Development and Validation of a Core Knowledge Questionnaire for Primary Cancer Prevention: a Delphi and Web-based Respondent-driven Sampling Study

doi:10.12114/j.issn.1007-9572.2025.0448

Chinese General Practice ›› 2026, Vol. 29 ›› Issue (28): 4147-4156.DOI: 10.12114/j.issn.1007-9572.2025.0448

• Original Research • Previous Articles Next Articles

Development and Validation of a Core Knowledge Questionnaire for Primary Cancer Prevention: a Delphi and Web-based Respondent-driven Sampling Study

1. Department of Epidemiology and Health Statistics, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu 610041, China
2. Department of Cancer Prevention and Control, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China

Received:2025-09-15 Revised:2026-01-22 Published:2026-10-05 Online:2026-09-02
Contact: ZHU Cairong, ZHANG Yawei

癌症一级预防核心知识知晓问卷的开发与验证：一项Delphi与网络应答驱动抽样研究

1．610041　四川省成都市，四川大学华西公共卫生学院（华西第四医院）流行病学与卫生统计学系
2．100021　北京市，国家癌症中心　国家肿瘤临床医学研究中心　中国医学科学院北京协和医学院肿瘤医院

通讯作者: 朱彩蓉, 张亚玮
作者简介:
作者贡献：
东勇飞负责撰写论文；东勇飞、陈昭燕、刘真岑负责数据整理、统计分析、论文审阅；孙培元、胡卓伦、黄璜、朱彩蓉、张亚玮负责项目管理、论文审阅；朱彩蓉、张亚玮负责研究的构思与设计、研究指导；张亚玮负责经费支持；东勇飞、陈昭燕、孙培元、陈海畅、李学朝、田韫菏、李紫君、刘雅丹、雷馨逸、张维、严天明、周聪俊、吴凤仪、李里诗洛、张冠群、闫琪、吴梦瑶、付瑞瑛、林宇冰、马修齐负责数据收集。
基金资助:
中国医学科学院中央级公益性科研院所基本科研业务费专项资金(2021-RC310-009); 首都卫生发展科研专项(2022-1G-4023)

Abstract

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, Standardized 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。有必要据此制订循证建议，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月采用两轮专家咨询（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协调（Kendall's W）系数评估。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

两轮专家咨询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系数分别为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系数为0.874，McDonald's ω系数为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知晓问卷。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

CLC Number:

R 739.9

DONG Yongfei,CHEN Zhaoyan,SUN Peiyuan, et al. Development and Validation of a Core Knowledge Questionnaire for Primary Cancer Prevention: a Delphi and Web-based Respondent-driven Sampling Study[J]. Chinese General Practice, 2026, 29(28): 4147-4156. DOI: 10.12114/j.issn.1007-9572.2025.0448.
东勇飞,陈昭燕,孙培元等. 癌症一级预防核心知识知晓问卷的开发与验证：一项Delphi与网络应答驱动抽样研究[J]. 中国全科医学, 2026, 29(28): 4147-4156. DOI: 10.12114/j.issn.1007-9572.2025.0448.

Figures/Tables 8

References 37

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特征	第一轮（n=23）		第二轮（n=31）
特征	人数	百分比(%)	人数	百分比(%)
工作机构性质
学术研究机构	15	65.2	19	61.3
疾病预防控制中心	3	13.0	3	9.7
其他医疗机构	5	21.7	9	29.0
职称
高级	14	60.9	19	61.3
副高级	5	21.7	8	25.8
中级	3	13.0	3	9.7
学历
博士研究生	15	65.2	20	64.5
硕士研究生	6	26.1	9	29.0
本科	2	8.7	2	6.5
专业领域
公共卫生与预防医学	16	69.6	25	80.6
计算机应用科学	2	8.7	2	6.5
循证医学	2	8.7	2	6.5
行为与社会科学	1	4.3	0	0.0
护理学	1	4.3	1	3.2
卫生政策	1	4.3	1	3.2
工作年限
< 10年	5	21.7	6	19.4
10~19年	6	26.1	11	35.5
20~29年	4	17.4	5	16.1
≥30年	8	34.8	9	29.0

