A Culturally Tailored School-Based Cancer Education Pilot in Tunisia: Effects on Knowledge, Attitudes, and Stigma among High School Students
1
Laboratoire d'hématologie moléculaire et cellulaire, Institut Pasteur de Tunis, Tunis, Tunisia
Popul. Med. 2026;8(Supplement Supplement 1):A2772
ABSTRACT
BACKGROUND:
Cancer is a growing public health challenge in low- and middle-income countries such as Tunisia, where breast, lung, and colorectal cancers are increasingly prevalent. Adolescents, especially high school students, are at a formative stage for adopting health-promoting behaviors. School-based interventions using interactive methods have shown promise in improving cancer-related knowledge and attitudes, but sustaining behavioral change remains difficult. In Tunisia, cultural taboos and limited health literacy highlight the need for culturally adapted approaches. This pilot study assessed a novel intervention designed to improve knowledge, attitudes, self-efficacy, and behavioral intentions among Tunisian high school students, with a focus on destigmatizing cancer.
METHODS:
A quasi-experimental pre–post–follow-up design included 120 students (intervention: n=60; control: n=60) from two high schools. The intervention consisted of three 1-hour sessions: (1) reading and discussing Ftouma a un cancer ... Et alors, a narrative about a teenager’s cancer journey; (2) a 10-minute video with guided discussion; and (3) a group research project with presentations. The control group viewed only the video. Outcomes were assessed via a validated questionnaire at baseline (T0), one week (T1), and three months (T2). Acceptability was explored through two focus groups (n=12). Repeated-measures ANOVA and thematic analysis were applied.
RESULTS:
The intervention group demonstrated significant improvements in knowledge (T0: M=4.8; T1: M=7.9; p<0.001) and attitudes (T0: M=3.1; T1: M=4.3; p<0.001), partially retained at T2 (knowledge: M=6.8; attitudes: M=3.8). The control group showed modest knowledge gains (p=0.01) but no attitude change. Self-efficacy and behavioral intentions did not improve (p>0.05). Qualitative findings emphasized the narrative’s relatability and stigma-reducing impact. Teachers reported high feasibility.
CONCLUSIONS:
This culturally tailored, low-cost intervention enhanced short-term knowledge and attitudes, with qualitative evidence of destigmatization. Booster sessions appear necessary to sustain impacts. The teacher-led model is feasible for LMICs and warrants further testing with practical skill-building components and in rural contexts.
Cancer is a growing public health challenge in low- and middle-income countries such as Tunisia, where breast, lung, and colorectal cancers are increasingly prevalent. Adolescents, especially high school students, are at a formative stage for adopting health-promoting behaviors. School-based interventions using interactive methods have shown promise in improving cancer-related knowledge and attitudes, but sustaining behavioral change remains difficult. In Tunisia, cultural taboos and limited health literacy highlight the need for culturally adapted approaches. This pilot study assessed a novel intervention designed to improve knowledge, attitudes, self-efficacy, and behavioral intentions among Tunisian high school students, with a focus on destigmatizing cancer.
METHODS:
A quasi-experimental pre–post–follow-up design included 120 students (intervention: n=60; control: n=60) from two high schools. The intervention consisted of three 1-hour sessions: (1) reading and discussing Ftouma a un cancer ... Et alors, a narrative about a teenager’s cancer journey; (2) a 10-minute video with guided discussion; and (3) a group research project with presentations. The control group viewed only the video. Outcomes were assessed via a validated questionnaire at baseline (T0), one week (T1), and three months (T2). Acceptability was explored through two focus groups (n=12). Repeated-measures ANOVA and thematic analysis were applied.
RESULTS:
The intervention group demonstrated significant improvements in knowledge (T0: M=4.8; T1: M=7.9; p<0.001) and attitudes (T0: M=3.1; T1: M=4.3; p<0.001), partially retained at T2 (knowledge: M=6.8; attitudes: M=3.8). The control group showed modest knowledge gains (p=0.01) but no attitude change. Self-efficacy and behavioral intentions did not improve (p>0.05). Qualitative findings emphasized the narrative’s relatability and stigma-reducing impact. Teachers reported high feasibility.
CONCLUSIONS:
This culturally tailored, low-cost intervention enhanced short-term knowledge and attitudes, with qualitative evidence of destigmatization. Booster sessions appear necessary to sustain impacts. The teacher-led model is feasible for LMICs and warrants further testing with practical skill-building components and in rural contexts.
| eISSN: | 2654-1459 |
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