A Cluster Randomized Trial Study on Effectiveness of Health Education Module(HEAMOD) on Colorectal Cancer Screening Uptake among Workers in Kuantan District,Pahang State, Malaysia

Interventions: The intervention arm will receive health education module (HEAMOD). It is specifically developed for this study, using the Preventive Health Model (PHM) and diffusion of innovation theory (DIT), which consist of: group education, practical session on fecal immunochemical test (FIT) and WhatsApp group follow-up. For group education, there will be 2 methods of group education delivery. First,a 2 hour health talk will be given by the researcher in the form of a Power Point presentation. The PowerPoint will be constructed together with a consultant colorectal surgeon for content verification. This will focus on giving awareness of the relative advantage of the FIT. The first PowerPoint presentation will focus on the background on colorectal cancer (CRC) and importance of early screening. The second PowerPoint presentation will focus on treatment options should they be positive of the FIT. The second mode of delivery would be a group discussion, lasting 2 hours. Participants will be divided into several small groups. With the help of enumerators, barriers and obstacles in taking up screening will be explored. Further reinforcement of CRC screening knowledge will be given. The participant will be assisted if any issue or question arises. This will cover the key constructs in the PHM which are perceived susceptibility, perceived barriers, perceived benefits, social influence and self-efficacy, in addition to knowledge component. For practical session on FIT, there will be a demonstration on FIT by enumerators consisting of healthcare workers to show how to do the test in a correct manner, lasting 1 hour. Participants will be asked to take 2 faecal samples for 2 consecutive days. These samples will be collected within 3 months after the practical session on FIT is done. This will test for four DIT constructs on the acceptability of FIT which are relative advantage, complexity, compatibility and trial ability. Lastly, there will be a WhatsApp group follow-up. Every follow-up of the trial will be communicated using WhatsApp. Once a week, a reminder mechanism will be implemented to remind participants to do the screening and return it to the research team as soon as possible. In addition, those who have done the test will report to the WhatsApp group, facilitating those who have not done it to do the test too. This covers the domain of observability in the DIT. The overall duration for the intervention is 3 months.