Effectiveness of Oral Cancer awareness and Prevention Education on Knowledge, Skill and Attitude toward Oral Cancer among Auto Drivers
Muthuselvapathi. M1, Devakirubai. E2
1Lecturer, Al Shifa College of Nursing, Lemon Valley, Perinthalmanna, Malappuram, Kerala, India.
2Dean, Sacred Heart Nursing College, The Tamil Nadu Dr. M. G. R. Medical University,
Madurai, Tamil Nadu, India.
*Corresponding Author E-mail: muthuselvapathi@gmail.com
ABSTRACT:
Background: Oral cancer is the third most common cancer in India and the sixth most prevalent worldwide. Squamous cell carcinoma accounts for 90% of all oral cancers, and has a 5-year survival rate of around 60%. However, early diagnosis can increase the survival rate to over 90%. In 2020, the WHO estimated that there were 377,713 new cases of oral cancer and 177,757 deaths from the disease globally. It affects various parts of the mouth, including the lips, tongue, gums, and other oral tissues, and is often associated with modifiable risk factors such as smoking, excessive alcohol use, poor diet, and inadequate oral hygiene. Aim: The aim of the current study is to evaluate the effectiveness of oral cancer awareness and prevention education on knowledge, skill, and attitude among auto drivers. Methodology: A quantitative research approach was used for this study. Non – equivalent pre-test post-test control group design, a quasi-experimental approach was adopted for this study. A total of 100 samples were selected purposively, out of which 50 were allotted to the experimental group and 50 were allotted control group. Data were collected using structured knowledge questionnaire, attitude scale towards oral cancer, and oral self-examination observational checklist. The data were analyzed using descriptive and inferential statistics. Results: The current study findings revealed that Oral Cancer Awareness and Prevention Education (OCAPE) was effective in increasing the knowledge on oral cancer (‘t’ = 25.09, P= 0.001); in improving the attitude (t’ = 27.40, P= 0.001); and in increasing the skill regarding oral self-examination (t’= 48.31, p= 0.001) of the auto drivers. There was very highly significant positive moderate correlation between knowledge and attitude (r=0.45, p=<0.001), knowledge and skill (r = 0.35, p = <0.001), skill and attitude (r =0.48, p = < 0.001). There was significant association between pre-test knowledge score and place of residence (χ² = 10.24, p = 0.001). Conclusion: The study findings highlighted that nurses play a pivotal role in increasing the awareness, practice and attitude towards oral cancer among high-risk groups. The findings clearly elucidate that the awareness and education helps in adoption of appropriate life style measures to prevent oral cancer thus reducing the global burden of oral cancer.
KEYWORDS: Oral Cancer, Auto Drivers, OCAPE, Knowledge, Skill, Attitude, Oral Self Examination.
