Assessing the Effectiveness of a School Educational Video on Cancer and Radiotherapy

概要

Assessing the Effectiveness of a School Educational Video on Cancer and Radiotherapy
Masanari Minamitania, Atsuto Katanob and Keiichi Nakagawaa
aDepartment

of Comprehensive Radiation Oncology, The University of Tokyo, Hongo Bunkyoku, Tokyo, Japan
bDepartment of Radiology, The University of Tokyo Hospital, Hongo, Bunkyo-ku, Tokyo, Japan
Abstract
Background: Japan has recently begun introducing educational programmes on cancer as
part of Health and Physical Education (HPE) classes in schools. In support of this work, the
Japanese Society for Radiation Oncology has developed an educational video to enhance
children’s understanding of cancer and radiotherapy.
Objectives: This study examined the perceived effectiveness of this video among teachers
and clarified whether their specialisation played a role in their responses.
Methods: An online survey was administered to junior and senior high school teachers
without a history of cancer. Respondents’ demographic characteristics, healthy lifestyle
habits, anxiety about cancer treatment, and knowledge about cancer and radiotherapy were
surveyed pre- and post-video. We compared the data from science teachers, HPE teachers,
and teachers of other specialties. Subsequently, we performed a multiple logistic regression
analysis to estimate significant factors that predicted post-watch correct-answer rates.
Results: Science teachers were less anxious about radiotherapy and surgery than the otherspecialty teachers. They were also the most knowledgeable about cancer and radiotherapy.
Post-viewing correct-answer rates improved, except for questions about medical physics and
damage to normal cells. The multiple regression analysis identified age (β = 0.07), sex (β =
0.08), anxiety about radiotherapy (β = -0.09), and pre-video correct-answer rates (β = 0.46)
as significant factors predicting post-watch correct-answer rates.
Conclusion: The video was beneficial in enhancing teachers’ understanding of cancer and
radiotherapy. Compared to HPE and other-specialty teachers, science teachers were superior
in terms of cancer and radiotherapy comprehension. There may be value in exploring
possibilities for cross-disciplinary instruction involving not only HPE, but also science
teachers in cancer education, especially radiotherapy education.
Corresponding Author:
Masanari Minamitani, Department of Comprehensive radiation oncology, The University of
Tokyo, 7-3-1 Hongo Bunkyo-ku, Tokyo 113-0033, Japan
Email: minamitani-tky@umin.ac.jp

Introduction
Cancer is a major cause of death worldwide (Sung et al., 2021). In Japan, it has been the
leading cause of death since 1981, and more than half the Japanese population is likely to be
diagnosed with cancer at least once in their lifetime (National Cancer Center, Japan. n.d.). The
Cancer Control Act was enacted in 2006 and revised in 2016, and a Basic Plan to Promote
Cancer Control Programmes was formulated in 2007 (Ministry of Health, Labour and Welfare
2018a; Monden, 2013). A new statement regarding school cancer education was incorporated
into the Third Basic Plan to Promote Cancer Control Programmes. It reads as follows: “The
national government shall strive to enhance cancer education by developing a system to
utilise cancer specialists (visiting lecturers) according to local circumstances, based on the
nationwide implementation status of cancer education” (Ministry of Health, Labour and
Welfare 2018a; Monden, 2013). Recent reports in Japan show that cancer education
programmes have led to short-term improvements in understanding cancer (Yako-Suketomo
et al., 2018; Nagaoka et al., 2022). However, Japanese children possess only a limited
comprehension of cancer, making the development of cancer education modules a crucial
undertaking (Ueda et al., 2014; Sugisaki et al., 2014).
Cancer education programmes are already being provided in elementary, junior high,
and high schools throughout Japan. Japan’s school curriculum incorporates instruction on
cancer education in Health and Physical Education (HPE) classes and aims to help children (1)
to properly understand cancer and (2) subjectively consider the importance of life and health
(Ministry of Education, Culture, Sports, Science and Technology, 2016a). The Ministry of
Education, Culture, Sports, Science, and Technology (MEXT) published guidelines for cancer
education in 2016, which detail the programme contents and the effective use of visiting
lecturers (Ministry of Education, Culture, Sports, Science and Technology, 2016a). A variety of
teaching materials are freely available (Ministry of Education, Culture, Sports, Science and
Technology, 2016b, n.d.). Japanese cancer education covers not only prevention, but a wide
range of topics including screening, treatment, palliative care, and patient understanding
(Ministry of Education, Culture, Sports, Science and Technology, 2016a, Yako-Suketomo et al.,
2018; Kye et al., 2019). The educational contents of cancer education in Japan varies according
to grade level, with senior high school education focusing on cancer treatment (Ministry of
Education, Culture, Sports, Science and Technology, 2018).
Radiotherapy is a primary modality of cancer treatment. Although it is relevant to up
to 50% of cancer patients, its implementation rate is low in Japan (Delaney and Barton, 2015;
Numasaki et al., 2022). Many cancer patients express anxiety about radiotherapy (Shimotsu
et al., 2010), and among the general population between30% to 40% of people feel negatively
about radiotherapy (Watts, 2011). These impressions may be a result of the atomic bomb
incident in Hiroshima during World War II, the 2011 nuclear accident in Fukushima, and the

