{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,30]],"date-time":"2026-07-30T16:00:15Z","timestamp":1785427215866,"version":"3.56.0"},"reference-count":48,"publisher":"AOSIS","issue":"1","license":[{"start":{"date-parts":[[2026,7,21]],"date-time":"2026-07-21T00:00:00Z","timestamp":1784592000000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"abstract":"<jats:p>Background:\u00a0South Africa faces a growing cancer burden characterised by late-stage presentation, limited screening uptake and disparities in access to cancer education. While evidence-based cancer education programmes developed in high-income countries demonstrate effectiveness, direct transfer without contextual modification may compromise relevance and acceptability within resource-constrained health settings.\nAim:\u00a0To systematically adapt the United States (US)-based Cancer\u2013Community Awareness Access Research &amp; Education (c-CARE) programme as a multi-cancer education intervention for implementation within the South African primary health care (PHC) context using Card et al.\u2019s seven-step adaptation framework.\nSetting:\u00a0The adaptation was conducted in KwaZulu-Natal (iLembe District) and Gauteng (Johannesburg), South Africa, in collaboration with provincial Departments of Health, community health workers, traditional health practitioners and faith-based leaders.\nMethods:\u00a0This implementation science study employed Participatory Action Research integrated with Card\u2019s framework to guide a structured adaptation process (January 2023 \u2013 January 2024). Thirty-eight consultative meetings were conducted to review programme materials, identify linguistic, cultural and structural mismatches and implement iterative revisions while preserving core intervention components.\nResults:\u00a0Key adaptations included the addition of cervical cancer as a priority module; incorporation of South African epidemiological data and referral pathways; translation into isiZulu and Sesotho; integration of mental health, spirituality and palliative care content; and restructuring of delivery to align with the South African Health System. Core evidence-based content, modular design and interactive pedagogical strategies were retained.\nConclusion:\u00a0Framework-guided adaptation enabled contextual recalibration of c-CARE while maintaining fidelity to core components.\nContribution:\u00a0This study provides a transparent model for adapting evidence-based cancer education interventions for culturally diverse, resource-constrained PHC systems.<\/jats:p>","DOI":"10.4102\/phcfm.v18i1.5442","type":"journal-article","created":{"date-parts":[[2026,7,20]],"date-time":"2026-07-20T13:42:48Z","timestamp":1784554968000},"update-policy":"https:\/\/doi.org\/10.4102\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Adapting a United States cancer education programme for South Africa: A participatory, culturally tailored approach using Card\u2019s Seven-Step adaptation framework"],"prefix":"10.4102","volume":"18","author":[{"ORCID":"https:\/\/orcid.org\/0009-0005-2131-3561","authenticated-orcid":false,"given":"Usangiphile","family":"Buthelezi","sequence":"first","affiliation":[{"id":[{"id":"https:\/\/ror.org\/04qzfn040","id-type":"ROR","asserted-by":"publisher"}],"name":"University of KwaZulu-Natal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0110-0938","authenticated-orcid":false,"given":"Buhle","family":"Lubuzo","sequence":"additional","affiliation":[{"id":[{"id":"https:\/\/ror.org\/04qzfn040","id-type":"ROR","asserted-by":"publisher"}],"name":"University of KwaZulu-Natal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3590-4942","authenticated-orcid":false,"given":"Martha","family":"Tingen","sequence":"additional","affiliation":[{"id":[{"id":"https:\/\/ror.org\/007rawr89","id-type":"ROR","asserted-by":"publisher"}],"name":"Augusta University Health"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3588-1755","authenticated-orcid":false,"given":"Hlolisile","family":"Chiya","sequence":"additional","affiliation":[{"id":[{"id":"https:\/\/ror.org\/04qzfn040","id-type":"ROR","asserted-by":"publisher"}],"name":"University of KwaZulu-Natal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1919-1241","authenticated-orcid":false,"given":"Sithabisile G.","family":"Gigaba","sequence":"additional","affiliation":[{"id":[{"id":"https:\/\/ror.org\/04qzfn040","id-type":"ROR","asserted-by":"publisher"}],"name":"University of KwaZulu-Natal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0006-2982-1015","authenticated-orcid":false,"given":"Bridgette","family":"Goeieman","sequence":"additional","affiliation":[{"name":"Afia Tai, Johannesburg, South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0007-1932-8304","authenticated-orcid":false,"given":"Sibongile","family":"Ramotsela","sequence":"additional","affiliation":[{"name":"Afia Tai, Johannesburg, South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1188-6949","authenticated-orcid":false,"given":"Zamasomi","family":"Luvuno","sequence":"additional","affiliation":[{"id":[{"id":"https:\/\/ror.org\/04qzfn040","id-type":"ROR","asserted-by":"publisher"}],"name":"University of KwaZulu-Natal"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"2580","published-online":{"date-parts":[[2026,7,21]]},"reference":[{"key":"ref0","doi-asserted-by":"crossref","unstructured":"Bray F, Laversanne M, Sung H, et al. 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