Comprehensive workplace intervention for cancer prevention in China

Globally, cancer is the second leading cause of death and approximately 70% of the cancer deaths occur in low- and middle-income countries (LMICs). The death numbers are continuing to increase, which puts a tremendous burden on individuals and the healthcare system in LMICs.

Workplace is an important channel for cancer prevention and control. Several high-income countries, such as the US and the UK, have established workplace health promotion programmes to address behaviour risk factors of cancer. These programmes have been successfully implemented, resulting in a significant improvement not only in behaviour changes of the employees, but also in the work-related outcomes, including economic returns of the employers.

Based on the international experience and local assessment, our research will adapt existing evidence-based strategies and establish a scalable model for cancer prevention that can be widely applied in Chinese workplaces. A comprehensive workplace intervention package, which will address major behaviour risks of cancer for the employees, such as tobacco and alcohol use, unhealthy diet, obesity and lack of physical activity, will be developed, implemented and evaluated through a series of multilevel involvement strategies covering individual programmes, organizational policies and supportive environment and with the support of a tailored smartphone application. In this research, we will test the adaptability of the intervention package across various workplaces in diverse regions with different diets and lifestyles. We will select 15 workplaces with approximately 1500 employees from three cities located in the northern, central and southern provinces of China respectively - mostly in the economically underdeveloped areas. By full engagement of employers and employees in a staggered design with the intervention duration lasting for 1 year, 1.5 years and 2 years respectively, the research aims to achieve the individual behaviour changes in modifiable risk factors of cancer. In the long term, the research outcome will also be demonstrated by the reduction of occurrence of cancer and other major non-communicable diseases, such as stroke and heart attacks of employees, the productivities of the employees and their work performance, as well as the economic benefits of the employers.

The comprehensive workplace intervention will bring enormous benefits to millions of Chinese workplace population and furthermore, will have a great potential to be adapted by many other LMICs with a similar situation of heavy cancer burden. The research will provide evidence and solutions to address the common challenges of these countries, particularly to overcome the barriers in intervention implementation. Ultimately, the research outcome will contribute to the attainment of the United Nations' Sustainable Development Goal 3.4 by reducing a great deal of premature mortality from cancers. The success of this research will lead to significant global health impact in a world with huge health and economic burden caused by cancer.

Workplace cancer prevention interventions have been widely conducted in some high-income countries. However, the effective implementation of these evidence-based strategies is lacking in low- and middle-income countries (LMICs). It is an urgent task for LMICs to overcome the implementation barriers to reduce the cancer burden.

This research aims to adapt existing strategies of workplace health promotion in the prevention and control of cancer and build a scalable model in China. The research is designed as a stepped wedge cluster randomised controlled trial. We will recruit 15 workplaces with approximately 1500 employees across three low and middle economic cities of China. All the workplaces will be staggered into intervention stage randomly for three steps and will receive a 12-months' intervention and then maintain to the end of the project. The duration of the project is 48 months. A comprehensive workplace intervention package addressing major behaviour risks of cancer for the employees, such as tobacco and alcohol use, unhealthy diet, obesity and lack of physical activity, will be developed and implemented through multilevel involvement strategies covering individual programmes, organizational policies and supportive environment with the support of a mobile application. The primary outcome is the change in modifiable behaviour risk factors of cancer after the intervention. The research will also assess the changes of attendance of employees, the healthcare costs of organizations and the occurrence of cancer of employees in the long term.

The comprehensive workplace intervention for cancer prevention in low- and middle-income regions of China, if proven to be effective and cost-effective, will not only provide evidence and recommendations to the national policies on cancer prevention in China, but also have a great potential to be adapted by other LMICs.