Abstract: Background Nearly half of all cancers can be prevented through primary prevention methods, and standardized questionnaires to assess knowledge and awareness of primary cancer prevention are essential for evaluating the effectiveness of prevention implementation. There is therefore a need to develop evidence-based recommendations to guide people in reducing their exposure to cancer risk factors. Objective This study aimed to develop and validate a standardized questionnaire to assess knowledge and awareness of primary cancer prevention, based on the China Code Against Cancer (CCAC). Methods Two cross-sectional surveys were conducted from May to October 2024. The questionnaire was developed and refined through a two-round Delphi process (n=34), followed by a pilot study using convenience sampling (n=344), and a web-based respondent-driven sampling (RDS) survey (n=571). The reliability of the Delphi consensus was evaluated using response rates, credibility coefficients, and Kendall's coefficient of concordance (Kendall's W). The final questionnaire's reliability and structural validity were assessed using Cronbach's α, McDonald's ω, and confirmatory factor analysis. Results The expert response rates in the two Delphi rounds were 95.83% and 100.00%, with credibility coefficients of 0.894 and 0.912, and Kendall's W values of 0.148 and 0.097, respectively (both P<0.001), indicating strong expert consensus. Based on expert feedback and empirical analysis, a final questionnaire comprising 34 items across two dimensions (knowledge and belief) was developed. The internal consistency was high, with Cronbach's α = 0.874 and McDonald's ω = 0.905. Confirmatory factor analysis indicated good model fit. Conclusion We successfully developed and validated a standardized questionnaire for assessing knowledge and awareness of primary cancer prevention based on CCAC. This tool provides a scientific basis for evaluating cancer prevention education efforts and promoting evidence-based health communication strategies.

Key words: Neoplasms, Cancer, Primary prevention, Delphi method, Respondent-driven sampling, Questionnaire

摘要： 背景 近半数癌症可通过一级预防避免，因此癌症一级预防知识与意识的标准化评估工具对评估预防措施效力至关重要。有必要据此制定循证建议，指导公众减少致癌因素暴露。目的 本研究旨在依据《抗癌守则（2025年版）》开发并验证一份标准化问卷，用于评估居民对癌症一级预防知识的知晓情况。方法 研究于2024年5—10采用两轮Delphi专家咨询（n=34）、便利抽样试点调查（n=344）以及网络应答驱动抽样问卷调查（n=571）共同完成问卷的开发与验证。Delphi 共识的可靠性通过专家响应率、可信度系数和 Kendall 一致性系数（Kendall's W）评估。最终问卷的信度与结构效度则分别通过Cronbach's α系数、McDonald's ω 系数及验证性因子分析进行检验。结果 两轮Delphi 法中专家响应率分别为95.83%和100.00%，可信度系数为0.894和0.912，Kendall's W 分别为0.148和0.097（P值均<0.001)，显示专家意见高度一致。结合专家建议与调查数据，最终问卷确定为包含“知识”和“信念”两个维度、共 34 项条目的结构。该问卷的 Cronbach's α 为 0.874，McDonald's ω 为 0.905，验证性因子分析结果显示模型拟合良好。结论 本研究基于《抗癌守则（2025 年版）》开发并验证了一份具有良好信效度的癌症一级预防核心知识问卷。该工具可用于评估公众知晓水平，并为癌症预防知识的科普推广和健康教育效果评估提供科学依据。

关键词: 肿瘤, 癌症, 一级预防, 德尔菲法, 应答驱动抽样, 标准化问卷