Feasibility Study to Actively Disseminate the Latin America and the Caribbean Code Against Cancer in Primary Healthcare Centers (FLACC-Brazil)

Feasibility Study to Actively Disseminate the Latin America and the Caribbean Code Against Cancer in Primary Healthcare Centers in Aparecida de Goiania (Brazil) - FLACC-Brazil

Phase II non-randomized four-arm study (before/after pragmatic trial) that will test 2 different implementation strategies either combined or separately for the dissemination of the Latin America and the Caribbean Code Against Cancer within four different primary healthcare units in Aparecida de Goiânia.

Study Overview

• Status: Not yet recruiting
• Conditions: Cancer; Latin America and the Caribbean Code Against Cancer (LAC Code)
• Intervention / Treatment: Behavioral: WhatsApp-Based Cancer Prevention Messaging; Behavioral: Online Cancer Prevention Workshop for Healthcare Professionals; Behavioral: Combined WhatsApp Messaging and Online Workshop

• Study Type: Interventional
• Enrollment (Estimated): 1200
• Phase: Not Applicable

Contacts and Locations

• Study Contact: Name: Diogo G Bugano, MD; Phone Number: +551121511233; Email: diogo.gomes@einstein.br

Study Locations

• Brazil
  • GO
    • Aparecida de Goiania, GO, Brazil
      • HMAP - Hospital Municipal de Aparecida de Goiânia
      • Contact: Mayler O. N. de Santos, MD; Phone Number: +55 62 3878-5100; Email: mayler.santos@einstein.br

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult; Older Adult
• Accepts Healthy Volunteers: Yes

Description

Inclusion Criteria:

• Adults (≥18 years old)
• Registered at a participating primary healthcare center (UBS) in Aparecida de Goiânia
• Healthcare professionals with at least three months of employment at a participating UBS
• Ability to provide informed consent

Exclusion Criteria:

- Prior diagnosis of any cancer or currently undergoing cancer treatment

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Health Services Research
• Allocation: Non-Randomized
• Interventional Model: Parallel Assignment
• Masking: None (Open Label)

Number of Arms

4

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
No Intervention: Control Group; Participants in this arm will receive no intervention during the study period. They will complete baseline and follow-up assessments to evaluate changes in cancer prevention literacy and health services-related outcomes over time, serving as a comparison for the intervention arms.
Experimental: G1: WhatsApp Messaging Intervention - General Population; Participants in this arm will receive structured cancer prevention messages via WhatsApp over a four-week period. The messages will cover key recommendations from the Latin America and the Caribbean Code Against Cancer (LAC Code), focusing on actionable steps to reduce cancer risk. Healthcare professionals (HCPs) assigned to this group will not receive any training.	Behavioral: WhatsApp-Based Cancer Prevention Messaging; Participants in this group will receive a structured series of WhatsApp messages containing evidence-based cancer prevention recommendations from the Latin America and Caribbean Code Against Cancer (LAC Code). Messages will be delivered over four weeks, 3 times a week, covering key topics such as smoking cessation, healthy diet, physical activity, and regular screening. Engagement metrics will be tracked to assess feasibility and adherence.
Experimental: G2: Online Workshop for Healthcare Professionals (HCP); Description: Healthcare professionals (HCPs) in this arm will participate in an online, self-paced workshop designed to enhance their knowledge and communication skills related to cancer prevention. The workshop will provide evidence-based training on discussing cancer risk factors and prevention strategies with patients, aligning with the LAC Code recommendations. General population participants assigned to this group will not receive WhatsApp messages.	Behavioral: Online Cancer Prevention Workshop for Healthcare Professionals; Healthcare professionals assigned to this group will participate in an online workshop designed to improve their knowledge of the LAC Code and communication strategies for cancer prevention counseling. The workshop includes recorded lectures, interactive modules, and knowledge assessments. Completion rates and participant satisfaction will be measured.
Experimental: G3: Combined Intervention (WhatsApp + Workshop); This arm will integrate both intervention strategies. General population participants will receive WhatsApp messages with cancer prevention recommendations, while healthcare professionals will complete the online workshop. This combined approach aims to assess whether reinforcing cancer prevention messages at both the community and healthcare provider levels leads to improved outcomes in cancer prevention literacy and health services utilization.	Behavioral: Combined WhatsApp Messaging and Online Workshop; Participants in this group will receive both interventions: WhatsApp messages with cancer prevention recommendations and access to the online workshop. The intervention aims to assess whether a combined approach enhances adherence and impact. Engagement with both interventions will be monitored.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Feasibility of the WhatsApp-Based Intervention	Number of participants who report having read at least one WhatsApp message.	Up to 2 weeks after WhatsApp intervention completion
Acceptability of the WhatsApp-Based Intervention	Mean acceptability score from participant survey (Likert scale 1-5) evaluating message usefulness and clarity.	Up to 2 weeks after WhatsApp intervention completion
Appropriateness of the WhatsApp-Based Intervention	Proportion of participants who indicate willingness to receive similar messages in the future (Yes/No).	Up to 2 weeks after WhatsApp intervention completion

