Table 3.

Published intervention studies targeting health care professionals, by study design

Author	Country and WHO region	Cancer	Study design	Sample size	Population	Intervention(s)	Duration of intervention	Testing	Outcome measure	Results
Controlled intervention studies targeting health care professionals
Moshfeghi 2010 30	Iran EMR	Breast cancer	Controlled intervention study/RCT	128	Randomly sampled physicians in Arak city	Video training vs. systematic review Histology, anatomy, epidemiology, assessment, and diagnosis of breast cancer	0.5‐hour video vs. distributed printed handouts	Pre‐intervention   Post‐intervention (immediately after)	Knowledge	Mean significant increase in total knowledge score before and after both interventions. No significant difference between the two educational interventions.
Ceber 2010 11	Turkey EUR	Breast cancer	Controlled intervention study/RCT	291	Nurses and midwives from two health districts in rural Izmir	Breast cancer educational program vs. control Presentations and videos on statistics, risk factors, symptoms, BSE, screening, and guidelines	Not reported	Post‐intervention at 1 year	Knowledge	Significant improvement of total knowledge score compared with control.
Torbaghan 2014a 31	Iran EMR	Breast cancer	Controlled intervention study/RCT	130	Female medical employees of a university	Educational intervention vs. control Lectures, questions and answers, videos, booklet and digital disk on breast cancer awareness, screening, prevention, and barriers	3 × 1–1.5‐hour sessions	Pre‐intervention   Post‐intervention at 1 month	Knowledge	Significant improvements for awareness, susceptibility, benefits, barriers, and behavior constructs.
Karadag 2014a 32	Turkey EUR	Breast cancer	Controlled intervention study/RCT	69	Nursing students in a health college only	Traditional lecturing method vs. Six Learning Hats method Lecture vs. active approach on knowledge and beliefs of breast cancer and BSE	Not reported	Pre‐intervention   Post‐intervention at 15 days and 3 months	Knowledge	Knowledge score significantly increased for traditional learning method (9.32 to 14.41, p < .001), and for Six Thinking Hats method (9.20 to 14.73, p < .001).
Vithana 2015 33	Sri Lanka SEAR	Breast cancer	Controlled intervention study/RCT	85	Public health midwives only	Training program vs. control Didactic lectures, discussions, practical sessions, and role‐plays	2‐day training program	Pre‐ intervention   Post‐intervention at 1 and 6 months	Knowledge	Statistically significant increase in knowledge, attitudes, and practices of midwives who received intervention compared with those who did not.
Ginsburg 2014 18	Bangladesh SEAR	Breast cancer	Controlled intervention study/RCT	22,337	Case‐finding for female participants in Khulna	mHealth vs. mHealth and Navigation vs. control Smart phone application and video to guide interview, report data, inform, and offer appointment. Navigation training was provided to health workers in second arm	Case‐finding program run over 4 months	Post‐intervention (immediately after)	Other (treatment access)	mHealth demonstrated no significant increase in subsequent care attendance compared with control (63% vs. 53%). However, patient navigation showed significant improvements in care attendance compared with without navigation (63% vs. 43%, p < .0001).
Ngoma 2015 15	Tanzania AFR	Breast, cervix, and other not specified	Controlled intervention study/RCT	10,979	Village residents of two randomly chosen Tanzanian villages	Case‐finding vs. control Village navigators were trained to actively seek cases and refer to health care to decrease advanced cancer rates	3‐day health aide training for program run over 3 years	Post‐intervention at 1, 2, and 3 years	Stage of disease	The intervention village had significant downstaging to stage I and II disease (23% to 51% to 74%, p < .001), whereas no significant downstaging was observed in the control village (11% to 22% to 37%, p = not significant).
De Angelis 2012 16	Nicaragua AMR	Childhood cancer	Controlled intervention study	Not reported	Physicians working in first or second level health care centers in pediatric oncology	Training program vs. control Program focused on upskilling diagnosis and treatment of childhood oncological diseases	Not reported	Post‐intervention Retrospective data analysis over 3 years	Time interval	Median time from symptom onset to diagnosis was decreased in districts with a training program implemented (20.5 vs. 40 days, p = .0019).
