Educational interventions to improve bowel cancer awareness and screening in Organisation for Economic Co-operation and Development countries: A scoping review

Highlights • Main types of education interventions included lay community health educators, health professional educators/counselling, education materials, mass media campaigns and other types. The ‘other’ types included 12 different education intervention strategies which did not fit into the four types above, for example, a theatre play, women’s health day, a video, decision aid, or Facebook group or promotion.• Lay community health educator education showed improvements in both screening participation and awareness of bowel cancer and screening.• Frequent state-wide mass media campaigns run throughout the year can increase screening participation by encouraging new participants or re-screeners when they become eligible.• Facebook campaigns and telephone counselling had limited improvements in screening participation.


Introduction
Bowel cancer is the third most common cancer and the second highest leading cause of cancer deaths globally (Global Colon Cancer Association, 2021b).Research suggests it is linked to lifestyle factors, including physical inactivity, poor diet, tobacco smoking and high alcohol consumption (Rawla et al., 2019;World Cancer Research Fund & American Institute for Cancer Research, 2018; Cancer Research UK.What is bowel cancer Updated, 2021).To tackle this problem, it is recommended to raise awareness of the following about bowel cancer: incidence rates, prevention, and how early detection can lead to successful treatment (Global Colon Cancer Association, 2021b).Research has shown that bowel cancer is most preventable and highly treatable when detected early, with a five-year survival rate of >90 % compared to 13 % when detected at a later stage (m 2 ).Screening has contributed to reduced mortality rates globally by ensuring detection and subsequent removal of pre-cancerous polyps (Rawla et al., 2019).There is evidence to suggest that >50 % reduction in bowel cancer mortality rates between 1975 and 2010 in USA can be attributed to screening (Zauber, 2015).
Many Organisation for Economic Co-operation and Development (OECD) countries have implemented nation-wide bowel cancer screening programs including Australia, France, United Kingdom, New Zealand, Ireland, and Germany (Martini et al., 2016).Most of these programs are implemented through home test kits sent via postal mail to eligible individuals aged >50 years (Global Colon Cancer Association, 2021a; Australian Government Department of Health, 2022; Health Service Executive.Bowel screening -BowelScreen.Updated, 2019; New Zealand Government Ministry of Health, n.d; National Health Service.Overview bowel cancer Updated, 2021).These test kits include inexpensive stool tests via the faecal occult blood test (FOBT) or faecal immunochemical test (FIT) (Global Colon Cancer Association, 2021a).
Since implementing these screening programs, participation rates have been low for many of these countries (Global Colon Cancer Association, 2021a).Current data suggests only 40.9 % (2020-21) of the eligible population participate in the national program screening in Australia, and 46.6 % in Ireland (2020-21) (Australian Institute of Health and Welfare, 2023; Health Service executive.BowelScreen Programme Report, 2022).Higher participation rates have been observed in England in recent years with up to 69.6 % in 2021-22 (Cancer Research UK.Bowel Screening Uptake.Updated, 2023).Strategies to improve screening participation are therefore needed to allow these programs to achieve their objectives.An Australia study showed an increase in participation to 60 % could prevent a further 37,300 cases and 24,800 deaths (Lew et al., 2017).Raising awareness of risk factors, symptoms and early detection through screening is one way to achieve this.Previous studies have implemented different types of interventions to increase bowel cancer awareness and screening participation.One study implemented an education intervention through a community pharmacy awareness program (Sendall et al., 2018).Another study implemented two state-wide interventions and compared the impact on screening participation (Lofti-Jam et al., 2019).A state-wide television mass media campaign promoting the National Bowel Cancer Screening Program in Australia was also compared with a lower-intensity promotion method of a television advertisement, printed and online advertising (Lofti-Jam et al., 2019).Understanding the study designs, how the interventions were implemented and whether the interventions were successful may assist in the development of successful education interventions to improve awareness and screening participation.
As most OECD countries continue to have low screening rates, increasing public awareness of symptoms and risk factors may encourage improved screening participation (Kanavos and Schurer, 2010).Several reviews have been conducted previously, including, reviews of bowel cancer screening-only interventions in clinical settings (Schliemann et al., 2021;Dougherty et al., 2018), a review of small media influencing FOBT screening (Baron et al., 2008) and a 2016 review of community-based promotion interventions to improve awareness and screening (Martini et al., 2016).As the 2016 review excluded interventions based on behavioural change models (Martini et al., 2016), the current review aimed to update and broaden this evidence by summarising community education interventions (including theoryinformed) for improving bowel cancer awareness and screening in OECD countries.