Other Outcome Measures

Outcome Measure	Measure Description	Time Frame
Receipt of Cancer Prevention Counseling Among the General Population (KAS Questionnaire)	Proportion of general population participants reporting receipt of at least one type of cancer prevention counseling (e.g., smoking cessation, diet, physical activity) as assessed by the KAS questionnaire	Baseline and final assessment (up to 2 weeks after intervention)
Intention to Provide Cancer Prevention Counseling Among Healthcare Professionals (KAP Questionnaire)	Proportion of healthcare professionals reporting intention to integrate cancer prevention counseling into clinical practice, assessed via the KAP questionnaire.	Baseline, post-workshop (up to 2 weeks), and final assessment (up to 2 weeks after intervention)

Collaborators and Investigators

• Sponsor: Hospital Israelita Albert Einstein
• Collaborators: International Agency for Research on Cancer

Publications and helpful links

General Publications

• Strasser-Weippl K, Chavarri-Guerra Y, Villarreal-Garza C, Bychkovsky BL, Debiasi M, Liedke PE, Soto-Perez-de-Celis E, Dizon D, Cazap E, de Lima Lopes G Jr, Touya D, Nunes JS, St Louis J, Vail C, Bukowski A, Ramos-Elias P, Unger-Saldana K, Brandao DF, Ferreyra ME, Luciani S, Nogueira-Rodrigues A, de Carvalho Calabrich AF, Del Carmen MG, Rauh-Hain JA, Schmeler K, Sala R, Goss PE. Progress and remaining challenges for cancer control in Latin America and the Caribbean. Lancet Oncol. 2015 Oct;16(14):1405-38. doi: 10.1016/S1470-2045(15)00218-1.
• Delucchi KL, Tajima B, Guydish J. Development of the Smoking Knowledge, Attitudes, and Practices (S-KAP) Instrument. J Drug Issues. 2009 Mar;39(2):347-364. doi: 10.1177/002204260903900207.
• Patsopoulos NA. A pragmatic view on pragmatic trials. Dialogues Clin Neurosci. 2011;13(2):217-24. doi: 10.31887/DCNS.2011.13.2/npatsopoulos.
• Busetto L, Wick W, Gumbinger C. How to use and assess qualitative research methods. Neurol Res Pract. 2020 May 27;2:14. doi: 10.1186/s42466-020-00059-z. eCollection 2020.
• Espina C, Feliu A, Gonzalez Vingut A, Liddle T, Jimenez-Garcia C, Olaya-Caro I, Perula-De-Torres LA. Population-Based Cancer Prevention Education Intervention Through mHealth: A Randomized Controlled Trial. J Med Syst. 2024 Jan 9;48(1):9. doi: 10.1007/s10916-023-02026-y.
• Nardi A, Mitrova S, Angelici L, De Gregorio CG, Biliotti D, De Vito C, Vecchi S, Davoli M, Agabiti N, Acampora A. Developing a Questionnaire Evaluating Knowledge, Attitudes and Behaviors on Audit & Feedback among General Practitioners: A Mixed Methods Study. Healthcare (Basel). 2023 Apr 24;11(9):1211. doi: 10.3390/healthcare11091211.
