Adaptation of the "European Code Against Cancer" (ECAC) to the cultural needs of low income women in Greece: comparative effectiveness of health education approaches.

The European Code Against Cancer (ECAC) was administered to four groups of women, each comprising about 50 women. In the first group, the Greek translation of the original code was given; in the second group a set of explanatory cartoons was given in addition to the code; in the third group a more simplified version of the code was administered; lastly, in the fourth group the code was administered and in addition, mothers were tutored for about 15 minutes by a psychologist. A comparison group of 76 women were not exposed to ECAC. After 4 to 7 days, all women were given a 78-item questionnaire, probing their perceived knowledge (PK) about cancer etiology and prevention, their accurate knowledge (AK) and eventually their correct knowledge (CK), (all expressed in %). No difference, with respect to any of the above three parameters was noted between the three groups of women who were given the ECAC, the ECAC with cartoons or the modified ECAC without individual tutoring on the one hand and the comparison group on the other. By contrast, there was a substantial and highly significant improvement of knowledge among women who were given the ECAC and who were also individually tutored; this difference in CK was accounted for by improvement in both PK and AK. Improvement was particularly evident in respect to questions dealing with cancer screening, nutritional and occupational cancers, whereas there was little improvement with respect to knowledge concerning some aspects of tobacco smoking and exposure to radiation. CK about cancer etiology and prevention was positively correlated with AK about contraception and nonsmoking status, even among women of the same age and educational status.