The effect of Senior High School Nurse-led Educational (SHiNE) Project in improving knowledge and attitudes towards primary and secondary prevention of cervical cancer among Students in Ghana: A Cluster Randomised Controlled Trial

A nurse-led health education session or Senior High School Nurse-led Educational (SHiNE) project. A one-day multimodal (verbal, printed and multimedia) school-based intervention will include a set of evidence-based strategies. This strategy was selected based on a) critical review of models for school-based sex education, health education towards HIV/AIDs and use of contraception, b) improving health knowledge among high school students based on literature reviews and judgement by the health behaviour researchers, local educationist and obstetricians, c) probability of being scaled up and sustained across senior high schools in Ghana. d) a pilot and feasibility test to refine the intervention with n = 293 students from n = 4 schools (This pilot trial was completed in 2023). The pilot intervention was well received and there will be no planned refinements to the intervention delivered as part of this RCT. The proposed intervention consists of four components: Face-2-face session Printed leaflets Web-education Game APP Face-2-face session: Sessions will be delivered by a nurse, the investigator given her experience in conducting health education among adolescents over one hour. The nurse will use PowerPoint presentations (prepared as part of the pilot intervention) with relevant learning aids such as videos and pictures to enhance learning. These materials have been reviewed and no refinements needed after the pilot study. Leaflets: Printed leaflets was developed as part of the pilot intervention (no refinements needed after pilot study) and will be available at the session to be distributed to the attendees for reference after the face-2-face session. Existing resources from evidence-based literature of cervical cancer including WHO information on cervical cancer and HPV vaccination program in low-income countries and Uganda HPV vaccination project leaflet, were included in the presentation materials. The leaflets were adopted because of their ability to provide comprehensive cervical cancer and HPV vaccine information incorporating medical and psychosocial content, simple, plain words and transferability to the Ghanaian setting. A research assistant will be provided with an observer sheet to record attendance and participant. delivery of modules. Web-based education: Web-based education will be provided to students after the face-2-face session. The website was developed as part of the pilot study and contains very similar information in the slides for the face-to-face presentation. The platform is anonymous, and no names and contact details will be collected. Short videos and images about cervical cancer incidence in Ghana; risk factors, signs and symptoms, primary and secondary prevention will be embedded in the website as well as information sources and the list of locations in Ghana where HPV vaccinations and cervical screening can be accessed. The videos are presented in English and two most spoken local languages. Adherence will be assessed using website analytics and self-administered evaluation surveys. Gaming APP: A gaming APP was be developed as part of the pilot intervention study. The content of the gaming APP contain questions pooled from comments and questions provided by students in the comment section of a descriptive survey conducted prior to this project. It also contain evidence and non-evidence based statements about cervical cancer and HPV infection from the WHO website and other evidence from the literature. The gaming APP is compatible with android devices only as android devices are mostly used in Ghana. Adherence will be assessed using analytics and self-administered evaluation surveys.