特征	第一轮（n=23）		第二轮（n=31）
特征	人数	百分比(%)	人数	百分比(%)
工作机构性质
学术研究机构	15	65.2	19	61.3
疾病预防控制中心	3	13.0	3	9.7
其他医疗机构	5	21.7	9	29.0
职称
高级	14	60.9	19	61.3
副高级	5	21.7	8	25.8
中级	3	13.0	3	9.7
学历
博士研究生	15	65.2	20	64.5
硕士研究生	6	26.1	9	29.0
本科	2	8.7	2	6.5
专业领域
公共卫生与预防医学	16	69.6	25	80.6
计算机应用科学	2	8.7	2	6.5
循证医学	2	8.7	2	6.5
行为与社会科学	1	4.3	0	0.0
护理学	1	4.3	1	3.2
卫生政策	1	4.3	1	3.2
工作年限
< 10年	5	21.7	6	19.4
10~19年	6	26.1	11	35.5
20~29年	4	17.4	5	16.1
≥30年	8	34.8	9	29.0

特征	人数	百分比(%)
性别
男	333	58.32
女	238	41.68
年龄
<25岁	346	60.60
25~<35岁	101	17.69
35~<45岁	34	5.95
45~<55岁	70	12.26
≥55岁	20	3.50
居住地
城市	328	57.44
乡村	243	42.56
受教育程度
中学及以下	55	9.63
高中	39	6.83
本科、大专	356	62.35
研究生	121	21.19
职业
医疗机构工作人员	50	8.76
公务员	9	1.58
社会团体从业人员	63	11.03
企业员工	86	15.06
自由职业者	32	5.60
农民工	14	2.45
学生	281	49.00
其他	36	6.30
家庭年收入
<1万元	77	13.49
>1万~5万元	196	34.33
>5万~10万元	153	26.80
>10万元	145	25.39
医保类型
城镇居民医疗保险	318	55.69
城镇职工医疗保险	186	32.57
新型合作医疗保险	33	5.78
私人医疗保险	16	2.80
其他	18	3.15

特征	人数	百分比(%)
性别
男	333	58.32
女	238	41.68
年龄
<25岁	346	60.60
25~<35岁	101	17.69
35~<45岁	34	5.95
45~<55岁	70	12.26
≥55岁	20	3.50
居住地
城市	328	57.44
乡村	243	42.56
受教育程度
中学及以下	55	9.63
高中	39	6.83
本科、大专	356	62.35
研究生	121	21.19
职业
医疗机构工作人员	50	8.76
公务员	9	1.58
社会团体从业人员	63	11.03
企业员工	86	15.06
自由职业者	32	5.60
农民工	14	2.45
学生	281	49.00
其他	36	6.30
家庭年收入
<1万元	77	13.49
>1万~5万元	196	34.33
>5万~10万元	153	26.80
>10万元	145	25.39
医保类型
城镇居民医疗保险	318	55.69
城镇职工医疗保险	186	32.57
新型合作医疗保险	33	5.78
私人医疗保险	16	2.80
其他	18	3.15

维度	问题条目	系数	标准误	Z值	P值	因子载荷
知识	q1	0.114	0.017	6.57	<0.001	0.282
	q3	0.123	0.012	10.28	<0.001	0.429
	q6	0.073	0.018	4.16	<0.001	0.181
	q7	0.054	0.019	2.79	0.005	0.122
	q8	0.182	0.015	12.24	<0.001	0.500
	q10	0.157	0.011	14.82	<0.001	0.588
	q11	0.167	0.013	12.74	<0.001	0.518
	q12	0.126	0.016	7.91	<0.001	0.336
	q13	0.094	0.009	10.01	<0.001	0.419
	q15	0.158	0.012	12.99	<0.001	0.526
	q19	0.294	0.024	12.43	<0.001	0.507
	q20	0.210	0.027	7.73	<0.001	0.329
	q22	0.208	0.041	5.07	<0.001	0.220
	q23	0.362	0.026	14.16	<0.001	0.566
	q24	0.312	0.031	10.13	<0.001	0.423
	q25	0.262	0.017	15.41	<0.001	0.607
	q26	0.259	0.016	15.90	<0.001	0.622
	q27	0.403	0.029	13.85	<0.001	0.555
	q28	0.394	0.025	15.83	<0.001	0.619
	q29	0.075	0.028	2.65	0.008	0.116
	q30	0.053	0.025	2.13	0.033	0.093
	q32	0.698	0.039	17.99	<0.001	0.685
	q33	0.579	0.043	13.32	<0.001	0.538
	q34	0.255	0.030	8.49	<0.001	0.359
	q35	0.622	0.035	17.96	<0.001	0.683
	q37	0.233	0.029	8.00	<0.001	0.340
	q38	0.160	0.039	4.11	<0.001	0.179
	q39	0.431	0.058	7.45	<0.001	0.318
信念	q2	0.058	0.008	7.09	<0.001	0.316
	q4	0.156	0.016	10.04	<0.001	0.429
	q5	0.065	0.007	8.70	<0.001	0.380
	q9	0.167	0.010	17.10	<0.001	0.672
	q14	0.098	0.008	12.98	<0.001	0.547
	q16	0.104	0.008	12.65	<0.001	0.538
	q17	0.106	0.008	12.75	<0.001	0.540
	q18	0.052	0.020	2.56	0.011	0.114
	q21	0.261	0.021	12.44	<0.001	0.518
	q31	0.561	0.042	13.43	<0.001	0.553
	q36	0.280	0.028	9.94	<0.001	0.424