INTRODUCTION:
Oral cancer is a significant public health concern in India and contributes substantially to the global cancer burden.1 India accounts for nearly one-third of the worldwide incidence of oral cancer, making it one of the most affected countries.2 According to GLOBOCAN estimates, oral cancer is the most common cancer among men in India and remains a leading cause of cancer-related morbidity and mortality.3 The high incidence and mortality rates are largely attributed to the widespread use of tobacco and areca nut products, delayed diagnosis, and low levels of public awareness.4
The major risk factors associated with oral cancer include smoking, smokeless tobacco use, areca nut chewing, and alcohol consumption. India is among the largest consumers of smokeless tobacco globally, and its use significantly increases the risk of oral malignancies. Individuals using tobacco products are reported to have a 7 to 10 times higher risk of developing oral cancer when compared to non-users.5 Other contributing factors include poor oral hygiene, micronutrient deficiencies, chronic oral irritation, and lack of routine oral health screening.6
Auto drivers constitute a high-risk occupational group due to their lifestyle and work-related factors. Long working hours, occupational stress, exposure to environmental pollutants, irregular dietary habits, and easy accessibility to tobacco and alcohol contribute to the increased prevalence of risk behaviors among this group. A study revealed that a majority of auto drivers were either smokers or users of smokeless tobacco, while awareness regarding oral cancer risk and preventive screening was notably low. This combination of high-risk habits and poor awareness places auto drivers at greater vulnerability for developing oral cancer.7
Despite advancements in diagnostic and treatment modalities, most oral cancer cases in India are diagnosed at an advanced stage due to lack of awareness regarding early signs and symptoms. Delayed diagnosis results in poor prognosis, extensive treatment, increased financial burden, and reduced quality of life.8 Evidence suggests that early detection through awareness programs, regular screening, and oral self-examination can significantly improve survival rates and reduce disease burden.9
Considering the high burden of oral cancer, the strong association with preventable risk factors, and the low awareness among high-risk groups, there is a critical need for targeted educational interventions.10 Therefore, the purpose of the present study is to evaluate the effectiveness of Oral Cancer Awareness and Prevention Education on knowledge, attitude, and skills related to oral cancer among auto drivers. Such interventions are expected to promote early detection, encourage healthy behavioral changes, and contribute to the reduction of oral cancer burden in the community.11
OBJECTIVES:
1. To assess and compare the pre-test and the post-test level of knowledge, and attitude towards oral cancer among auto drivers.
2. To assess and compare the post test level of skill among auto drivers in the experimental group and control group.
3. To evaluate the effectiveness of Oral Cancer Awareness and Prevention Education on knowledge, skill and attitude towards oral cancer among auto drivers.
4. To find out the relationship between knowledge, skill, and attitude towards oral cancer among auto drivers.
5. To find out the association between knowledge, skill, and attitude towards oral cancer with selected demographic variables of auto drivers.
MATERIALS AND METHODS:
Research Design: A quantitative research approach with a quasi-experimental, non-equivalent pre-test, post-test control group design was adopted to evaluate the effectiveness of Oral Cancer Awareness and Prevention Education (OCAPE) on knowledge, attitude, and skill related to oral cancer among auto drivers. The design involved pre-test assessment, administration of the intervention to the experimental group, and post-test assessment for both experimental and control groups.
Study Setting: The study was conducted at two selected auto stands in Madurai, Tamil Nadu. Shivanalaya Auto Stand, Arapalayam, served as the experimental group setting, while Meenakshi Auto Stand, K- Pudhur, served as the control group setting. These sites were selected due to the high concentration of auto drivers and feasibility of data collection.
Population and Sampling Technique:
The target population comprised auto drivers working in Madurai city. The accessible population included auto drivers registered at the selected auto stands. A total sample of 100 auto drivers was selected using a purposive sampling technique. Fifty auto drivers from Shivanalaya Auto Stand were assigned to the experimental group and fifty from Meenakshi Auto Stand to the control group.
Inclusion and Exclusion Criteria:
Auto drivers aged 18–60 years, male, registered with the selected auto stands, having habits of smoking, alcohol consumption, tobacco or areca nut use, and willing to participate were included. Auto drivers who were previously diagnosed with oral cancer, had already undergone oral cancer awareness education, were temporary drivers, or unwilling to participate were excluded from the study.
Tool Description:
Data were collected using structured and standardized tools developed through literature review and expert validation. The tools included:
1. A structured checklist to screen risk factors related to oral cancer
2. A structured interview schedule to collect socio-demographic data
3. A structured knowledge questionnaire consisting of 17 items assessing awareness of oral cancer
4. A structured observation checklist with 10 steps to assess oral self-examination skill
5. A structured attitude scale based on the Health Belief Model with 21 Likert-type statements
The tools demonstrated high reliability, with reliability coefficients ranging from 0.89 to 0.98.
