Adapting a United States cancer education programme for South Africa: A participatory, culturally tailored approach using Card’s Seven-Step adaptation framework

Abstract

Background: South 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.
Aim: To systematically adapt the United States (US)-based Cancer–Community Awareness Access Research & 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.’s seven-step adaptation framework.
Setting: The 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.
Methods: This implementation science study employed Participatory Action Research integrated with Card’s framework to guide a structured adaptation process (January 2023 – 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.
Results: Key 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.
Conclusion: Framework-guided adaptation enabled contextual recalibration of c-CARE while maintaining fidelity to core components.
Contribution: This study provides a transparent model for adapting evidence-based cancer education interventions for culturally diverse, resource-constrained PHC systems.