Development and Validation of a Core Knowledge Questionnaire for Primary Cancer Prevention: a Delphi and Web-based Respondent-driven Sampling Study

癌症一级预防核心知识知晓问卷的开发与验证：一项Delphi与网络应答驱动抽样研究

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题号	维度	问题	正确答案
是非题
q1	知识	暴露于二手烟不会显著增加患肺癌的风险 □正确　□错误　□不知道	错误
q2	信念	戒烟可以降低患癌的风险 □正确　□错误　□不知道	正确
q3	知识	超重或肥胖不会增加癌症的发病风险 □正确　□错误　□不知道	错误
q4	知识	坚持合理运动，减少久坐时间，不能降低癌症发病风险 □正确　□错误　□不知道	错误
q5	信念	老年人或有基础疾病的特殊人群应在自身能力允许范围内坚持多运动，有助于预防癌症 □正确　□错误　□不知道	正确
q6	信念	不管是喝红酒、白酒还是啤酒，都会增加患癌的风险 □正确　□错误　□不知道	正确
q7	信念	喝酒脸红的人群，饮酒致癌的风险可能更大 □正确　□错误　□不知道	正确
q8	知识	霉变食物中的黄曲霉素不是人类明确的致癌物 □正确　□错误　□不知道	错误
q9	知识	食用霉变食物后，只要不出现症状，就不会对人体健康造成影响 □正确　□错误　□不知道	错误
q10	知识	长期食用过烫食物和饮品（温度超过65 ℃），不会增加患食道癌的风险 □正确　□错误　□不知道	错误
q11	知识	经常过量摄入甜食或含糖饮品不会增加患癌风险 □正确　□错误　□不知道	错误
q12	信念	经常摄入全谷物可以降低肠道相关癌症的发病风险 □正确　□错误　□不知道	正确
q13	信念	使用清洁的餐具和公筷公勺可有效预防幽门螺杆菌（HP）感染 □正确　□错误　□不知道	正确
q14	信念	工厂中经常接触致癌化学物质的工人，更应该遵守职业防护规定，做好防护措施 □正确　□错误　□不知道	正确
q15	知识	长期暴露在烈日下不会增加患皮肤癌的风险 □正确　□错误　□不知道	错误
q16	信念	高温油炸过程可能释放致癌物，所以要尽量控制油温和油炸时间，并开启抽油烟机或排风扇 □正确　□错误　□不知道	正确
q17	信念	按时完成HPV疫苗接种方案可以降低女性患上宫颈癌的风险 □正确　□错误　□不知道	正确
单选题
q18	知识	肺癌的主要危险因素是： □a.肥胖　□b.霉变食物　□c.吸烟　□d.不知道	c
q19	知识	对于20岁及以上成年人，正常的BMI范围是？[BMI=体质量（kg）/身高（m）²] □a.<18.5　□b.18.5~<24.0　□c.24.0~<28.0　□d.不知道	b
q20	知识	如何通过保持健康体重降低癌症发病风险？ □a.让体重短时间内达到正常范围　□b.科学的运动和饮食□c.进食后立即剧烈运动促进食物消化　□d.不知道	b
q21	知识	以下哪种说法是正确的？ □a.多吃西蓝花等十字花科蔬菜会增高患癌风险　□b.全谷物营养价值不高，可以不吃□c.增加膳食纤维的摄入可以降低患结直肠癌风险　□d.不知道	c
q22	知识	下面哪种癌症与幽门螺杆菌（HP）有关： □a.肺癌　□b.胃癌　□c.淋巴瘤　□d.不知道	b