subsequent media coverage thereof (Gillan et al., 2014, Hasegawa et al., 2020). Additionally,
Japan exempted radiation education from the school curriculum between 1977 and 2011, and
teachers have expressed concern about instruction on radiation due to their lack of
understanding and experience (Hori et al., 2019).
Recently, there has been renewed interest in the use of visual instructional tools in
higher education (Kay, 2012). Several studies have shown that educational videos about
radiotherapy can enhance cancer patients’ understanding of, and reduce their anxiety about,
radiotherapy (Jimenez et al., 2018; Matsuyama et al., 2013). However, as late as 2021,
classroom education material on radiotherapy was still lacking in Japan, prompting the
Japanese Society for Radiation Oncology (JASTRO) to develop an educational video with a
focus on cancer and radiotherapy. Although JASTRO did not clearly define the video’s target
audience, the video may be suitable for use with senior high school students, given that cancer
treatment is primarily discussed in senior high schools (Ministry of Education, Culture, Sports,
Science and Technology, 2018). That said, the video’s content may also be understandable and
of relevance to junior high school students.
Digital educational materials, including videos, can be effective as part of cancer
education, but their use remains limited. (Sugisaki et al., 2014, 2019). Therefore, focusing on
the future development of such materials is crucial. The video developed by JASTRO has
English subtitles and is freely accessible from the MEXT and JASTRO websites (Japanese
Society for Radiation Oncology, 2021), but its perceived effectiveness has not been
investigated. The primary purpose of this study was to verify whether this video is beneficial
in improving the understanding of cancer and radiotherapy. Additionally, although cancer
education is conducted as part of HPE classes, given the technical aspects of radiation and
radiation treatment science teachers may be better suited than HPE teachers to teach cancer
and radiotherapy. Therefore, the second objective of this study was to clarify which
specialisation of teachers has a better understanding of cancer and radiotherapy. We believe
this study will contribute to enhancing cancer and radiotherapy education in future curricula.
Methods
Video content
JASTRO created the video in early 2021 under the supervision of affiliated radiological
oncologists and medical physicists, including two of the authors of this paper (MM & KN), and
released it in September 2021 (Japanese Society for Radiation Oncology, 2021). The video
exists in two versions: a 90-second short version and the 8-minute original video. The latter
targets cancer education classes. As shown in Figure 1, the video uses real life scenes and
animations to explain the process of cancer formation, clinical practice, effectiveness and the