• Espina C, Feliu A, Maza M, Almonte M, Ferreccio C, Finck C, Herrero R, Dommarco JR, de Almeida LM, Arrossi S, Garcia PJ, Garmendia ML, Mohar A, Murillo R, Santamaria J, Tortolero-Luna G, Cazap E, Gabriel OO, Paonessa D, Zoss JW, Luciani S, Carvalho A, Schuz J; Working Groups of Scientific Experts. Latin America and the Caribbean Code Against Cancer 1st Edition: 17 cancer prevention recommendations to the public and to policy-makers (World Code Against Cancer Framework). Cancer Epidemiol. 2023 Oct;86 Suppl 1:102402. doi: 10.1016/j.canep.2023.102402. Epub 2023 Oct 16.
• Fleary SA, Paasche-Orlow MK, Joseph P, Freund KM. The Relationship Between Health Literacy, Cancer Prevention Beliefs, and Cancer Prevention Behaviors. J Cancer Educ. 2019 Oct;34(5):958-965. doi: 10.1007/s13187-018-1400-2.
• Morris NS, Field TS, Wagner JL, Cutrona SL, Roblin DW, Gaglio B, Williams AE, Han PJ, Costanza ME, Mazor KM. The association between health literacy and cancer-related attitudes, behaviors, and knowledge. J Health Commun. 2013;18 Suppl 1(Suppl 1):223-41. doi: 10.1080/10810730.2013.825667.
• Barrios CH, Werutsky G, Mohar A, Ferrigno AS, Muller BG, Bychkovsky BL, Castro E CJ, Uribe CJ, Villarreal-Garza C, Soto-Perez-de-Celis E, Gutierrez-Delgado F, Kim JS, Ismael J, Delgado L, Santini LA, Teich N, Chavez PC, Liedke PER, Exman P, Barroso-Sousa R, Stefani SD, Caceres SAB, Rebelatto TF, Pastrana T, Chavarri-Guerra Y, Vargas Y, Cazap E. Cancer control in Latin America and the Caribbean: recent advances and opportunities to move forward. Lancet Oncol. 2021 Nov;22(11):e474-e487. doi: 10.1016/S1470-2045(21)00492-7.
• Rezende LFM, Lee DH, Louzada MLDC, Song M, Giovannucci E, Eluf-Neto J. Proportion of cancer cases and deaths attributable to lifestyle risk factors in Brazil. Cancer Epidemiol. 2019 Apr;59:148-157. doi: 10.1016/j.canep.2019.01.021. Epub 2019 Feb 14.

Helpful Links

• GLOBOCAN

Study record dates

Study Major Dates

• Study Start (Estimated): May 1, 2025
• Primary Completion (Estimated): October 1, 2025
• Study Completion (Estimated): November 1, 2025

Study Registration Dates

• First Submitted: March 20, 2025
• First Submitted That Met QC Criteria: May 2, 2025
• First Posted (Actual): May 11, 2025

Study Record Updates

• Last Update Posted (Actual): May 11, 2025
• Last Update Submitted That Met QC Criteria: May 2, 2025
• Last Verified: April 1, 2025

More Information

Terms related to this study

• Keywords: Health Literacy; Health Services Research; Implementation Science; Cancer Prevention; Latin America and the Caribbean Code Against Cancer (LAC Code)
• Other Study ID Numbers: LACCODE - FLACC-Brazil

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO
• IPD Plan Description: Individual participant data (IPD) will not be shared due to privacy considerations and institutional policies governing data access. However, aggregated and de-identified study results will be shared through peer-reviewed publications and conference presentations.

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No
• product manufactured in and exported from the U.S.: No