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Effect of Oral Cancer Awareness on Oral Cancer Screening Practices among Adults in Nigeria

Abstract

Oral cancer is an important public health concern that can result in substantial morbidity, mortality, functional impairment, and reduced quality of life when diagnosis occurs at an advanced stage. Early recognition of suspicious oral lesions and appropriate professional examination can facilitate timely diagnosis and management. Adults may be exposed to several risk factors associated with oral cancer, including tobacco use, harmful alcohol consumption, certain forms of betel or areca nut exposure where applicable, persistent human papillomavirus infection, and other behavioural or environmental factors. Oral cancer awareness provides adults with information about oral cancer, risk factors, warning signs, prevention, the importance of oral examination, and available professional screening or early-detection services. Oral cancer screening practices refer to behaviours related to seeking and utilizing appropriate oral health examinations or screening services for the identification of potentially suspicious oral lesions, particularly among individuals at increased risk or those experiencing persistent oral symptoms. In Nigeria, inadequate awareness, misconceptions about oral cancer, limited knowledge of risk factors and warning signs, fear of diagnosis, cost, and limited access to dental and oral healthcare services may discourage adults from utilizing appropriate screening or early-detection services. Effective oral cancer awareness may improve knowledge and encourage adults to seek appropriate oral examinations and professional evaluation. Against this background, this study investigates the effect of oral cancer awareness on oral cancer screening practices among adults in Nigeria. The study is anchored on the Health Belief Model, Social Cognitive Theory, and Knowledge-Attitude-Practice framework. The Health Belief Model explains preventive health behaviour through perceived susceptibility, perceived severity, perceived benefits, perceived barriers, and cues to action, providing a basis for understanding adults' decisions regarding oral cancer screening and early detection. Social Cognitive Theory emphasizes the interaction between knowledge, self-efficacy, social influences, behavioural capabilities, and environmental conditions in shaping health behaviour. The Knowledge-Attitude-Practice framework provides a basis for examining how improved knowledge and attitudes resulting from oral cancer awareness may influence oral cancer screening practices. Collectively, these theoretical perspectives provide a suitable framework for explaining how oral cancer awareness may influence oral cancer screening practices among adults in Nigeria. The study will adopt a quantitative quasi-experimental research design. Primary data will be collected from adults in selected communities and healthcare or dental facilities in Nigeria using a structured interviewer-administered questionnaire and, where feasible, verification of attendance for oral health examination through appropriate facility records with participants' consent and confidentiality safeguards. A multistage sampling technique will be employed to select states, local government areas, communities, healthcare facilities, and eligible adults. Where feasible, selected communities or participant groups will be assigned to intervention and comparison groups. Participants in the intervention group will receive structured oral cancer awareness education covering oral cancer, risk factors, warning signs, prevention, tobacco and alcohol-related risks, HPV-related risks, the importance of oral hygiene and regular professional oral examinations, and the appropriate response to persistent or suspicious oral symptoms. Oral cancer screening practices will be assessed using indicators such as previous professional oral examination, utilization of appropriate oral cancer screening or early-detection services, willingness to undergo professional examination when recommended, prompt presentation for persistent oral lesions or symptoms, and compliance with follow-up recommendations where applicable. Descriptive statistics will be used to summarize participants' sociodemographic characteristics, oral cancer knowledge, exposure to awareness education, and screening practices. Inferential statistical techniques, including chi-square tests, paired-sample tests, independent-sample tests, and logistic or multiple regression analysis, will be used to determine the effect of oral cancer awareness on oral cancer screening practices. Appropriate diagnostic tests will also be conducted to assess the reliability of the research instrument, model assumptions, goodness of fit, and robustness of the findings. The study is expected to find that oral cancer awareness has a significant positive effect on oral cancer screening practices among adults in Nigeria. Adults exposed to structured oral cancer awareness education are expected to demonstrate improved knowledge of oral cancer risk factors, warning signs, prevention, and the importance of professional oral examination. Education may increase perceived susceptibility and severity, reduce misconceptions and fear, improve recognition of suspicious oral changes, and encourage timely utilization of appropriate oral healthcare services. However, awareness alone may not guarantee sustained screening practices because adults may continue to face barriers such as cost, limited availability of dental services, geographical distance, fear of diagnosis, lack of regular dental visits, and inadequate access to qualified oral healthcare professionals. Consequently, oral cancer awareness is expected to be most effective when supported by accessible and affordable dental and oral health services, professional counselling, effective referral systems, tobacco and alcohol control measures, and community-based oral cancer prevention programmes. The study is expected to contribute to the literature on oral cancer prevention, cancer awareness, oral health education, screening behaviour, dental health, non-communicable disease prevention, and public health in Nigeria by providing empirical evidence on the effect of oral cancer awareness on oral cancer screening practices among adults. The findings will provide useful information to the Federal Ministry of Health and Social Welfare, National Primary Health Care Development Agency (NPHCDA), state ministries of health, dental and oral health services, dental hospitals, healthcare providers, dentists, community health workers, public health practitioners, development partners, and policymakers regarding strategies for improving oral cancer prevention and early detection. The study will also provide evidence-based recommendations for strengthening community-based oral cancer awareness, improving access to professional oral examinations, increasing public knowledge of oral cancer warning signs and risk factors, strengthening referral systems, and promoting appropriate oral cancer screening and early-detection practices among adults across Nigeria.

Keywords: Oral cancer awareness, oral cancer screening practices, adults, oral cancer, oral health, cancer prevention, cancer screening, health education, early detection, dental health, non-communicable diseases, public health, Nigeria.