Randomised controlled community trial assessing efficacy of the AWACAN-ED public toolkit - study protocol

Sep 22, 2026

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The protocol evaluates a randomised, multisite community trial addressing late cancer presentation in sub-Saharan Africa. It tests a culturally tailored AWACAN-ED infographic toolkit delivered in South Africa and Zimbabwe to improve cancer symptom awareness and help-seeking intention. Participants will be randomised to one of three co-produced cancer awareness tools covering breast, cervical, and colorectal symptoms. Primary outcome is symptom recall; secondary outcomes include intention to seek help, emotional impact, and acceptability, measured preintervention and at 15 minutes and one month, with ethics approvals in both countries.

LanguageEnglish

CategoryResearch & Report

FormatPDF

Pages7

Reading Time18 min

AccessFree to download

Abstract

Introduction

Methods and analysis

Ethics and dissemination

Strengths and limitations of this study

Trial registration and determinants of advanced diagnosis

Open access Protocol 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 Suzanne Scott ,1 Jone G Lurgain ,1 Sarah Day ,2 Bothwell T Guzha,3 Ekaterina Pazukhina,1 Kirsten Deanne Arendse,1 Sudarshan Govender ,4 Mike Chirenje,3,5 Valerie Anne Sills,1 Jane Harries,6 Rosemary Jacobs,7 Jennifer Moodley,4,8 Fiona M Walter1,9 To cite: Scott S, Lurgain JG, Day S, et al. 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. BMJ Open 2026;16:e106400 . doi:10 . 1136/ bmjopen-2025-106400 ► Prepublication history and additional supplemental material for this paper are available online. To view these files, please visit the journal online ([https://doi.org/10.1136/](https://doi.org/10.1136/)[ ](https://doi.org/10.1136/)[bmjopen-2025-106400](bmjopen-2025-106400)) . JM and FMW are joint senior authors. Received 11 June 2025 Accepted 21 December 2025 © Author(s) (or their employer(s)) 2026. Re-use permitted under CC BY. Published by BMJ Group. For numbered affiliations see end of article. Correspondence to Professor Suzanne Scott; [suzanne.scott@qmul.ac.uk](suzanne.scott@qmul.ac.uk) 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, thereis 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 AWACANED programme website. STRENGTHS AND LIMITATIONS OF THIS STUDY ⇒ The study will test the psychological impact of culturally sensitive health messaging and infographics in English and four local languages in the African aWAreness of CANcer and Early Diagnosis (AWACAN-ED) public toolkit to investigate emotional response to engagement with the toolkit. ⇒ Engagement of community members of different ages in the codesign and development of the intervention to enhance cultural appropriateness. ⇒ Although each South African and Zimbabwean province was selected to be representative of rural and urba

FAQs

What does the AWACAN-ED public toolkit aim to improve?

It aims to improve cancer symptom awareness and encourage timely intention to seek help, supported by messages to consult primary care if symptoms occur.

How is the trial designed and where will it be conducted?

It is a randomised, multisite controlled community trial conducted in rural and urban settings in South Africa’s Western Cape Province and in Zimbabwe’s Harare and surrounding provinces.

What are the primary and secondary outcomes?

The primary outcome is recall of symptoms. Secondary outcomes include intention to seek help, emotional impact, and acceptability of the toolkit, measured before and after intervention at 15 minutes and one month.

Sep 22, 2026

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