# Increased Knowledge Mediates the Effect of Game Changers for Cervical Cancer Prevention on Diffusion of Cervical Cancer Screening Advocacy Among Social Network Members in a Pilot Trial

## TL;DR

A peer-led training program increased cervical cancer prevention advocacy among participants and their social network members, with increased knowledge playing a key role in spreading the advocacy.

## Contribution

This study identifies increased knowledge as a mediator of advocacy diffusion in a social network context for cervical cancer prevention.

## Key findings

- Increased cervical cancer knowledge partially mediated the intervention's effect on advocacy engagement among social network members.
- The intervention's effect on advocacy was not moderated by alter characteristics.
- Knowledge gains were linked to greater engagement in cervical cancer prevention advocacy.

## Abstract

Game Changers for Cervical Cancer Prevention (GC-CCP), a peer-led, group advocacy training intervention, increased cervical cancer (CC) prevention advocacy not only among intervention recipients, but also their social network members (referred to as “alters”) who were targeted with advocacy in a pilot randomized controlled trial. We examined mediators and moderators of this effect on alter advocacy, to understand how and for whom the intervention had such an effect.

Forty women (index participants) who had recently screened for CC enrolled and were randomly assigned to receive the GC-CCP intervention (n = 20) or the wait-list control (n = 20). Up to three alters from each participant (n = 103) were surveyed at baseline and month 6. Measures of CC-related cognitive constructs (knowledge, enacted stigma, and risk management self-efficacy), as well as extent of advocacy received from index participants, were assessed as mediators of the intervention effect on alter advocacy using multivariate regression analyses. Alter characteristics were examined as moderators.

Increased CC-related knowledge partially mediated the intervention effect on increased alter engagement in CC prevention advocacy; those with greater gains in knowledge reported greater engagement in advocacy. No moderators of the intervention effect were identified.

The effect of GC-CCP on alter CC prevention advocacy is enhanced by increased alter knowledge pertaining to CC prevention, causes, and treatment and suggests this may be key for diffusion of intervention effects on increased CC prevention advocacy throughout a social network.

NCT04960748 (registered on clinicaltrials.gov, 7/14/2021).

The online version contains supplementary material available at 10.1007/s12529-023-10217-7.