Module 2: Population awareness and beliefs
This section provides more information on Module 2, the module looking at population awareness, attitudes and beliefs about cancer.
Module 2 is exploring the attitudes and beliefs the general public have towards cancer. Populations with lower cancer awareness and more negative beliefs about cancer outcomes may be more likely to delay seeing their doctor about any suspicious symptoms they may have. This in turn may lead to more advanced stage at cancer diagnosis and poorer survival.
Professors Amanda Ramirez (King’s College London) and Jane Wardle (University College London) co-chair and lead the work in this module. They work in close collaboration with scientists from all ICBP partner jurisdictions, forming an international research team.
Module 2 has recently provided the first robust international comparison of population awareness and beliefs about cancer. It tested the hypothesis that differences in the levels of cancer awareness and beliefs contribute to observed international differences in cancer survival. These results could potentially be used to identify target for interventions to address low cancer awareness and negative beliefs. Such interventions could include cancer awareness campaigns.
The Module 2 central team analysed the data on population awareness and beliefs, with support from statisticians. Key outputs include:
- robust international comparisons of the current state of population awareness and beliefs about cancer
- improved understanding of the association between cancer awareness and beliefs and survival
These outputs are presented in a paper, 'Differences in cancer awareness and beliefs between Australia, Canada, Denmark, Norway, Sweden and the UK (the International Cancer Benchmarking Partnership): do they contribute to differences in cancer survival' published by the British Journal of Cancer.
You can find more information about this paper and access it free of charge on our publications page.
The ABC measure
The international Module 2 team has developed the Awareness and Beliefs about Cancer (ABC) survey instrument to assess the general public’s attitudes and beliefs about cancer.
The ABC is an international survey instrument which includes questions designed to find out more about:
- what individual people know about the signs and symptoms of cancer
- what their beliefs towards cancer treatment and outcomes are
- what might put people off from seeing their doctor
The questionnaire was first developed and tested in UK English. This process included in-depth interviews with a sample from the general public to probe whether the questions were easily understood and clear. Following the testing process in the UK, the team then developed a different version of the ABC for each ICBP partner jurisdiction. Each version has the same core questions but these have been translated, adapted and harmonised to make sure that they are relevant locally.
A paper written by the Module 2 central team, describing the development and testing of the ABC measure, was published in the BMJ Open. You can find more information about this paper and access it free of charge on our publications page.
The international market research provider Ipsos MORI conducted computer-assisted telephone interviews using the ABC instruments in each ICBP partner jurisdiction. They surveyed over 19,000 men and women aged 50 or over in Australia (New South Wales and Victoria), Canada, England, Northern Ireland, Denmark, Norway, Sweden and Wales.
This fieldwork took place over a five month period from May – September 2011. In addition, some jurisdictions also surveyed younger people (men and women aged 35-43) or asked questions from three optional survey elements developed by the international team. These optional modules focus on:
- awareness of cancer risk factors
- awareness and beliefs about cancer screening
- awareness and beliefs about ovarian cancer
Module 2 governance
The ICBP Programme Board oversees the work of the Module 2 central team, which collaborates closely with a group of international partners. An academic reference group provides peer review on methodology, analyses and conclusions.
- Jane Wardle, University College London
- Amanda Ramirez, King's College London
- Alice Simon, City University London
- Lindsay Forbes, King's College London
- Australia (Victoria): Kerry Haynes, Melanie Wakefield
- Australia (New South Wales): Anita Dessaix, Donna Perez
- Canada: Lisa Petermann, Deb Keen
- Denmark: Line Hvidberg, Anette Pedersen, Christian Wulff & Peter Vedsted
- Northern Ireland: Conan Donnelly, Michael Donnelly
- Norway: Maria Vigmostad
- Sweden: Carol Tishelman, Magdalena Lagerlund
- Wales: Kate Brain
Academic reference Group
The independent academic reference group members are:
- Professor Neil Aaronson (the Netherlands)
- Dr Liesbeth van Osch (the Netherlands)
- Professor David Cella (USA)
- Professor Keith Petrie (New Zealand)
- Professor Henrik Moller (UK)
Survey field work provider
Module 2 Publications
Do people in different countries have different thoughts and feelings about cancer? And does that affect how those countries do when it comes to the number of people who survive cancer?