Methods
This scoping review was conducted according to the JBI Manual for Evidence Synthesis (Peters et al., 2020) and reported according to PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-analyses extension for Scoping Reviews) checklist (Tricco et al., 2018).This review was conducted in accordance with methodology described by Arksey and O'Malley (Arksey and O'Malley, 2005) and Colquhoun et al. (Colquhoun et al., 2014).See Table 1 for the eligibility criteria.
Primary outcome measures were bowel cancer awareness and screening levels following educational interventions, focusing on the interventions design, implementation, and findings.Awareness outcomes were measured through awareness and knowledge and screening through uptake or intentions.
The search was conducted using four databases, PubMed, EMBASE, Web of Science and CINAHL.Search strategies were altered to fit the database's search capacities in consultation with a research librarian (Appendix A).After the preliminary searches retrieved 5692 studies, the eligibility criteria were updated, and studies were limited to English studies published from 2016 to 2022.The 2016 limit was agreed upon due to a similar review conducted, to synthesise evidence from contemporary studies (Martini et al., 2016).Database searches had weekly alerts to identify relevant studies to include until September 2022.Grey literature was searched by checking included studies reference lists.
Database search results were exported into EndNote software (Clarivate, 2022).One researcher (NG) screened references in EndNote to remove duplicate, non-OECD country and studies prior to 2016.Covidence software (Innovation VH, n.d) was used to screen studies.Title and abstract and full-text screening was conducted by two researchers independently.Disputed studies were resolved through consensus or a third researcher's input.Search results are displayed on a PRISMA diagram (Fig. 1) (Page et al., 2021).Data was extracted from included studies using a data extraction template in Covidence software (Veritas Health Innovation, n.d).The authors adapted the template from the JBI Manual for Evidence Synthesis (Peters et al., 2020) (Appendix B) and piloted it using two studies (Shepherd et al., 2022;Fernandez et al., 2022).Data was extracted by one author (NG) and checked by another (SL, KO, MS).Data extracted from included studies were categorised into themes based on education intervention types to compare results within and between themes.

Table 1
Inclusion and exclusion criteria for the studies in the scoping review.2).Some studies reported on several education types.

Education interventions to improve bowel cancer awareness/ knowledge
3.1.1.Education materials Four studies reported findings of education materials to improve awareness (two education materials plus LCHEE (Jo et al., 2017;Nguyen et al., 2017); two education materials only (Christy et al., 2016;Fransen et al., 2017).All studies reported findings on brochures, one with photonovella and one with a national screening kit.Fransen et al. (Fransen et al., 2017) interviewed participants with low health literacy about the accessibility and comprehensibility of a national screening kit.Screening knowledge improved for 10 of 16 items measured (Appendix C), excluding information about risk, voluntary screening, and screening sensitivity (Fransen et al., 2017).Fransen et al. (Fransen et al., 2017) found low health literacy individuals may benefit from other methods (pictorial, animations, narratives) than a brochure and instructions to explain screening.Participants browsed the brochure for pictures, read headings, and reported there was too much information.Some information was confusing for example, the FOBT was not diagnostic, or the difference between FOBT and colonoscopy as the follow up diagnostic test (Fransen et al., 2017).

2018)
. Three studies measured change in awareness (Briant et al., 2018;Holle et al., 2020;Hoffman et al., 2016).Hoffman et al. (Hoffman et al., 2016) found mixed results in awareness changes post-physician-led presentation.Chow et al. (Chow et al., 2020) provided counselling to rural individuals staying at a city-based lodge awaiting healthcare; 98 % felt they were provided sufficient information about screening (Chow et al., 2020).The physician and LCHEE-led presentation had 92 % participants report they learnt something about bowel health (Cassel et al., 2020).

Mass media
Two studies used mass media for awareness education (Torrance et al., 2021;Katz et al., 2017).Katz et al. (Katz et al., 2017) found billboards and posters easy to understand the message and few participants saw the newspaper articles making them less effective.

