Adaptation and Usability of a Lifestyle Cancer Prevention Screener for US Populations: A Mixed Methods Study

Abstract Background: The World Cancer Research Fund/American Institute for Cancer Research (WCRF/AICR) Cancer Prevention Recommendations provide evidence-based guidance on modifiable lifestyle factors associated with cancer risk. While a standardized scoring system exists to assess adherence at the population level, there is a lack of brief, culturally appropriate tools for assessing individual-level adherence in U.S. settings. This study aimed to adapt and evaluate the usability of a WCRF/AICR Screener originally developed in Spain for use among U.S. adults. Methods: The screener was culturally adapted through expert review and included 17 items assessing anthropometrics, physical activity, diet, and breastfeeding. An iterative mixed-methods design was used, consisting of two rounds of online survey administration (round one: n=153; round two: n=151) followed by cognitive interviews (round one: n=5; round two: n=4). Quantitative usability was assessed using Likert-scale questions, and qualitative data were analyzed to evaluate comprehension and ease of use. Results: Across both rounds, over 90% of participants reported that the screener was easy to understand and would be acceptable for use in clinical or research settings. Cognitive interviews identified challenges related to dietary recall and interpretation of select items. Iterative refinements were tested to improve clarity, and the final screener demonstrated high acceptability. Conclusions: The adapted WCRF/AICR screener is a feasible, low-burden tool for assessing adherence to cancer prevention recommendations at the individual level in U.S. adults. Impact: With further validation, this instrument may support clinical counseling, risk communication, and intervention research targeting modifiable cancer risk factors.