title: eCROPS-CA: a systematic approach toward effective and sustainable cancer prevention in rural China.
abstract: BACKGROUND
  Effective prevention against cancers depends heavily on sustained individual efforts practicing protective behaviors and avoiding risk factors in a complex sociocultural context, which requires continuous and personalized supports. Contemporary prevention relies primarily on strategies targeting general population with limited attention being paid to individualized approaches. This study tests a novel package called, in acronym of core intervention components, eCROPS-CA that leverages protective behaviors against over 80% leading cancers among high risk individuals via continuous and tailored counseling by village doctors.
  
  
  METHODS
  The study utilizes a quesi-RCT design involving 4320 high risk individuals selected, via rapid and detailed risk assessments, from about 72,000 farmers aged 35+ in 36 administrative villages randomized into equal intervention and delayed intervention arms. The intervention arm receives baseline and semiannual follow up evaluations plus eCROPS-CA for 5 years; while the control arm, only the baseline and follow-up evaluations for the first 5 years and eCROPS-CA starting from the 6(th) year if the intervention is proved effective. eCROPS-CA comprises electronic supports and supervision (e), counseling cancer prevention (C), recipe for objective behaviors (R), operational toolkit (O), performance-based incentives (P), and screening and assessment (S). Evaluation measures include: incidence and stage of the leading cancers, cancer-related knowledge, attitudes and practices; easy biophysical indicators (e.g., body mass index, blood pressure); intervention compliance, acceptance of the package.
  
  
  CONCLUSIONS
  The prevention package incorporates key success factors in a synergetic way toward cost-effectiveness and long-term sustainability. It targets a set rather than any single cancer; choses village doctors as key solution to the widespread lack of professional manpower in implementing personalized and thus relatively sophisticated prevention; adopts real-time monitoring in reaching continuous improvement; utilizes smart web aids to enable prioritizing complex determinants of objective behaviors, linking counseling sessions happened at different time points and hence delivering highly coordinated prevention; uses 2-stage risk assessment models in identifying high risk individuals so as to focus on the most needed; applies standardized operation procedures in simplifying and smoothing behavior intervention yet ensuring delivery of essential steps and key elements.
  
  
  BACKGROUND
  ISRCTN33269053.
authors.affiliation: School of Health Service Management, Anhui Medical University, Hefei, Anhui, China. jingchai82@sina.com.
authors.forename: Jing
authors.initials: J
authors.lastname: Chai
authors.affiliation: School of Health Service Management, Anhui Medical University, Hefei, Anhui, China. 1264854421@qq.com.
authors.forename: Xingrong
authors.initials: X
authors.lastname: Shen
authors.affiliation: Department of Literature Review and Analysis, Library of Anhui Medical University, Hefei, Anhui, China. 853571123@qq.com.
authors.forename: Rui
authors.initials: R
authors.lastname: Feng
authors.affiliation: School of Health Service Management, Anhui Medical University, Hefei, Anhui, China. jing_hp@sina.com.
authors.forename: Jing
authors.initials: J
authors.lastname: Cheng
authors.affiliation: Anhui Center for Disease Control and Prevention, Hefei, Anhui, China. ahahcyj@163.com.
authors.forename: Yeji
authors.initials: Y
authors.lastname: Chen
authors.affiliation: Anhui Center for Disease Control and Prevention, Hefei, Anhui, China. 1061390122@sina.com.
authors.forename: Zhengqiu
authors.initials: Z
authors.lastname: Zha
authors.affiliation: Anhui Center for Disease Control and Prevention, Hefei, Anhui, China. xiao816meng@sina.cn.
authors.forename: Shangchun
authors.initials: S
authors.lastname: Jia
authors.affiliation: School of Health Service Management, Anhui Medical University, Hefei, Anhui, China. 1010066583@qq.com.
authors.forename: Han
authors.initials: H
authors.lastname: Liang
authors.affiliation: School of Health Service Management, Anhui Medical University, Hefei, Anhui, China. 1252509750@qq.com.
authors.forename: Ting
authors.initials: T
authors.lastname: Zhao
authors.affiliation: School of Health Service Management, Anhui Medical University, Hefei, Anhui, China. 1214984721@qq.com.
authors.forename: Rui
authors.initials: R
authors.lastname: Sha
authors.affiliation: Luan Center for Disease Control and Prevention, Luan, Anhui, China. 295240260@qq.com.
authors.forename: Yong
authors.initials: Y
authors.lastname: Shi
authors.affiliation: Luan Center for Disease Control and Prevention, Luan, Anhui, China. 1350612172@163.com.
authors.forename: Kaichun
authors.initials: K
authors.lastname: Li
authors.affiliation: School of Health Service Management, Anhui Medical University, Hefei, Anhui, China. dbwang@vip.sina.com.|Collaboration Center for Cancer Control, First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China. dbwang@vip.sina.com.
authors.forename: Debin
authors.initials: D
authors.lastname: Wang
mesh_terms: D002681:China; D003362:Cost-Benefit Analysis; D005260:Female; D006801:Humans; D008297:Male; D009369:Neoplasms / Q000453:epidemiology* / Q000473:pathology / Q000517:prevention & control; D012307:Risk Factors; D012424:Rural Population