Cancer primary prevention (CPP), particularly through evidence-based recommendations like the 4th
European Code Against Cancer (ECAC4), represents a cost-effective strategy to reduce cancer burden. Dissemination
and implementation (D&I) of CPP strategies remain fragmented and inconsistent, and instruments to assess
dissemination of CPP are lacking. This study aimed to develop and validate an instrument to assess the public (i)
perceptions of CPP message characteristics, and (ii) public perceptions of ECAC4.
Methods: The validation of the ́Information on Cancer Primary Prevention` instrument was developed through
a multi-stage process grounded in two D&I frameworks: McGuire’s Communication-Persuasion Matrix and Rogers’
Diffusion of Innovations. After literature review, items were generated for the two questions assessing message
characteristics (channel preferences and source trustworthiness) and 25 items to assess ECAC4 five perceived
attributes: advantage, compatibility, complexity, trialability, and observability. Validation involved cognitive interviews
for message characteristics, expert validation through a two-round Delphi panel for ECAC4 attributes, and pre-testing
with 240 adults recruited through an online panel. Exploratory factor analysis (EFA) was conducted to assess structural
validity, and Cronbach’s alpha was used to evaluate internal consistency.
Results: Refinements in terminology, response scales, and item wording were implemented after cognitive
interviews for the two questions of message characteristics (channel preference and source trustworthiness).
EFA revealed three factors for channel preferences (Traditional broadcast media, Digital media/online interactive
platforms, and Print media and interpersonal; α=0.703–0.775) and two factors for source trustworthiness (Official
sources and Unofficial sources; α=0.792–0.859). The five ECAC4 attributes were evaluated in a Delphi panel with two
rounds – due to participant attrition the panel was discontinued before full consensus could be reached for all items;
five items were adapted based on expert qualitative feedback and included in the pre-test. All five ECAC4 attributes
subscales demonstrated unidimensionality with strong factor loadings (>0.50) and good to excellent reliability
(α=0.714–0.831).