cost of radiotherapy, latest treatments (e.g., intensity-modulated radiation therapy (IMRT)
and stereotactic body radiotherapy (SBRT)), and the possibility of achieving a balance
between treatment and work (Japanese Society for Radiation Oncology, 2021). The contents
of the videos were carefully curated to include technological advances that have improved the
effectiveness of radiotherapy, minimised its adverse effects, and reduced treatment duration,
thereby facilitating a better balance between treatment and work obligations. Previous
research conducted by our team has established that radiotherapy was believed to be
associated with a higher risk of cancer recurrence, a higher incidence of adverse events, longer
treatment periods, increased costs, and a more demanding commute to hospitals compared
to surgical interventions in Japan (Minamitani et al., 2021).
Figure 1 about here
Survey procedure
Due to the difficulty of accessing children, an online survey was conducted with
schoolteachers from May 27 and June 8, 2022 through the internet research company
Macromill, Inc. The company has access to information such as age, gender and address, of
10 million individuals who have registered as survey candidates. An email outlining the survey
was sent to the candidates. The respondents accessed a web page, confirmed that they
understood the study purpose, and provided informed consent, before completing the survey.
After doing so, they receive a reward point equivalent to one dollar. We aimed to obtain
approximately 2,000 valid responses.
We developed a survey instruments# specifically for this investigation. The opening
questions screened the respondents; only junior or senior high school teachers with no
personal history of cancer could proceed with the survey. The questions that followed
enquired about the respondents’ characteristics, such as their lifestyle
(smoking/alcohol/exercise/diet/obesity), teaching specialisation, role and responsibility in
school, school location and type, experience of watching the video, and whether they had
anxieties about radiation therapy, surgery and chemotherapy. The anxiety score for each
treatment was recorded on a 5-point Likert scale, on which a lower score indicated more
anxiety. Additionally, the respondents answered 10 specific questions about cancer and
radiotherapy, tailored to the video content, before watching the video. Their responses were
coded: “correct,” “incorrect”, and “don’t know.” Respondents were not allowed to return to
the previous page after answering all 10 questions and proceeding to the next page of the
online survey to watch the 8-minute JASTRO video. They were free to pause but could not
fast-forward or rewind the video while watching it. After finishing the video, they answered
the same 10 questions again. Respondents between 22 and 69 years of age without any

history of cancer who were junior/senior high school teachers and provided informed consent
were included in the analysis. Those with prior and unidentifiable experience of watching the
video were excluded.
The questionnaire and methodology for this study was approved by the Institutional
Review Board of the Graduate School of Medicine and Faculty of Medicine, the University of
Tokyo (2019363NI).
Statistical analysis
Chi-squared tests were used for categorical variables and analysis of variance (ANOVA) for the
continuous variables to compare background characteristics among the three groups of
teachers: science teachers, HPE teachers, and teachers of other specialties (hereafter, otherspecialty teachers). We referred to the Organization for Economic Co-operation and
Development (OECD) regional typology to divide place of residence into two groups:
predominantly urban and intermediate/predominantly rural (Organization for Economic Cooperation and Development, 2011, 2016). Each lifestyle was defined by a binary variable of
recommended (1) and non-recommended (0) for five factors: smoking (recommended: never
smoked), drinking alcohol (recommended: weekly alcohol consumption of < 150g), exercising
(recommended: ≥ 37.5 and ≥ 31.9 metabolic equivalent hours per day for men and women),
eating salted meals (recommended: consumption of < 0.67g of fish roe per day), and being
overweight (recommended: body mass index [BMI] within the range of 21 – 27 for men and
19 – 25 for women); these were based on the thresholds used in a previous study (Charvat et
al., 2013). Subsequently, the sum of the scores on these variables was calculated and the total
was referred to as the “healthy behaviour score.”
Anxiety level toward each cancer treatment (radiotherapy/surgery/chemotherapy)
was evaluated between the three teacher groups and among all of the respondents. A paired
t-test was used to detect the change in the correct-answer rates for the 10 questions before
and after exposure to the video. Pre- and post-test scores were also evaluated in each of the
three groups using the t-test. Bonferroni’s correction was employed for multiple comparisons,
and multiple regression analysis was performed to estimate the significant factors that
predicted respondents’ post-video correct-answer rates. The independent variables were the
teacher and school characteristics, healthy behaviour score, anxiety toward radiotherapy, and
the pre-video correct-answer rates. Healthy behaviour score and anxiety were dichotomous
variables based on a median split technique. In the multiple regression analysis, forced entry
was employed to include all predictor variables simultaneously into the regression model,
regardless of their individual significance. B values, known as unstandardised coefficients, and
β values, standardised coefficients, were calculated to examine the relationships between the
predictor variables and the outcome variable. All analyses were performed using SPSS version