Mass media.
Varied intervention formats compared the framing of messages to improve screening intentions or uptake including video (n = 2) (Carcioppolo et al., 2020;Lucas et al., 2021), Facebook promotion (n = 1) (Lee-Won et al., 2017), and an online education module (n = 2) (Lucas et al., 2016;Lucas et al., 2018).Loss-framed messaging consistently improved screening uptake or intentions in five studies (Carcioppolo et al., 2020;Lee-Won et al., 2017;Lucas et al., 2021;Lucas et al., 2016;Lucas et al., 2018) and was more effective compared to gain-framed messaging.Facebook promotion study (Lee-Won et al., 2017) and a video study (Carcioppolo et al., 2020) both found loss-framed messaging was associated with colonoscopy intentions through inducing fear.Lee-Won et al. (Lee-Won et al., 2017) reported fear-evoking messages may encourage screening by highlighting the harms to one's health if they do not screen.Both studies suggested loss-framed messages were more useful for individuals without bowel cancer worry by inducing emotions (Carcioppolo et al., 2020;Lee-Won et al., 2017).Those with worries may benefit from humour-framed messages (Carcioppolo et al., 2020).Message framing studies found culturally tailored messaging had more improvements than standard-messaging among African American participants (Lucas et al., 2021;Lucas et al., 2018).Lucas et al. (Lucas et al., 2018) reported those with higher racial identity benefited more with additional culturally tailored message.

Summary of evidence for bowel cancer awareness/knowledge and screening education
Child LCHEE (Parker et al., 2021), a home health party (Briant et al., 2018), a women's health day (McBride and Gesink, 2018) and a local theatre play (Friedman et al., 2019) all improved awareness and screening intentions and should be further explored.LCHEE faith-based education and counselling is an option to explore further for improving awareness/knowledge as all four studies showed improvements, two reported statistically significance (Appendix C) (Holt et al., 2019;Maxwell et al., 2019;Maxwell et al., 2020;Jenkins et al., 2022).
Similarly with inflatable colon tours (Boutsicaris et al., 2021;Miguel et al., 2020;Portilla-Skerrett et al., 2019;Molina et al., 2018).Although, both LCHEE faith-based education and the inflatable colon tour approaches did not show promising results for improving screening uptake and/or intentions.Reasons for this may be screening barriers such as income, health insurance and/or fear of the screening procedure or cancer diagnosis (Boutsicaris et al., 2021;Portilla-Skerrett et al., 2019).Portilla-Skerrett (Portilla-Skerrett et al., 2019) found participants reported fear of cancer diagnosis (44 %) and screening procedure (14 %) as factors not to screen.Boutsicaris (Boutsicaris et al., 2021) reported knowledge alone was not enough to change the screening behaviour, as the barriers of health insurance and income had statically significant associations with screen intent.All the inflatable colon tour and faithbased education studies were conducted in USA where cost and health insurance can be barriers to screening.These two LCHEE options should be explored in countries with free screening options to measure the impact on screening intent/uptake with such barriers removed.
Considering the evidence for awareness/knowledge, it appears that LCHEE approaches, brochures plus LCHEE or a culturally tailored video and workshops approaches may be best for improving bowel cancer awareness.Nineteen (86.4 %) LCHEE studies reported improvements in awareness.Brochures plus LCHEE improved awareness more than education materials alone (Jo et al., 2017;Nguyen et al., 2017;Cuaresma et al., 2018).As for screening, both brochures and brochures plus LCHEE were effective although, only brochures plus LCHEE increased screening among those not up-to-date (Jo et al., 2017;Nguyen et al., 2017;Cuaresma et al., 2018).A culturally tailored video with two group workshops improved awareness but did not measure screening (Nakajima et al., 2022).
Considering the evidence for screening, it appears LCHEE with social support, directly providing screening, brochures plus LCHEE, statewide mass media campaigns, some health professional approaches and fear or loss-framed messaging were most effective for screening uptake and/or intentions.LCHEE and social support were effective at improving screening uptake among six studies (Warner et al., 2019;Dominic et al., 2020;Ou et al., 2019;Rafie et al., 2020;Elder et al., 2017;Tong et al., 2017).Directly providing screening options to participants may also encourage uptake (Boutsicaris et al., 2021;Dominic et al., 2020;Ou et al., 2019;Maxwell et al., 2016;Ruggli et al., 2019;Christy et al., 2016;McBride and Gesink, 2018;O'Keefe et al., 2018).This was observed among several education types.Statewide mass media campaigns were effective at improving screening uptake in the short-term (up to 2-months post campaign) (Durkin et al., 2020;Durkin et al., 2019a).
Evidence measuring awareness is lacking for mass media campaigns.Health professional approaches pharmacist counselling campaigns (Holle et al., 2020;Ruggli et al., 2019) and mobile bus clinic (Naguib et al., 2017) reached large participants numbers for education.These approaches showed promising results for screening uptake but reported limited or no findings on awareness which should be further explored.Physician and LCHEE sessions were able to overcome cultural barriers and improve screening intentions and uptake (Cassel et al., 2020).Such approach should be further explored.Lastly, fear or loss-based messaging showed more favourably than humour or gain-based messaging at improving screening intentions and should be considered in education approaches (Carcioppolo et al., 2020;Lee-Won et al., 2017;Lucas et al., 2021).

