The most important descriptive findings regarding the demographic characteristics of the respondents (n=2,508) were as follows: 52.9% were women; 37.2% were single; 42.3% had high school education; 30.8% had university attainments; 17.7% had a family history of cancer; 26.6% were smokers; and 10.4% were alcohol drinkers. More details about the demographic characteristics of the study respondents were reported elsewhere (14
presents the prevalence of correct knowledge on warning signs of cancer, with 95% confidence intervals for all the study participants—men and women. The table shows that, on a sign-by-sign basis, women were more aware than men (on average, 49.66% vs 41.76%)
Prevalence of correct knowledge about specific warning signs of cancer
shows the percentages of the correct answers to the questions on specific warning signs of cancer in each constructed classes. Class 1 included the individuals with higher knowledge level (class size: 18.8%), Class 3 included the individuals with poor awareness level (26.7%), and Class 2 included the individuals with mixed situation in terms of the awareness level (54.5%). The constructed classes (latent classes) play the role of categories of the dependent variable. Therefore, similar to multinomial logistic regression, Class 1 (high knowledge) was selected as a reference class.
Class-specific level of awareness about warning signs of cancer and the size of classes
contains the class-specific estimates of regression coefficients. The significant effective predictors of awareness level about warning signs, in order of importance, were level of education, gender, and marital status. Although other studied factors, such as age, family history, and lifestyle behaviours (smoking and alcohol drinking) were significant, they had a weak discriminative role.
Estimated class-specific covariates coefficients and related z-statistics and p values
The results revealed that, in general, the level of knowledge about warning signs of cancer among the studied sample was low. Our findings are consistent with those of a few studies in developing countries (6
). However, the level of awareness in a developed country is slightly higher (4
). Such a difference, in general, can be attributed to the social inequalities between developing and developed countries (7
Assessment of the effective factors on the knowledge level about warning signs of cancer indicated that the strongest predictor was the level of education. Our findings are consistent with findings of other studies (4
). It is possible to infer that people having high levels of educational attainment are in a better position to be able to attend to the health protective issues.
The results of our research showed that men were significantly less likely than women to be aware of the early warning signs of cancer. These findings are consistent with those of other studies evaluating the effect of gender on knowledge of cancer (7
). A possible explanation for this difference may lie with women's greater familiarity and use of primary healthcare services through, for example, participation in mass health programmes and their responsibility for their children's healthcare and interest in health within families (18
The results showed that the married people, particularly women, were more concerned about their health because of their responsibilities to the families. Hence, they had a higher level of awareness compared to the single ones. Our findings are consistent with those of Brunswick et al
. and Evans et al.
Previous studies on adult population in developed countries have shown that the middle-aged people recognized more signs than those who were younger or older (5
). However, in our study this factor provided weak discriminative effect (see the OR values).
It was expected that those with a family history of cancer (they may be more motivated to adopt preventive behaviours) were particularly likely to acknowledge the potential warning signs of cancer (20
). However, the findings of our study indicated that the family history had little influence on increasing the level of awareness.
These data may be considered the first step in the development of an intervention based on empirical findings that will identify areas for public education and intervention efforts as an important component of prevention of the disease. Such educational and intervention programmes should be culture-sensitive and accessible to all individuals, with special attention placed on reaching the populations of the highest risk to increase awareness about the disease leading to its early diagnosis. As a national cancer strategy, public education combined with the use of cancer-screening technology, focused on high-risk populations, is a cost-effective approach.