Intervention:
The intervention, termed Oral Cancer Awareness and Prevention Education (OCAPE), was administered only to the experimental group. It consisted of three components:
1. A 45-minute structured video-assisted teaching session on oral cancer covering definition, risk factors, signs and symptoms, prevention, and oral self-examination
2. Distribution of an informational brochure on oral cancer in Tamil
3. Demonstration and return demonstration of oral self-examination using a mirror and torch
Data Collection Procedure:
Ethical clearance was obtained prior to data collection. Permission was secured from the respective auto stand authorities. Written informed consent was obtained from all participants. Pre test assessments of knowledge and attitude were conducted for both groups. The intervention was administered to the experimental group in the second week. Post test assessment of knowledge, attitude, and skill was conducted for both groups 14 days after the intervention. The control group received the intervention after completion of the study.
Ethical Clearance:
The study was approved by the Institutional Ethics Committee of Sacred Heart Nursing College, Madurai. Participants were assured of confidentiality, anonymity, voluntary participation, and the right to withdraw at any time without penalty.
Statistical Analysis:
Data were analyzed using descriptive and inferential statistics. Descriptive statistics included frequency, percentage, mean, and standard deviation. Inferential statistics such as paired t-test, independent t-test, and chi-square test were used to evaluate the effectiveness of the intervention and to assess associations between variables. Statistical significance was set at p< 0.05.
RESULT:
Table 1: Frequency and percentage distribution of auto drivers According to socio demographic characteristics N = 100
|
Demographic variables
|
Experimental group (n=50) |
Control group (n=50) |
c2 value |
‘p’ Value |
|||
|
F |
% |
F |
% |
||||
|
Age |
<40 years |
20 |
40.00 |
23 |
46.00 |
0.38 |
0.83# |
|
41-50 years |
14 |
28.00 |
13 |
26.00 |
|||
|
>50 years |
16 |
32.00 |
14 |
28.00 |
|||
|
Education |
Primary education |
9 |
18.00 |
12 |
24.00 |
2.66 |
0.44# |
|
Secondary education |
7 |
14.00 |
11 |
22.00 |
|||
|
Higher secondary education |
32 |
64.00 |
24 |
48.00 |
|||
|
Graduation |
2 |
4.00 |
3 |
6.00 |
|||
|
Monthly Income |
<Rs.10000 |
9 |
18.00 |
7 |
14.00 |
1.49 |
0.48# |
|
Rs.10001-15000 |
18 |
36.00 |
24 |
48.00 |
|||
|
>Rs.15000 |
23 |
46.00 |
19 |
38.00 |
|||
|
Religion |
Hindu |
44 |
88.00 |
45 |
90.00 |
0.21 |
0.90# |
|
Muslim |
3 |
6.00 |
3 |
6.00 |
|||
|
Christian |
3 |
6.00 |
2 |
4.00 |
|||
|
Place of Residence |
Urban |
50 |
100.00 |
50 |
100.00 |
0.00 |
1.00# |
|
Rural |
0 |
0.00 |
0 |
0.00 |
|||
|
Semi urban |
0 |
0.00 |
0 |
0.00 |
|||
|
Marital Status |
Unmarried |
1 |
2.00 |
2 |
4.00 |
0.34 |
0.56# |
|
Married |
49 |
98.00 |
48 |
96.00 |
|||
|
Separated |
0 |
0.00 |
0 |
0.00 |
|||
|
Divorced |
0 |
0.00 |
0 |
0.00 |
|||
# - Not significant
Frequency and percentage distribution of socio-demographic variables of auto drivers in experimental and control groups. Chi-square test was used to assess the association. p < 0.05 was considered statistically significant.
Table 2: Comparison of Pre test and Post test Knowledge Score among Auto drivers N = 100
|
Group |
Test |
Mean |
SD |
Mean Difference |
t value |
p value |
|
Experimental (n=50) |
Pre test |
7.62 |
2.16 |
6.04 |
25.09 |
0.001*** |
|
Post test |
13.66 |
1.65 |
||||
|
Control (n=50) |
Pre test |
7.92 |
1.74 |
0.34 |
0.77 |
0.44 |
|
Post test |
8.26 |
1.61 |
Values are expressed as Mean±SD. Independent t test was used. p<0.05 was considered statistically significant.
