Plain English Summary
Background and study aims
Evidence shows that cancer survival rates are lower in disadvantaged communities, possibly due to low awareness of symptoms and delayed help-seeking. It is important that people increase their knowledge of cancer symptoms, so that they know when to go seek medical advice about their concerns, and therefore possibly detecting cancer earlier, which will improve their outlook. We have developed an interactive online health check questionnaire to be delivered in these communities by trained advisors which is designed to help people recognise possible cancer signs early. The health check is a short questionnaire completed on an iPad with the help of a trained advisor. There are 29 questions which ask participants about their background, lifestyle and health. They are then given a summary page at the end which colour codes their responses using a traffic light system (red, amber, green) to highlight areas where action and or advice should be taken. There is already some research to test what people think about the health check. Based on this changes have been made to improve it. The aim of this study is to see if the health check increases people’s knowledge of cancer signs and lifestyle risks and to see if increased knowledge encourages people to ask for help earlier.
Who can participate?
Adults aged 40 and older who live in a socioeconomically deprived areas of South and West Yorkshire (UK).
What does the study involve?
Participants are asked to complete a questionnaire on an iPad. This can be done by themselves or with the help of an advisor. It will ask about their knowledge of cancer symptoms and cancer lifestyle risks. It will also ask some background information about them. This will take around 20 minutes. Participants are then randomly allocated to one of two groups. Participants who are allocated to the first group do not do anything else on the day. Participants allocated to the second group are then asked to complete the online health check with the help of an advisor. Their results are summarised at the end on a single page. A red, amber, green traffic light system are used to show their results and the advisor will discuss their results with them. This takes around 25 minutes. Some sessions are recorded or observed. All participants are contacted again in two weeks and six months’ time to complete the questionnaire again. This is done on the telephone. In addition to the main study, some of the participants (around 45-50) are asked if they want to take part in an interview with one of the researchers. Interviews either takes place after the two week or six month questionnaire and lasts around 30 minutes. Participants are asked about their experiences of taking part and if they have any experiences of wider cancer awareness campaigns.
What are the possible benefits and risks of participating?
Participants will be providing important information about what people know and think about cancer symptoms. The questionnaires will help us test if the online health check improves people’s knowledge of cancer symptoms and cancer-related lifestyle risks. Those participants who are in the treatment group will also receive a one page summary of their health check results. Participants also receive high street shopping vouchers for completing the study. There is no direct risk to taking part in this trial, however, some people don’t like talking about cancer or find talking about cancer upsetting. If participants get upset they can talk directly to the advisor or contact local services for support, which are listed on the information booklet.
Where is the study run from?
The study is being coordinated by the Centre for Trials Research (CTR) in Cardiff University (UK).
When is the study starting and how long is it expected to run for?
May 2017 to August 2020
Who is funding the study?
Yorkshire Cancer Research (UK)
Who is the main contact?
Ms Yvonne Moriarty (Scientific)
Awareness and Beliefs About Cancer phase 3 (ABACus 3): Randomised controlled trial of the health check intervention to improve cancer symptom awareness and help-seeking among people living in socioeconomically deprived communities
The aim of this study is to undertake a phase 3 randomised controlled trial of the ABACus Health Check (previously developed and tested for feasibility/acceptability) as a means of improving cancer symptom awareness and help-seeking behaviour among adults living in socioeconomically deprived communities.
London Surrey NHS Research Ethics Committee, 12/10/2017, ref: 17/LO/1507
Randomised; Interventional; Design type: Not Specified, Not Specified
Primary study design
Secondary study design
Randomised controlled trial
Patient information sheet
Not available in web format, please use the contact details below to request a patient information sheet
Specialty: Cancer, Primary sub-specialty: Primary Care; UKCRC code/ Disease: Cancer/ Neoplasms of uncertain or unknown behaviour
The ABACus Health Check is an innovative community outreach intervention designed to improve cancer symptom knowledge, encourage positive beliefs in relation to cancer early detection, and increase motivation to seek help among adults (aged 40 years and older) living in deprived communities. The health check has been informed by a theoretical understanding of the barriers and enablers to timely help-seeking among people living in disadvantaged communities, and comprises an interactive touchscreen questionnaire with behavioural support delivered face-to-face by a trained advisor, taking around 35 – 45 minutes to complete. The intervention is primarily designed to reduce the “patient interval”, defined as the time between appraising a bodily change as a potential symptom of cancer and presenting in primary care, but also attempts to synergise cancer screening and early symptom detection by including cancer symptom content and screening messages. Individualised results are provided in a traffic light system, with ‘green’ indicating results where no signposting or change is suggested, ‘amber’ indicating an area where signposting or change could be considered, and ‘red’ results indicating that action should be taken. Results can be printed on a one page summary format for participants to take away. Information and signposting to relevant services (for example, General Practitioner, stop smoking and weight loss services) are provided based on individual results.