Discussion
The present review broadened evidence from a 2016 review of 18 studies on bowel cancer awareness and screening promotional campaigns (Martini et al., 2016).The 2016 review identified mass and small media, group and one-on-one education, financial support, special events and celebrity endorsements (Martini et al., 2016).All strategies except small media directly measured screening.Group education was identified as more effective than one-on-one education and financial support for screening.Only one mass media study measured knowledge, with an unspecified increase reported (Martini et al., 2016).The present review expanded on this including more studies measuring awareness/ knowledge, and education specific interventions including those informed by behavioural change theories, and compared interventions by educators, health professionals or lay educators.This allowed the authors to summarise types of educators who could benefit specific groups for both awareness and screening.This review suggested several types of education: education materials, mass media, HPE, LCHEE and other.Some studies used combined education types; LCHEE were most common to improve awareness and screening.Studies used different methods for reporting and measuring results.Each education type broadly led to differences in outcomes.

Mass media
Awareness education was implemented through mass media campaigns in two studies, both led to improvements.Comparisons between these studies were difficult as awareness measures differed.One measured percentage increase in awareness (Torrance et al., 2021), the other reported whether participants found the campaign easy to understand (Katz et al., 2017).Four studies focused on mass media campaigns to improve screening and reported mixed results.Two showed improvements for up to 2-months post-campaign (Durkin et al., 2020;Durkin et al., 2019b).A study that used billboards, posters, and newspaper articles found no difference between campaign and control groups (Katz et al., 2017).Another used a Facebook campaign with minimal reach and screening uptake (Koivogui et al., 2020).These findings suggest billboard and Facebook campaigns may not effectively encourage large scale screening.Katz et al. (Katz et al., 2017) billboard campaign did not include television, radio, or internet advertising and Koivogui et al. (Koivogui et al., 2020) suggested Facebook campaigns could be useful for younger audiences (50-54 years) who had not screened previously.Suggesting both campaigns have lesser reach and screening uptake compared to state-wide campaigns with television, online, social media and radio advertisements.
State-wide campaigns may be more effective for screening although with short-term effects.Durkin et al. (Durkin et al., 2020) suggested first-time or never previously participated screeners were encouraged due to the high-reach media approach.Television advertisements were useful to target older individuals thus, combining high and lower-reach media advertisements could target different eligible age groups.Durkin et al. (Durkin et al., 2020) suggested campaigns should run throughout the year to encourage eligible individuals to screen and maximise effect.Similarly, the 2016 review reported improvements in screening for three mass media studies and reported an association between screening rates and frequency of exposure to campaigns (Martini et al., 2016).

