EQUITA - A Feasibility Trial of a Faith-placed Intervention to Increase Screening Uptake in Black Adults

Using a mixed-methods approach and summarised as a narrative synthesis according to the progression criteria described below (Measures 1 - 11). Key feasibility domains include: time required for study setup and delivery; recruitment and retention of churches and participants; training and retention of peer facilitators; intervention delivery and adherence; data completeness and quality; and acceptability of procedures. Data sources will include recruitment and training logs, screening and consent forms, follow-up tracking sheets, and participant feedback surveys. Challenges and facilitators encountered will be documented in field notes by the study team. Quantitative data will be summarised descriptively (counts, percentages), and qualitative data will be thematically analysed. Findings will be assessed against pre-specified progression criteria to inform the viability of a future definitive trial.

The number of churches recruited will be recorded using a site recruitment log maintained by the study team. This log will record church name, date of agreement to participate, and contact details of church representatives. Descriptive statistics (e.g., counts and percentages) will be used to summarise the data.

A log will document the number of churches that agree to be randomised, including consent status and allocation group.

Participant screening and enrolment at baseline will be tracked in a participant recruitment log that includes date of screening, eligibility status, consent obtained (yes/no), and enrolment status. Numbers will be summarised using counts and percentages to assess recruitment feasibility.

Baseline demographic data (age, gender, and NHS screening eligibility) collected via participant questionnaires will be used to determine the distribution of participants across the four targeted screening programmes (cervical, breast, bowel, and AAA).

A follow-up tracking log will record all participants due for 3-month follow-up, the mode of follow-up contact (e.g., phone, email), and whether data collection was completed. Retention rates will be calculated as the proportion of enrolled participants who complete the follow-up assessment.

Acceptability of the informed consent process will be explored through qualitative interviews and/or focus groups conducted as part of the process evaluation. These discussions will examine participants' experiences of the consent process, including clarity of information, understanding of what participation involves, and overall satisfaction with how consent was obtained

Suitability of the data collection tools will be assessed through a mixed-methods approach. Completion rates will be calculated using descriptive statistics to evaluate the feasibility of administering the tools. In addition, feedback on the acceptability and clarity of the data collection measures will be gathered through qualitative methods (e.g. focus groups or interviews) and analysed thematically as part of the process evaluation.

The number of participants who explicitly consented to NHS data access will be recorded in the consent form and extracted into the study's NHS data access log. Percentages will be calculated relative to total enrolment. This will also be explored qualitatively

Data request forms sub mitted to NHS and matched datasets returned will be tracked in a secure data access log. The proportion of successful data matches will be calculated in relative to total for unsuccessful data request submitted to NHS.

A training participation log will record the number of enrolled participants who registered for and attended peer facilitator training sessions. The number retained as peer facilitators at 3-month follow-up will also be recorded. Counts and retention percentages will be calculated.

Dates of training registration, initiation, and completion will be documented in the training log. Time intervals will be calculated to determine the proportion trained within the target timeframe of 2-3 months.

Qualitative feedback on the intervention will be collected post-intervention through focus groups and interviews with both intervention and control participants. Feedback will be summarised thematically.

Change in attitude of barriers perceived towards screening programmes. This outcome is self-reported by participant

A questionnaire will be given to participants to test how religious beliefs influence health beliefs and willingness to obtain screening and medical treatments.

RHFQ includes 8 statements that are answered on 5-point Likert scale: 1=strongly disagree, 2=disagree, 3=undecided, 4=agree, 5=strongly agree Total scores range from 8 to 40. Higher scores indicate higher levels of religious fatalism, thus a lower willingness to attend screening due to religious beliefs.

The modesty measure for EQUITA is designed to assess the influence of cultural and religious values related to bodily privacy on cancer screening behaviours. Using two previously validated scales, the Modesty Measure for Muslim Women (MMM-W) by Padela et al. (2019) and Andrews' (2011) Modesty Scale.

The measure comprises six items, rated on a 5-point Likert scale from Strongly Disagree (1) to Strongly Agree (5). Higher scores indicate stronger modesty beliefs related to bodily privacy. Scores will be analysed to examine the relationship between modesty and screening intentions or behaviours.

Participant characteristics, such as age, location, education level, ethnicity, professional occupation and marital status, will be recorded and used for descriptive statistics ad subgroup analysis.

The measure knowledge of symptoms and risk factors of breast, cervical, and bowel cancer, awareness of the NHS screening programmes including age of invitation and frequency, a question including 22 barriers to screening ranging from emotional to practical barriers, attitudinal change to screening, self-reported screening uptake, intention, preparedness, and sociodemographic descriptors. The CAM captures participants' socioeconomic status by measuring level of education, living arrangements (owning outright, mortgage, renting from local authority/privately, squatting, other), and their postcode. The questionnaire will be administered online through Qualtrics (a telephone option will also be offered). Most items are multiple-choice or Likert-scale. Higher scores indicate greater cancer knowledge. Total scores and subdomain scores will be compared over time.

Questions assessing knowledge and awareness will be adapted from Suckow et al 2016These survey items, previously trialled in the UK and informed by other studies, include multiple-choice questions with single-choice responses on AAA definition, risk factors, detection methods, and the screening process. Correct responses will be summed. Higher scores indicate greater knowledge. Items are based on validated UK questionnaires.

Change in the number of participants who obtained screening following the intervention. This outcome is self-reported by participants. This (Yes/No) outcome will be assessed at follow-up. Uptake will be compared to baseline to assess the intervention's impact.

Screening data from the National Health Services (NHS) will be analysed to examine the change in the number of participants who obtained screening following the intervention.

Intervention participants will be asked to fill EQ-5D-5L questionnaires, which comprises five dimensions: mobility, self-care, usual activities, pain/discomfort and anxiety/depression. Each dimension has 5 levels: 1 = no problems, 2 = slight problems, 3 = moderate problems, 4 = severe problems and 5 = extreme problems. Scores can be reported by individual dimension or as an index value (range: -0.281 to 1.0, where 1 = full health). Higher index scores represent better health-related quality of life.

Measures multimorbidity based on a disease count approach, which consists of a list of 35 conditions to be asked which they have, as well as the option to include any other conditions. The total number of conditions reported will be counted. Higher scores indicate greater multimorbidity.