Development and validation of an instrument to assess public perception of cancer primary prevention information

BACKGROUND: 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). CONCLUSIONS: This instrument exhibits initial evidence of content and exhibits satisfactory psychometric properties, offering preliminary evidence of structural validity, and internal consistency. By operationalizing key constructs from established dissemination and implementation frameworks, it addresses critical gaps in cancer prevention communication research.