Education material
Brochures were the most common education material.Flipcharts aided education sessions although lacked specific findings.Education materials improved both awareness and screening.Our finding's showed brochures were more effective than photonovella to improve awareness and screening (Christy et al., 2016).Although awareness and screening findings differed for brochures compared to brochures plus LCHEE.For awareness, brochures were less effective than brochures plus LCHEE (Nguyen et al., 2017;Cuaresma et al., 2018).Perhaps due to the relationship between participants and educators and the repetition of information provided through varied modes of providing information, for example, having written brochures and verbal communication through LCHEE (Nguyen et al., 2017).In contrast, both interventions showed similar improvements in screening.Suggesting the addition of LCHEE may not encourage more screening participation compared to brochures alone.Though, Jo et al. (Jo et al., 2017) proposed brochures may have been sufficient to educate participants to screen without the need for further LCHEE, as participants had high education levels.Similarly, in Cuaresma (Cuaresma et al., 2018), which found no significant difference between groups, showed the control group had higher education levels compared to the intervention group.Thus, lower educated individuals may benefit from both for screening.Therefore, for most improvements in awareness and whole population approaches (low and high education levels) for screening, education interventions could combine brochures with LCHEE.
Findings showed providing a brochure with screening kit instructions may improve awareness (Fransen et al., 2017) although, the effectiveness of education materials may vary depending on individuals' health literacy levels.Those with low health literacy are less likely to complete stool tests from higher perceived barriers for example, it is embarrassing, confusing, and difficult (Arnold et al., 2012).Coronado et al. (Coronado et al., 2014) compared wordless (low health literacy) FIT instructions with worded instructions, to compare the understandability and acceptability.Participants preferred wordless instructions, with higher understandability and more user-friendly for low health literacy or non-English speaking individuals (Coronado et al., 2014).Davis et al. (Davis et al., 2017) compared screening uptake between groups provided a FIT kit (low health literacy photonovella booklet and video versus standard brochure).In contrast to the findings above, no significant difference between groups were identified.Although Davis et al. (Davis et al., 2017) reported they could not fully identify which intervention component were most effective and participants were not limited to those not up-to-date with screening (Davis et al., 2017).Therefore, for nationwide screening kit information to be understandable for the whole population, information should target low health literacy, including plain language, more pictures and scan codes to animations/narratives explaining information in different ways.

Health professional education and counselling
The HPE studies mixed results showed improvements in awareness may not lead to increased screening.Alternatively, providing screening directly to participants may contribute to higher screening (Boutsicaris et al., 2021;Ou et al., 2019;Ruggli et al., 2019;Christy et al., 2016;McBride and Gesink, 2018;O'Keefe et al., 2018).As five of six studies with moderate-high post-intervention screening rates, provided a screening option to participants.A pharmacist intervention provided FITs directly to 21,596 participants with successful test completions, suggesting this approach is effective to reach more individuals to screen (Ruggli et al., 2019).The study reported almost half of participants would not have screened without the intervention (Ruggli et al., 2019).This is consistent with other education intervention types in this review.Boutsicaris et al. (Boutsicaris et al., 2021) suggested providing FITs may have improved screening following inflatable colon tours.As both Boutsicaris et al. (Boutsicaris et al., 2021) and Portilla-Skerrett et al. (Portilla-Skerrett et al., 2019) had no change in intentions post-tour.Ou et al. (Ou et al., 2019) reported HPE only increased screening due to providing FITs to participants.McBride andGesink (McBride andGesink, 2018) andO'Keefe et al. (O'Keefe et al., 2018) suggested providing kits in these Canadian and USA studies reduced barriers to screen, easier to access (transport, costs), convenient and acted as a reminder.These findings are consistent with two reviews (Schliemann et al., 2021;Leach et al., 2021).Schliemann et al. (Schliemann et al., 2021) found more screening uptake with education and providing kits compared to education alone.Leach et al. (Leach et al., 2021) observed a larger effect size in increasing screening among studies which provided free or low-cost screening options.Therefore, providing screening directly to participants can be more effective than education alone.

Lay community health educators' education or counselling
Majority of LCHEE studies showed statistically significant N. Gadd et al. improvements in awareness.LCHEE with high screening improvements were enhanced education sessions within Filipino American community organisations with organisation allocated educators (Maxwell et al., 2016) and barber LCHEE within a barbershop (Sizer and Conyers, 2022).A nurse educated the barber to provide education to eligible clients during appointments.Contributors to success of these interventions may be removing barriers to access screening and utilising highly trusted community members as educators.This may be due to social connections and support between participants and educators.As many educators were chosen from within the target population/communities.An intervention where children taught families both significantly improved awareness and screening intentions (Parker et al., 2021).This child educator approach is novel in bowel cancer education and could be beneficial for future interventions.A similar approach was utilised for reducing tobacco smoking (Chung et al., 2019).The study educated teenagers about risks and encouraged cessation and found teenagers effectively promoted the information to peers, friends and family (Chung et al., 2019).These interventions may be effective by providing health promotion in often difficult to reach groups (Chung et al., 2019).In contrast, a LCHEE and patient navigation study found no difference in screening but statistically significant changes in knowledge among those who did and did not attend education (Mojica et al., 2016).Mojica et al. (Mojica et al., 2016) found some participants wanted to attend education but never intended to screen due to cost and time.This is consistent Cancer Council Victoria (Cancer Council Victoria, 2021), which suggest some individuals who do not screen can be classified as 'refusers', who are aware of screening although do not wish to participate.Indicating an increase in awareness may not lead to an increase in screening among refusers.