Table 3: Comparison of Pretest and Posttest Attitude Score among Auto drivers N = 100
|
Group |
Test |
Mean |
SD |
Mean Difference |
t value |
p value |
|
Experimental (n=50) |
Pre test |
54.30 |
4.29 |
20.14 |
27.90 |
0.001*** |
|
Post test |
74.44 |
2.72 |
||||
|
Control (n=50) |
Pre test |
54.92 |
3.04 |
1.06 |
1.86 |
0.07(NS) |
|
Post test |
55.98 |
3.16 |
# - Statistically not significant (NS)
***Statistically highly significant
Values are expressed as Mean ± SD. Independent t test was used. p < 0.05 was considered statistically significant.
Table: 4 Comparison of Posttest Skill Scores on Oral Self-Examination among Auto Drivers N = 100
|
Group |
Mean |
SD |
Mean Difference |
t value |
p value |
|
Experimental (n=50) |
9.24 |
0.82 |
6.84 |
48.31 |
0.001*** |
|
Control (n=50) |
2.40 |
0.57 |
*** Statistically very highly significant
Values are expressed as Mean ± SD. Independent t test was used. p < 0.05 was considered statistically significant.
DISCUSSION:
Oral cancer remains a major public health issue, particularly among high-risk occupational groups such as auto drivers, where awareness and preventive practices are often inadequate. The present study evaluated the effectiveness of Oral Cancer Awareness and Prevention Education (OCAPE) on knowledge, attitude, and oral self-examination skills. Baseline findings showed poor knowledge and predominantly neutral attitudes towards oral cancer in both groups, indicating a clear need for targeted education. Following the intervention, the experimental group demonstrated a statistically significant improvement in knowledge and attitude, while the control group showed minimal change, confirming the effectiveness of OCAPE. A substantial improvement in oral self-examination skills was observed in the experimental group, with most participants achieving adequate skill levels in the posttest, whereas the control group continued to show inadequate skills. This highlights the value of skill-based training in promoting early detection practices. A significant positive relationship between knowledge, attitude, and skill was observed in the experimental group, suggesting that increased knowledge positively influenced attitudes and skill acquisition. Associations between baseline scores and selected demographic variables indicate that socio demographic factors may affect initial awareness, but structured education effectively improves outcomes. Overall, the study provides strong evidence that OCAPE is an effective intervention for improving knowledge, attitude, and oral self-examination skills related to oral cancer among auto drivers, supporting its inclusion in community-based preventive health programs.
CONCLUSION:
The present study concluded that Oral Cancer Awareness and Prevention Education (OCAPE) was highly effective in improving knowledge, attitude, and oral self-examination skill related to oral cancer among auto drivers. The significant improvement observed in the experimental group after the intervention highlights the importance of structured educational programs for high-risk occupational groups. Enhanced knowledge led to positive attitude changes and improved preventive practices, particularly oral self-examination. The study emphasizes the pivotal role of nurses in community-based cancer prevention through health education, early detection strategies, and promotion of healthy lifestyle practices, thereby contributing to the reduction of oral cancer burden.
CONFLICT OF INTEREST:
The authors have no conflicts of interest regarding this Study.
ACKNOWLEDGEMENT:
The authors would like to thank the auto drivers of Shivanalaya Auto Stand and Meenakshi Auto Stand for their cooperation and support during the study.
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Received on 22.01.2026 Revised on 05.03.2026 Accepted on 11.04.2026 Published on 30.07.2026 Available online from August 05, 2026 Int. J. Nursing Education and Research. 2026;14(3):211-214. DOI: 10.52711/2454-2660.2026.00042 ©A and V Publications All right reserved
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