Quasi‐experimental studies targeting health care professionals
Khokher 2015 34	Pakistan EMR	Breast cancer	Quasi‐experimental study	146	Female participants in Lahore; mostly students (74%), including health science students (36%)	Audio‐visual educational activity Early detection, examination, and treatment options	3 × 20‐minute sessions run over 1 day	Pre‐intervention   Post‐intervention (immediately after)	Knowledge	There was a 66% increase in participants’ knowledge overall between pre‐ and post‐intervention questionnaire.
Ali 2006b 28	Pakistan EMR	Breast, colon, intestinal	Quasi‐experimental study	281	Students, teachers, and community members, and health care workers in Karachi	Educational sessions Presentations and examination models about cancers, their diagnosis, and treatment	15 × educational sessions conducted over 1 year	Pre‐intervention   Post‐intervention	Knowledge	Increased proportion of participants with greater general knowledge for cancer and less cancer stigma. There was no reported change in identifying signs and symptoms.
Devi 2007b 14	Malaysia WPR	Breast, cervix and nasopharyngeal	Quasi‐experimental study	Not reported	General population attending 154 rural clinics and 18 hospitals in Sarawak	Early cancer surveillance program Staff training to improve early detection, and raising public awareness through poster and pamphlet distribution	2‐day staff training and once‐off poster and pamphlet distribution	Pre‐intervention Retrospective data analysis over 1 year   Post‐intervention at 4 years	Stage of disease	Stage III and IV was significantly reduced for breast cancer (35% vs. 60%, p < .0001) and cervical (26% vs. 60%, p < .0001). No reduction was observed for nasopharyngeal cancer.
Suarez 2015 19	Colombia AMR	Childhood cancer	Quasi‐experimental study	280	Children diagnosed with acute lymphoblastic leukemia	Multifaceted intervention Improved treatment protocol, increased health care worker capacity, health care worker educational program, and social worker support	Intervention implemented over 3 years	Pre‐intervention Retrospective data analysis over 10 years   Post‐intervention Retrospective data analysis over 4 years	Other (survival, abandonment)	The study shows that after implementing the intervention, there was a significant improvement in complete remission survival (p = .005) and in abandonment rates (p < .001).
Zhang 2015 20	China WPR	Gastric cancer	Quasi‐experimental study	48	Patients referred to a single endoscopy center in Southern China	Endoscopy training vs. control Training program to improve detection, through weekly case discussions, journal reviews, and video studies	Weekly program run over 2 years	Post‐intervention Retrospective data analyzed over 2 years	Other (detection rate)	Significant improvement in the detection rate of early gastric cancer between the training and nontraining group (0.7% vs. 0.06%, p < .01).
Cross‐sectional studies targeting health care professionals
Mpunga 2014 17	Rwanda AFR	Not specified	Descriptive cross‐sectional study	437	Patient tissue specimens sent to a pathology service at a district hospital	Anatomic pathology lab service Implementation of anatomic pathology at a hospital through personnel and infrastructure	Implementation of service over 6 months	Post‐intervention at 6 months	Time interval	Median pathology interval 32 days; 72 specimens processed median per month.

A comprehensive breakdown of intervention and outcomes of the included studies are described, according to their study design and outcome measure.

^aStudy was deemed to be of low quality in study quality assessment.

^bStudy intervention targeted both the general population and health care professionals and has been listed in both Tables 2 and 3.

Abbreviations: AFR, African Region; AMR, Region for the Americas; BSE, breast self‐examination; EMR, Eastern Mediterranean Region; EUR, European Region; RCT, randomized controlled trial; SEAR, South‐East Asia Region; WHO, World Health Organization; WPR, Western Pacific Region.