{
  "abstract": "Introduction Despite the benefits of early diagnosis, most cancers in sub-Saharan African (SSA) countries are diagnosed at an advanced stage due to late presentation of symptoms, inadequate referral systems and poor diagnostic capacity. Health communication interventions have been used extensively in high-income countries to increase people’s awareness of cancer symptoms and encourage timely help-seeking. However, in SSA, there is still limited evidence on the effectiveness of these interventions and existing evaluations are mainly focused on communicable diseases rather than cancer.Methods and analysis A randomised, multisite, controlled community trial will evaluate a culturally tailored health infographic toolkit delivered in rural and urban settings in the Western Cape Province in South Africa and Harare and surrounding provinces in Zimbabwe. Participants will be randomised to receive one of three African aWAreness of CANcer and Early Diagnosis (AWACAN-ED) cancer awareness tools, coproduced with local communities, comprising health communication infographics with descriptions of breast, cervical and colorectal cancer symptoms plus messages to encourage consultation with primary care providers if symptoms occur, all presented in English and four local languages. We will recruit 144 participants in each of the three intervention groups (N=432). The primary outcome will be recall of symptoms and the secondary outcomes will be (1) intention to seek help, (2) emotional impact and (3) acceptability of the toolkit. Outcomes will be measured preintervention and at two points postintervention: after 15 min and 1 month.Ethics and dissemination Ethical approval was obtained in both participating countries, South Africa (148/2025) and Zimbabwe (363/2021). All participants will be required to provide written informed consent prior to participation. Findings will be disseminated through peer-reviewed publications, conference presentations and the AWACAN-ED programme website.Trial registration number PACTR202505475803308.",
  "authors": [
    {
      "affiliations": [
        "Wolfson Institute of Population Health, Queen Mary University of London, London, UK"
      ],
      "name": "Suzanne Scott"
    },
    {
      "affiliations": [
        "Wolfson Institute of Population Health, Queen Mary University of London, London, UK"
      ],
      "name": "Jone G Lurgain"
    },
    {
      "affiliations": [
        "School of Public Health, Faculty of Health Sciences, University of Cape Town, Cape Town, Western Cape, South Africa"
      ],
      "name": "Sarah Day"
    },
    {
      "affiliations": [
        "Faculty of Medicine & Health Sciences, University of Zimbabwe, Harare, Zimbabwe"
      ],
      "name": "Bothwell T Guzha"
    },
    {
      "affiliations": [
        "Wolfson Institute of Population Health, Queen Mary University of London, London, UK"
      ],
      "name": "Ekaterina Pazukhina"
    },
    {
      "affiliations": [
        "Wolfson Institute of Population Health, Queen Mary University of London, London, UK"
      ],
      "name": "Kirsten Deanne Arendse"
    },
    {
      "affiliations": [
        "School of Public Health, Faculty of Health Sciences, University of Cape Town, Rondebosch, South Africa"
      ],
      "name": "Sudarshan Govender"
    },
    {
      "affiliations": [
        "Faculty of Medicine & Health Sciences, University of Zimbabwe, Harare, Zimbabwe",
        "Department of Obstetrics, Gynaecology & Reproductive Sciences, University of California San Francisco School of Medicine, San Francisco, California, USA"
      ],
      "name": "Mike Chirenje"
    },
    {
      "affiliations": [
        "Wolfson Institute of Population Health, Queen Mary University of London, London, UK"
      ],
      "name": "Valerie Anne Sills"
    },
    {
      "affiliations": [
        "Cancer Association of South Africa, Johannesburg, South Africa"
      ],
      "name": "Jane Harries"
    },
    {
      "affiliations": [
        "UMTHA Strategy Planning and Development, Cape Town, South Africa"
      ],
      "name": "Rosemary Jacobs"
    },
    {
      "affiliations": [
        "School of Public Health, Faculty of Health Sciences, University of Cape Town, Rondebosch, South Africa",
        "Cancer Research Initiative, Faculty of Health Sciences, University of Cape Town, Rondebosch, South Africa"
      ],
      "name": "Jennifer Moodley"
    },
    {
      "affiliations": [
        "Wolfson Institute of Population Health, Queen Mary University of London, London, UK",
        "The Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK"
      ],
      "name": "Fiona M Walter"
    }
  ],
  "title": "Randomised controlled community trial assessing efficacy of the AWACAN-ED public toolkit to improve cancer symptom awareness and intention to seek help in South Africa and Zimbabwe: study protocol",
  "uid": "183ee4de-742c-5d3b-95c6-b9a08f4e603e"
}