 participants and sustained intentions in 29 (73%). Results overlayed with COM-B, identified messaging could support behaviour change by increasing awareness (psychological capability), providing a social cue (social opportunity), and encouraging emotions related to not wanting to get cancer or that they should be doing specific behaviours (reflective motivation). INTERPRETATION: Findings suggest communicating this message might have a positive effect on help-seeking behaviours in older adults (age ≥50 years). However, considerations include ensuring that the message is clear and understandable and that it doesn't induce fear. Although this study design allowed for more in-depth exploration, results are limited due to the small sample size. FUNDING: Cancer Research UK.

What drives public perceptions of e-cigarettes? A mixed-methods study exploring reasons behind adults' perceptions of e-cigarettes in Northern England.

BACKGROUND: Despite growing evidence that e-cigarettes are likely less harmful than cigarettes, perceptions of equal or more harm have increased worldwide. This study aimed to identify the most common reasons behind adults' perceptions of the (i) relative harm of e-cigarettes compared with cigarettes and (ii) effectiveness of e-cigarettes for smoking cessation. METHODS: Adults (N = 1646) from Northern England were recruited through online panels from December-March 2017/2018, using quota sampling to guarantee socio-demographic representativeness. Qualitative content analysis of open-ended responses was performed with codes representing reasons for a given perception about e-cigarettes. Percentages of participants who gave each reason for each perception were calculated. RESULTS: 823 (49.9%) participants agreed that e-cigarettes were less harmful than cigarettes, 283 (17.1%) disagreed, and 540 (32.8%) were undecided. The most common reasons for agreeing that e-cigarettes were less harmful than cigarettes were that they produce no smoke (29.8%) and fewer toxins (28.9%). Those who disagreed were most concerned about a perceived lack of trustworthy research (23.7%) and safety issues (20.8%). Lacking knowledge (50.4%) was the most common reason for being undecided. 815 (49.5%) of participants agreed that e-cigarettes were an effective smoking cessation aid, 216 (13.2%) disagreed, and 615 (37.4%) were undecided. The most common reasons participants gave for agreeing were related to e-cigarettes being successful smoking replacements (50.3%) and advice from family, friends or health professionals (20.0%). Respondents who disagreed were most concerned about e-cigarettes being addictive (34.3%) and containing nicotine (15.3%). Lacking knowledge (45.2%) was the most common reason for being undecided. CONCLUSIONS: Negative perceptions of e-cigarette harm were driven by concerns about a perceived lack of research and safety issues. Adults who viewed e-cigarettes as ineffective for smoking cessation feared that they perpetuate nicotine addiction. Campaigns and guidelines that address these concerns may help promote informed perceptions.

Demographic and psychological predictors of community pharmacists' cancer-related conversations with patients: a cross-sectional analysis and survey study.

BACKGROUND: There is increasing interest in the role of community pharmacy in the early diagnosis and prevention of cancer. This study set out to examine how often community pharmacists (CPs) encourage patients to spot or respond to potential signs and symptoms of cancer, and how often they help people to make an informed decision about taking part in bowel cancer screening. METHODS: Data from 400 UK CPs, who completed the 2018 Cancer Research UK Healthcare Professional Tracker survey, were analysed. The primary outcomes were: 'how often CPs encourage patients to spot or respond to potential signs and symptoms of cancer' and 'how often CPs encourage eligible people to make an informed decision to participate in bowel cancer screening'. Associations between behaviours and demographic and psychological variables (Capability, Opportunity and Motivation) were assessed using multivariate logistic regression. RESULTS: Most (n = 331, 82.8%) CPs reported occasionally, frequently or always encouraging patients to spot or respond to potential signs and symptoms of cancer, while only half (n = 203, 50.8%) reported occasionally, frequently or always helping people make an informed decision to participate in bowel cancer screening. Female sex (aOR: 3.20, 95%CI: 1.51, 6.81; p < 0.01) and increased Opportunity (aOR: 1.72, 95%CIs: 1.12, 2.64; p < 0.05) and Motivation (aOR: 1.76, 95%CIs: 1.37, 2.27; p < 0.001) were associated with encouraging patients to spot or respond to potential signs and symptoms of cancer; all three psychological variables were associated with helping people to make an informed decision to participate in bowel cancer screening (Capability: aOR: 1.39, 95%CIs: 1.26, 1.52, p < 0.001; Opportunity: aOR: 1.44, 95%CIs: 1.11, 1.87; p < 0.01; Motivation: aOR: 1.45, 95%CIs: 1.05, 2.00; p < 0.05). CONCLUSIONS: Most CPs encourage patients to spot or respond to potential cancer symptoms, while only half help them make an informed decision to participate in bowel cancer screening. A multifaceted approach, targeting multiple COM-B components, is required to change these behaviours.

A Sham-Controlled Study of Neurofeedback for Pain Management.

BACKGROUND: Neurofeedback (NFB) attempts to alter the brain's electrophysiological activity and has shown potential as a pain management technique. Existing studies, however, often lack appropriate control groups or fail to assess whether electrophysiological activity has been successfully regulated. The current study is a randomized controlled trial comparing changes in brain activity and pain during NFB with those of a sham-control group. METHODS: An experimental pain paradigm in healthy participants was used to provide optimal control of pain sensation. Twenty four healthy participants were blind randomized to receive either 10 × NFB (with real EEG feedback) or 10 × sham (with false EEG feedback) sessions during noxious cold stimulation. Prior to actual NFB training, training protocols were individually determined for each participant based on a comparison of an initial 32-channel qEEG assessment administered at both baseline and during an experimental pain task. Each individual protocol was based on the electrode site and frequency band that showed the greatest change in amplitude during pain, with alpha or theta up-regulation at various electrode sites (especially Pz) the most common protocols chosen. During the NFB sessions themselves, pain was assessed at multiple times during each session on a 0-10 rating scale, and ANOVA was used to examine changes in pain ratings and EEG amplitude both across and during sessions for both NFB and sham groups. RESULTS: For pain, ANOVA trend analysis found a significant general linear decrease in pain across the 10 sessions (p = 0.015). However, no significant main or interaction effects of group were observed suggesting decreases in pain occurred independently of NFB. For EEG, there was a significant During Session X Group interaction (p = 0.004), which indicated that EEG amplitude at the training site was significantly closer to the target amplitude for the NFB compared to the sham group during painful stimulation, but this was only the case at the beginning of the cold task. CONCLUSION: While these results must be interpreted within the context of an experimental pain model, they underline the importance of including an appropriate comparison group to avoid attributing naturally occurring changes to therapeutic effects.