Social support
Social support is used within several interventions and may have assisted in screening improvements.Dominic et al. (Dominic et al., 2020) combined education sessions with loved one's supporting participants to screen.Other interventions had community members or peers involved in group discussions (McBride and Gesink, 2018) or cast members of a theatre play (Friedman et al., 2019), all with promising results.Similarly, the 2016 review (Martini et al., 2016) found education and peer support increased screening motivation although, did not impact screening uptake at 6-months.These approaches may assist higher reach to raise awareness, promote health, and encourage screening by inspiring discussions among family and friends.As James et al. (James et al., 2022) reported individuals mostly prefer to discuss health with individuals they trust.Education interventions could benefit from incorporating social supports or LCHEE from within the target populations to promote success of the intervention.

In-person and virtual education components
Interventions that worked well to improve awareness had in-person components compared to virtual only.A phone versus web-based counselling study found phone counselling increased knowledge and screening more.This in-person approach, along with group discussions or individual education may be due to more opportunities to ask questions (Christy et al., 2020).Virtual interventions can limit this.The Facebook group intervention did not provide such opportunities and found improvements in awareness although no screening change (Key et al., 2020).The intervention may promote health messages to difficult to reach populations although, not encourage screening.Consistently, Yaacob et al. (Yaacob et al., 2020) used a mobile app to improve knowledge and attitudes towards screening.The app was successful to improve knowledge although, not screening attitudes.This may be due to difficulties in changing individuals' attitudes and behaviours; one needs to be ready for change and their values and beliefs need to align with the behaviour (Yaacob et al., 2020).The Women's health day, another in-person approach found combining screening and education with other health screening and priorities created a holistic approach and increased screening motivation (McBride and Gesink, 2018).The authors of this review were unable to identify other studies which combined health checks although, future interventions could consider such approach to encourage participation.Art-based education was another useful in-person approach.Friedman et al. (Friedman et al., 2019) reported the theatre play successfully distributed information, with moderate improvements in screening intentions.Similarly, Lofti-Jam et al. (Lofti-Jam et al., 2019) implemented a comedy show about screening for indigenous Australians with good results.Following the show, 88 % of attendees intended to screen and 76 % reported good screening awareness (46 % increase from pre-show) (Lofti-Jam et al., 2019).Art-based education could be a useful education strategy and should be further explored.Interventions attempting to improve awareness could do well to incorporate in-person approaches.

Strengths and limitations
A strength was the review provided contemporary information regarding awareness and screening education interventions.An eligibility criterion guided the inclusion process, and two authors screened all studies to remove risk of bias.A limitation was the search strategy included only English language studies which may limit findings for some OECD countries.Secondly, although grey literature was eligible in the inclusions, only published articles were identified.Due to human error, misclassification of studies may have occurred during data synthesis.Lastly, due to varied outcome measures between studies, an overall effect size for awareness and screening could not be produced.

Conclusion
Education types identified to improve bowel cancer awareness and screening were LCHEE, education materials, HPE, mass media and other.LCHEE were most common and effectively improved both awareness and screening.Brochures improved screening, but brochures plus LCHEE were more effective for awareness.A state-wide campaign run multiple times a year may be an effective mass media intervention for screening uptake.Providing screening opportunities with education would encourage screening, by reducing barriers and increasing convenience.Findings within this review could assist education intervention development for bowel cancer awareness and screening.
Author contributions.NG drafted the scoping review protocol, search strategy, data analysis, and manuscript.KO, SL, and MS reviewed the scoping review protocol, search strategy and draft manuscript.All authors were involved in the screening and data extraction.

Declaration of competing interest
The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.
N. Gadd et al.
Four studies used mass media for screening education, via public awareness campaigns (n = 3)(Durkin et al., 2020;Katz

Table 2
Definitions of the types of education interventions identified in the scoping review and the key findings of each type.
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Table 2
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