Protocol: Feasibility of an Online Intervention to Increase Awareness of Gynaecological Cancer in UK Students

Background In the UK more than 2500 Teenage and Young Adult (TYA) are diagnosed with cancer each year, the majority being melanomas or carcinomas (including gynaecological cancers). Alarmingly, almost a third (29%) of TYA cancers are diagnosed within accident and emergency departments. Early diagnosis is key to improved cancer outcomes. However, although a sample of university students, could identify the common cancer warning signs, (e.g. lumps, bleeding) they could not identify those less common including; constipation, frequency in urination and bloating. Further, despite awareness of warning signs, most young people would delay or avoid seeking help altogether. The key to lifelong monitoring and early detection of cancer is early exposure to cancer information and body awareness at a formative age. University is seen as a key life transition phase which will enable students to establish positive health behaviours.

We have developed an online behaviour change intervention for university students to support the early detection and intention to seek help for symptoms of gynaecological cancer. The intervention consists of a bespoke online gynaecological cancer awareness educational film and a volitional help sheet to plan future gynaecological help seeking. Aim: To establish the feasibility and acceptability of the intervention and to understand the barriers and enablers to uptake and how to improve the intervention to develop a definitive study for launch in UK Universities.

Methods A longitudinal 1:1 randomised mixed methods feasibility study design will be employed. Eligible participants are women (or those at risk of gynaecological cancer e.g., have ovaries, a uterus, cervix) over 18 at UK universities who can understand English. We aim to recruit N=86 participants online from UK Universities. The educational film provides information about the signs and symptoms of the five different forms of gynaecological cancer and will be delivered online to participants via Qualtrics™. The volitional help sheet encourages participants to self-monitor for gynaecological symptoms and then use a standard implementation intention exercise to identify cues to help-seeking/action. Cancer awareness will be assessed by the Young Person's Cancer Awareness Measure (YPCAM) at baseline, 4 weeks, 3 months and 6 months, along with assessment of the Theory of Planned Behaviour (TPB) domains. Semi-structured interviews with a subsection of the intervention group will explore the barriers and enablers to uptake.

Results Feasibility will be measured by assessing the proportion of recruitment and attrition rates per time point, study completion and adherence to the educational film and volitional help sheet. Mean score changes (intervention vs control) will be examined over the four timepoints adjusting for a single covariate (baseline scores). Interview data will be analysed using the six stages of reflexive thematic analysis. Progression criteria to a main trial would be the successful recruitment of 80% of the target sample.

Conclusion We hope the findings from this study will provide empirical evidence on the potential of the intervention to enhance cancer awareness and help-seeking behaviours for symptoms of gynaecological cancer among TYA. The long-term goal is to harness the insight gained form this study to provide evidence-based data that support the broader integration of open cancer awareness initiatives within university settings.

Inclusion criteria

• female students (or those at risk of gynaecological cancer e.g., have ovaries, a uterus, cervix).
• over 18 years of age
• attending UK universities
• resident in the UK
• able to understand written English.

Exclusion criteria

• non- female students and those who are not at risk of gynaecological cancer e.g. (don't have ovaries, a uterus, cervix)
• under 18 years of age
• non UK residents
• not able to understand written English