Complex Interventions for Cancer and Cholangiocarcinoma: A Systematic Review and Applications for Public Education.

Cholangiocarcinoma (CCA) is highly prevalent in Northeast Thailand and has a poor prognosis. The Community-based Health Education and Communication (CHEC) model is a complex health education intervention designed to prevent CCA. This review aims to identify complex health interventions for cancer and CCA prevention and determine the necessary evidence to enhance the CHEC program for evaluation in Khon Kaen, Thailand. A systematic review was conducted across nine electronic databases for articles published from January 1, 2012, to March 2024. Search terms were relevant to experimental study designs assessing community-based complex interventions for cancer and CCA prevention. Titles, abstracts, and full-text articles were screened according to PRISMA guidelines and the inclusion criteria by two independent reviewers. The Mixed Methods Appraisal Tool was used to assess the risk of bias of included studies, and the data was analyzed using a narrative approach. A total of 92 studies were included in this review: 32 studies focused on complex interventions for CCA prevention, while 60 studies addressed non-CCA cancer prevention. From 11 randomized controlled trials with significant positive outcomes and low risk of bias, five major intervention components were identified: health education, participant engagement, reminders, patient support, and health influencers. Health education was the most frequently implemented component, reinforcing its essential role in cancer prevention efforts. These components will be integrated into the CHEC model, with their development and implementation tailored to the Northeast Thailand community to prevent and improve CCA outcomes. This review offers actionable insights for public cancer education globally, particularly in low- and middle-income countries, by emphasizing the value of culturally tailored, multi-component, community-based education to enhance cancer prevention efforts.