Improving Muslim Women's Uptake of Cancer Screening (IMCAN)

The primary outcome of the project will be a narrative description of study feasibility, including recruitment and retention, protocol adherence and stakeholder acceptability. The primary outcome will be assessed using a mixed methods approach and assessed according the progression criteria, as described below.

Determine how many women accept the invitation to participate in the study and to estimate eligibility, recruitment and refusal rates.

This will be assessed using project monitoring data maintained by the research team which logs in detail all study data, including number of people, time, missing data, and cost where relevant.

Eligibility rate: Calculated as the number of participants screened/number of participants eligible x100%

Recruitment rate: Calculated as the number of enrolled participants/number of eligible participants x 100%

We will report recruitment and retention rates with 90% confidence intervals. Recruitment and retention rates will be summarised in relation to baseline characteristics, and differences in retention rates will be assessed using logistic regression methods.

Estimate the screening-non-responder rate. Non-responder rate: Calculated as the number of enrolled participants who were screening non-responders/number of eligible participants x 100%

Estimate loss to follow up/retention rate.

This will be assessed using project monitoring data Retention rate: Calculated as the number of participants who complete the 12 months follow up/number of participants in the intervention x100% This data will be compared for non-responders and partial responders.

Number of women who accepted the invitation to become peer educators, and the number of peer educators retained at 12 months. This will be assessed using project monitoring data.

Peer-educator recruitment rate: Calculated as the number of enrolled peer-educators/number of eligible peer-educators x 100% Peer-educator retention rate: calculated as the number of peer-educators at 12 months/number of peer-educators recruited x 100%

Whether the research team was able to obtain screening records for participants in all study location, and the proportion of participants who gave consent to access their screening records

The proportion of participants responding to questionnaires at baseline, 6 months and 12 months.

Measure key secondary outcome measures including behavioural intention proxies, and feasibility of self-reported data, missing data, estimates, variances and 95% CIs for any comparisons.

Baseline and follow up data

Data will be assessed in relation to each of the 3 different types of screening, as well as generally, to ensure we capture whether the intervention has a differential impact on different screening types.

We will also aim to compare behavioural change and self-reported data with the actual NHS screening data.

Participants' scores on outcome scales, and changes over time, will be reported using descriptive methods. Paired t-tests, or non-parametric alternatives, will be used to estimate changes over time, with 90% confidence intervals. Correlations between baseline and follow-up measures will be reported with 90% confidence intervals.

Comparison of measures on key domains for trial parameters will provide insight into the feasibility of the two different modes of delivery.

This will be inspected using project monitoring data baseline and follow up measures.

Including: eligibility rate, recruitment rate, retention rate, all measures non-responders/attenders and missing data

Visual inspection of trends and descriptive data will be used to establish whether comparisons between modalities is feasible.

Qualitative exploration of the acceptability of the process of recruitment, co-design phase, training, experiences and delivery of intervention.

Qualitative process evaluation focus groups with peer-educators. Including: experiences of co-design phase, experiences of recruitment of peer-educators, experiences of training, experiences of delivery of the intervention, language and use of interpreters, and perspectives on the intervention and study.

Qualitative exploration of the acceptability of the intervention and its delivery with participants and key stakeholders.

Qualitative process evaluation focus groups with participants and interviews with stakeholders.

This explores the following: content of the intervention, delivery mode of the intervention (face-to-face/online), delivery of the intervention (peer-educators, health care provider, religious perspective, personal testimonials), and experience and perspectives of taking part in the intervention

Qualitative exploration of the acceptability of the data collection methods and secondary outcome measures with participants and key stakeholders.

Qualitative process evaluation focus groups with participants and interviews with stakeholders Including: invitation to participate , recruitment processes, consent taking, baseline and follow-up secondary outcome measures, engagement in baseline and follow-up processes, and willingness to be randomised.

Explore qualitatively protocol adherence and barriers and enablers to key stakeholders such as research staff and collaborators. Qualitative process evaluation interviews with research staff and collaborators.

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 Higher scores indicate higher levels of religious fatalism, thus a lower willingness to attend screening due to religious beliefs

The Modesty Measure for Muslim women (MMM-W) will be given to participants to examine how self-representation among Muslim women can affect their health seeking behaviours.

The questionnaire will ask participants to indicate whether they 'agree', 'disagree' or 'ambivalent' to 10 statements about modest behaviour and healthcare

Participant characteristics, such as age, location, education level, ethnicity, professional occupation and marital status, will be recorded

This measure will assess changes in knowledge about the risk factors, symptoms and screening of breast, bowel and cervical cancer among participants.

The questionnaire will be administered online through Qualtrics (a telephone option will also be offered).

Multiple choice questions are used for this measure.

A cancer screening behaviour questionnaire will be given to participants. This consists of 2 parts:

• Participants will be asked about whether they attended breast, bowel or cervical cancer screening and if they are planning to attend screening. The answers for these questions will be: 'yes', 'no' or 'I don't know'.
• The second part includes statements that represent barrier and facilitator beliefs that might affect screening behaviour. Participants will be asked to indicate the level of agreement with each statement on 5-point liker scale: 1=strongly disagree, 2=disagree, 3=undecided, 4=agree, 5=strongly agree

Change in the number of participants who obtained screening following the intervention. This outcome is self-reported by participants

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: no problems, slight problems, moderate problems, severe problems and extreme problems.