Developing and Validating Health Education Module for Prostate Cancer Prevention Behavior in Iraqi Male University Staff

Background and Rationale Limited knowledge, attitudes, and unfavorable practices toward prostate cancer can delay early detection and the adoption of preventive behaviors among men at increased risk. Health education is a low-cost strategy to address these gaps, and web-based delivery allows working adults to access educational content at a time and place convenient to them. This trial will assess whether a structured, Arabic-language web-based health education module improves prostate cancer prevention knowledge, attitudes, and practices among male university staff in Iraq. In Iraq, PCa is the ninth most prevalent cancer, with 1313 cases (5.55%). It is the 4th most widespread tumor among males in the top 10, with 1313 cases (12.38%). The 2020 Annual Statistics Report of the Ministry of Health/Environment Iraq (MOH) classified prostate cancer as one of the top ten primary site cancer fatalities. It caused 3.3% of all cancer deaths and 6.5% of male deaths, ranking sixth among all malignancies.

Setting and Cluster Allocation The study will be conducted at Middle Technical University (MTU), Iraq, which comprises 17 colleges and institutes (5 colleges and 12 institutes) located in five cities. The unit of randomization is the college or institute (cluster). From 8 eligible colleges/institutes, two clusters will be selected using simple random sampling, and one will be randomly allocated to the intervention group and the other to the control group using randomization method, sealed-envelope lottery. Allocation will be performed by an independent person not involved in recruitment.

Within each allocated cluster, male staff will be invited to take part, and volunteers who meet the eligibility criteria will be enrolled consecutively until the required sample size of 80 participants per group is reached.

Sample Size Calculation The sample size was calculated using G*Power version 3.1.9.4 (F-tests family). Calculations were performed for repeated-measures ANOVA (between factors, within factors, and within-between interaction), and the largest resulting sample size was adopted. Parameters were a medium effect size (f = 0.25; Cohen, 1988), α = 0.05, power (1 - β) = 0.80, two groups, and two measurement points (pre-test and post-test). The minimum required sample size was 128 participants. Allowing for an anticipated 20% drop-out rate, the sample size was inflated to 160 (128 / 0.80), i.e., 80 participants per group.

Intervention The intervention group will receive a web-based health education module (HEM) on prostate cancer prevention behaviors, delivered in Arabic through a web application over 12 weeks. The first session, delivered through the intervention group's WhatsApp group, will introduce the study and provide instructions on accessing and using the web application. Subsequent sessions will deliver educational content covering promoting behaviors for prostate cancer prevention comprised of six topics, consisting of an introductory home page and five learning modules that address the anatomy and function of the prostate gland, prostate gland diseases, the causes and risk factors of prostate cancer, the methods used for the diagnosis and treatment of prostate cancer, and prostate cancer prevention measures. Various educational content, including an overview of the prostate gland and prostate cancer statistics, descriptions of benign prostatic hyperplasia and prostatitis, unmodifiable and modifiable risk factors, screening and confirmatory diagnostic tests, treatment modalities, and preventive behaviors and measures, was incorporated into the web application module.

WhatsApp will be used as the communication and follow-up platform for reminders, answering questions, and supporting use of the web application. The researcher will supervise delivery of the module, monitor participants' progress and use of the web application, and provide guidance to participants. The timing of contact sessions will be arranged flexibly with the approval of MTU and the participating colleges and institutes.

Control Group Participants in the control group will not receive the web-based health education module during the 12-week study period and will continue with their usual activities.

Prevention of Contamination Because randomization occurs at the college/institute level, participants in the intervention and control groups will work at different sites. Where possible, clusters located in different geographic areas will be selected, reducing the likelihood that participants in the two groups interact or share intervention materials. Separate WhatsApp groups will be created for each study group, and access to the web application will be restricted to intervention group participants.

Data Collection Procedures Data will be collected using a structured, self-administered questionnaire in Arabic, delivered through Google Forms and distributed via each group's WhatsApp group. The questionnaire was developed by authors. Both groups will complete the questionnaire at baseline (before the intervention) and immediately after completion of the 12-week intervention period, using the same instrument at both time points.

Participants may be withdrawn if they are unable or unwilling to comply with the study requirements, fail to attend scheduled sessions, or experience substantial changes in health conditions that could affect the study results.

Statistical Analysis Data will be analyzed using IBM SPSS Statistics version 26. Baseline characteristics of the two groups will be compared using appropriate tests (e.g., independent t-test or chi-square test). Changes in knowledge, attitude, and practice scores between the intervention and control groups from pre-test to post-test will be examined using mixed (within-between) repeated-measures ANOVA, consistent with the sample size calculation. A p-value \< 0.05 will be considered statistically significant. Scores will be analyzed as continuous and categorical variables. Raw scores are converted to percentages (0-100%), where ≥70% is classified as Good Knowledge, Positive Attitude, and Positive Prevention Practices, and \<70% as Poor/Negative. Based on this 70% threshold, the raw score cut-offs are: Knowledge ≥25, Attitude ≥161, and Practices ≥95. Higher scores indicate better outcomes.