# From knowledge to action: strengthening cancer prevention knowledge in schools among adolescents in Germany

## TL;DR

A school-based multimedia program in Germany improved adolescents' knowledge of cancer prevention and retained some of that knowledge three months later.

## Contribution

A multimedia-enhanced school intervention significantly improved and retained cancer prevention knowledge among German adolescents.

## Key findings

- Baseline knowledge of cancer prevention was low among German adolescents.
- Knowledge scores increased significantly after the multimedia intervention and remained elevated for three months.
- Alcohol abstinence, healthy diet, and physical activity showed the most sustained knowledge retention.

## Abstract

This prospective interventional study assessed adolescents’ baseline knowledge of the 12 European Code Against Cancer (ECAC) recommendations and evaluated the impact of a school-based multimedia enhanced intervention on knowledge improvement and retention.

The intervention comprised six 45-min multimedia lessons promoting knowledge of all 12 ECAC recommendations in German secondary schools. Materials were developed and refined by an interdisciplinary expert panel and underwent pilot testing before implementation. An anonymous single-recall-based, open-ended questionnaire assessed baseline knowledge (t0) and mean knowledge gains immediately post-intervention (t1) and at three months follow-up (t2). Descriptive statistics were computed, with quantitative variables summarized by mean and standard deviation, and qualitative variables by absolute and relative frequencies.

A total of 923 pupils participated (51.8% female; 39.0% male; 9.2% diverse/undeclared), with 923 completing baseline (t0), 873 post-intervention (t1), and 779 the follow-up assessments (t2). Notable knowledge gaps regarding the ECAC were present at baseline. Mean (M) knowledge scores increased significantly across all three assessment time points with post-intervention scores (t1, M = 7.63 (Standard deviation (SD) = 2.67); p < 0.0001) significantly higher than at baseline (t0, M = 4.11 (SD = 1.84)). Largest average improvements post intervention (t0-t1) were observed for breastfeeding importance (+ 50%; 1.20% (t0), 51.2% (t1), p < 0.001), vaccination participation (+ 49.6%; 13.9% (t0), 63.5%(t1), p < 0.001) and regular physical activity (+ 39.4%, p < 0.001).The most sustainable recommendation improvements [calculated by (t2-t0)/(t1-t0)] were observed for alcohol abstinence (0.76); healthy dietary pattern (0.72), and physical activity (0.69) respectively. Conclusions: Multimedia enhanced school-based interventions incorporating the ECAC recommendations effectively increase cancer prevention knowledge among adolescents and knowledge retention after three months. While knowledge retention trends indicated a need for reinforcement, our results demonstrate the effectiveness of early, targeted interventions to address baseline knowledge gaps and provide insights that could potentially shape future interventions.

Multimedia enhanced school-based interventions incorporating the ECAC recommendations effectively increase cancer prevention knowledge among adolescents and knowledge retention after three months. While knowledge retention trends indicated a need for reinforcement, our results demonstrate the effectiveness of early, targeted interventions to address baseline knowledge gaps and provide insights that could potentially shape future interventions.

The online version contains supplementary material available at 10.1186/s12889-026-26442-0.

• Knowledge gaps exist among German adolescents about cancer prevention risk reduction.

• School-based digital interventions significantly reduce knowledge gaps.

• Greatest knowledge retention after 3 months was for alcohol abstinence, having a healthy diet and increasing physical activity.

• Knowledge retention trend shows a need for reinforcement to obtain sustained results

The online version contains supplementary material available at 10.1186/s12889-026-26442-0.