Participants are recruited from community (i.e. local groups) and health (i.e. GP surgeries) settings and randomised to either intervention (online health check) or control (usual available care/support) on a 1:1 ratio. Quantitative data is collected at baseline, two weeks and six months post randomisation. Measured used include: Adapted Awareness and Beliefs about Cancer measure (ABC), 6-item State-Trait Anxiety Inventory (STAI-6), Lifestyle using Theory of Planed Behaviour, self-rated health, screening behaviour, Client Service Receipt Inventory, Demographics, Contact Details and Recruitment Information (setting type etc). The primary analysis will predict follow-up cancer symptom recognition at 2 weeks using baseline cancer symptom recognition as well as key demographic variables in a linear analysis of covariance model (ANCOVA). All participants receive a total of £15 high street shopping vouchers (£10 at baseline and £5 at six months) as a thank you for taking part.
Qualitative data supports the process evaluation and includes: interviews with lay advisors (n=3) pre and post-delivery, audio recordings/observations (n=24-25/n=12-13) of health check delivery sessions, interviews with participants at 2-4 weeks post randomisation (n=30), interviews with participants post 6 months (n=15-20). All participants who take part in an interview additionally receive £10 as a thank you for completing an interview).
Primary outcome measure
Cancer symptom knowledge (calculated as the mean aggregated symptom recognition score), measured using the adapted (Awareness and Beliefs about Cancer) measure at 2 weeks.
Secondary outcome measures
1. Cancer Beliefs, measured using the adapted ABC measure at 2 weeks and 6 months
2. Barriers to presentation, measured using the adapted ABC measure at 2 weeks and 6 months
3. Help-seeking intentions, measured using the adapted ABC measure at 2 weeks and 6 months
4. Cancer worry, measured using the State Trait Anxiety Inventory (STAI) measure at 2 weeks and 6 months
5. Intervention implementation costs, measured using the Client Service Receipt Inventory at 6 months
Exploratory outcomes measures:
1. Cancer screening intentions, beliefs and self-reported behaviours measured using the Theory of Planned Behaviour Questionnaire at 2 weeks and 6 months
2. Lifestyle intentions (stop smoking, weight loss, reduce alcohol consumption), measured using the Theory of Planned Behaviour Questionnaire at 2 weeks and 6 months
3. Cancer risk factor awareness, measured using the adapted ABC at 2 weeks and 6 months
Overall trial start date
Overall trial end date
Reason abandoned (if study stopped)
Participant inclusion criteria
1. Aged 40 years and over
2. Recruited from socioeconomically deprived areas of South and West Yorkshire (i.e. Sheffield, Barnsley, Rotherham, Wakefield) or Southeast Wales (i.e. Merthyr Tydfil and Newport)
Target number of participants
Planned Sample Size: 246; UK Sample Size: 246
Participant exclusion criteria
1. Non-English speakers
2. Unable to give informed consent
3. A participant from the phase 2 feasibility study (only relevant in South East Wales)
Recruitment start date
Recruitment end date
Countries of recruitment
Trial participating centre
Cwm Taf University Health Board R&D
Research & Development Department Royal Glamorgan Hospital Ynysmaerdy Rhondda Cynon Taf
Trial participating centre
Aneurin Bevan University Health Board R&D
Research & Development Office Aneurin Bevan University Health Board Clinical Research and Innovation Centre St Woolos Hospital
Trial participating centre
West Yorkshire R&D
Douglas Mills Bowling Old Lane
Trial participating centre
South Yorkshire R&D
Research & Development Unit Sheffield Health & Social Care FT Fulwood House Old Fulwood Road
Yorkshire Cancer Research
Funding Body Type
private sector organisation
Funding Body Subtype
Results and Publications
Publication and dissemination plan
Exact details of the publication policy are still being developed. However, broadly the researchers plan on publishing a protocol paper in a high impact paper once they are into recruitment (2018/2019) and the main trial results in a high-impact paper at the end of the trial (post-2020).
IPD sharing statement:
The datasets generated during the current study will be available upon request from the study manager Yvonne Moriarty (Moriartyy@cardiff.ac.uk) with an agreed/signed data-sharing agreement. De-identified participant data will be made available to the scientific community with as few restrictions as feasible, whilst retaining exclusive use until the publication of major outputs. Cardiff University holds data for 15 years.
Intention to publish date
Participant level data
Available on request
Basic results (scientific)
2019 protocol in: https://www.ncbi.nlm.nih.gov/pubmed/30866887 [added 15/03/2019]