This study looked at whether differences between countries in what people know about cancer and what people believe about cancer outcomes could help explain differences in their cancer survival rates. The study asked people about things like what increases the risk of cancer, whether a symptom could be caused by cancer, how likely they are to visit the doctor with a symptom and what might put them off and how they feel about the chances of surviving cancer. Countries with populations that have lower cancer awareness and more negative beliefs about cancer outcomes may be more likely to delay seeing their doctor about any symptoms they may have. This may lead to more cancers being diagnosed at a later stage and, in turn, poorer survival.
ICBP researchers developed and used a new research tool, the Awareness and Beliefs about Cancer (ABC) measure, to study people’s awareness and beliefs. Nearly 20,000 men and women aged 50 and older were interviewed in Australia, Canada, Denmark, Norway, Sweden and the UK – resulting in the strongest international comparison of awareness and beliefs about cancer in the general population yet.
The study suggested that international differences in cancer survival, as highlighted in previous ICBP research, are not likely to be explained by differences in awareness and beliefs about cancer and cancer outcomes. The results showed that the public awareness of cancer symptoms and beliefs about cancer outcomes was similar internationally. All of the countries reported that around eight out of eleven cancer symptoms were recognised by members of the public. In all of the countries, people had positive beliefs about cancer with around nine out of ten people agreeing that ‘cancer can often be cured’ and seven out of ten disagreeing that ‘a diagnosis of cancer is a death sentence’.
More people in the UK than in other countries said that there were specific reasons they wouldn’t go to their GP, even with a symptom that worried them. People in the UK mentioned that embarrassment and not wanting to waste the doctor’s time would put them off seeing their doctor. Across all countries, the knowledge that the risk of cancer increases with age was low, particularly in the UK. Low one year cancer survival in the UK and Denmark does not seem to be explained by poor awareness and negative beliefs about cancer. This paper calls for continued research into why international cancer survival differences exist.
If you are interested in reading the paper, ‘Differences in cancer awareness and beliefs between Australia, Canada, Denmark, Norway, Sweden and the UK (the International Cancer Benchmarking Partnership): do they contribute to differences in cancer survival?’ you can find it on the British Journal of Cancer’s web page free of charge. If you are interested in reading a more in-depth analysis of the research, you can find it at the Science Update Blog.
How researchers developed a survey to measure people’s awareness and beliefs about cancer in different countries.
This paper describes the development and testing of the Awareness and Beliefs about Cancer measure, or ABC measure. ICBP researchers created this tool to measure cancer awareness and beliefs about cancer outcomes across six different countries in five different languages. Existing studies of knowledge and beliefs have focused on individual countries, so this tool is important to let us measure what happens in different countries and compare the results. Different factors influence public awareness and beliefs about cancer, including cultural attitudes to cancer, how much public education is provided about cancer and how health care is organised and delivered. Researchers took these things into account when developing the ABC. They also made sure that questions were culturally sensitive and had the same meaning across all jurisdictions. The team developed six versions of the ABC, to be used across Australia, Canada, Denmark, Norway, Sweden and the UK as part of an ICBP study. The ABC measure can also now be used by researchers in other countries outside of the ICBP to study their population’s awareness and beliefs about cancer. In addition, researchers interested in creating surveys can use the developmental and testing methods described in this paper to create new research tools.
If you are interested in reading the paper, ‘An International Measure of Awareness and Beliefs about Cancer: Development and Testing of the ABC’ you can find it on the BMJ Open’s web page free of charge.
Question about cancer? Contact our information nurse team