q23	知识	对于经常接触致癌化学物质的人，为避免将致癌物带回家或者其他公共场所，应采取哪些措施： □a.下班后直接离开工作场所　□b.离开工作区及时更换工作服和其他易受污染的个人物品□c.把工作服带回家清洗　□d.不知道	b
q24	知识	长期接触粉尘工作的劳动者最有可能患下列哪种疾病？ □a.心脏病　□b.糖尿病　□c.肺部疾病，包括矽肺、石棉肺、肺癌、胸膜间皮瘤等　□d.不知道	c
q25	知识	下面哪项措施不能降低皮肤癌发生风险？ □a.合理涂抹防晒霜　□b.定期进行皮肤自我检查　□c.长时间暴露在阳光下　□d.不知道	c
q26	知识	以下关于乙肝疫苗接种的说法，正确的是： □a.接种乙肝疫苗可以降低患上肝癌的风险　□b.只有在感染了乙肝病毒之后才需要接种乙肝疫苗□c.接种乙肝疫苗后就不会得肝癌　□d.不知道	a
多选题
q27	知识	关于霉变食物和槟榔及其制品的危害，以下哪些说法是正确的？ □a.槟榔制品为一类致癌物，应减少食用　□b.长期食用槟榔会增加患口腔癌的风险□c.只有食用大量霉变食物才会导致健康问题　□d.槟榔中的某些成分具有成瘾性　□e.不知道	a, b, d
q28	知识	以下哪些关于过烫食物和饮品（温度超过65 ℃）的健康风险的描述是正确的？ □a.长期食用过烫食物，可能会导致食道损伤□b.饮品只要不是烫到无法入口，就不会对人体造成伤害□c.食管癌与食用过烫食物和饮品有关联□d.过烫食物和饮品既会引起即时的不适也会导致长期健康问题□e.不知道	a, c, d
q29	知识	关于腌制、熏烤类和高温油炸食物，以下哪些说法是正确的？ □a.腌制食品中高盐分和N-亚硝基化合物会促使胃癌的发生□b.熏烤类食物含有致癌物质□c.高温油炸食物口感好，但是高温油炸会产生苯并芘致癌物□d.加工肉制品可以作为日常饮食的主要来源□e.不知道	a, b, c
q30	知识	下面哪些行为有助于预防幽门螺杆菌（HP）的感染: □a.饭前便后勤洗手　□b.接种疫苗　□c.使用公勺公筷□d.不用共用牙具，定期更换牙刷　□e.不知道	a, c, d
q31	知识	以下哪些行为可能会增加患皮肤癌的风险 □a.长时间暴晒　□b.频繁进行美黑（室内日光浴）　□c.使用遮阳伞或遮阳帽□d.长期被紫外线灯照射　□e.不知道	a, b, d
q32	知识	关于减少室内空气污染的有效方式，下列哪些是正确的？ □a.不在室内吸烟　□b.使用空气清新剂　□c.经常开窗通风□d.尽量使用清洁能源（如天然气或电）做饭和供暖　□e.不知道	a,c,d
q33	知识	下列哪些是室内空气污染的致癌物？ □a.甲醛（新刷的油漆、新家具等） □b.煤气、煤炉、火炉等燃煤设施的排放物□c.燃气炉、燃气烤箱和其他天然气设备产生氮氧化物排放物□d.二手烟□e.不知道	a, b, c, d
q34	知识	以下关于母乳喂养的好处，正确的有 □a.促进产后恢复　□b.预防母亲心血管疾病　□c.降低卵巢癌、子宫癌等风险□d.减少母婴之间传染病的传播　□e.不知道	a, b, c

拟合优度指标	χ²/df	CFI	SRMR	RMSEA	TLI
理想值	<3.00	>0.95	<0.05	<0.06	>0.95
可接受值	<5.00	>0.90	<0.08	<0.08	>0.90
结果	2.87	0.81	0.05	0.05	0.80

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