27, with a significance level of 5%.
Results
Of the 39,821 respondents who started the survey by the deadline, 36,494 were excluded for
not being junior/senior high school teachers. Due to their personal cancer history, 179
additional individuals were excluded. The remaining 3,148 proceeded with answering the
survey, but 1,249 dropped out because of interruptions. A final 1,899 individuals completed
the survey, of which 350 claimed that they had already seen the videos, and 145 did not
describe their viewing experience. Therefore, a total of 1,404 responses qualified for analysis.
Table 1 compares the background information for the three groups. The total number of
other-specialty teachers was 1,141, including 233 mathematics teachers (20%), 198 English
language teachers (17%), and 195 social studies teachers (17%). Science teachers were
predominantly men (p = 0.046), and HPE teachers were younger (p = 0.049). Concerning
lifestyle, the HPE teachers were superior in terms of exercise (p < 0.01) but less so in terms of
smoking (p = 0.075) and diet (p = 0.068).
Table 1 about here
Table 2 shows the anxiety score of the three groups toward each treatment. We
identified a significant difference between radiotherapy (p < 0.01) and surgery (p < 0.01).
Multiple comparisons showed that the science teachers were significantly less anxious about
both treatments (radiotherapy; p = 0.01, surgery; p = 0.01) than other-specialty teachers.
Among all respondents, the means and standard deviations of each score were as follows:
radiotherapy (2.52 ± 1.05), surgery (2.63 ± 1.10), and chemotherapy (2.65 ± 1.05) (p = 0.004).
Multiple comparisons showed that radiotherapy was associated with the most anxiety relative
to other therapies (radiotherapy vs. surgery; p = 0.028, radiotherapy vs. chemotherapy; p <
0.01, surgery vs. chemotherapy; p = 1).
Table 2 about here
The pre- and post-video correct-answer rates are displayed in Table 3. All questions,
except those about medical physicists (Question 3) and damage to normal cells (Question 5),
showed an increase in the rates of correct answers post-video. Three questions saw an
improvement of more than 40% post-video, namely high-precision radiotherapy (Question 6),
feasibility of outpatient radiotherapy (Question 8), and insurance coverage of radiotherapy
(Question 9). However, the HPE teachers did not acquire enough knowledge after the video
to improve the correct-answer rate for Questions 1 (p = 0.57), 3 (p = 0.62), and 5 (p = 0.21). In

comparing the pre- and post-video correct-answer rates independently between the three
groups, the pre-video correct-answer rates were 55.0% ± 21.0% (science), 42.0% ± 21.9%
(HPE), and 46.5% ± 22.9% (other-specialty) (p < 0.01); the post-video correct-answer rates
were 74.6% ± 17.0% (science), 67.2% ± 23.4% (HPE), and 70.1% ± 22.0% (other-specialty) (p =
0.013). Multiple comparisons showed a significant difference between the science and HPE
teachers (pre-video; p < 0.01, post-video; p = 0.026) and between science and other-specialty
teachers (pre-video; p < 0.01, post-video; p = 0.031), although the scores of the HPE and otherspecialty teachers showed no difference (pre-video; p = 0.21, post-video; p = 0.21).
Table 3 about here
Table 4 shows the results of the multiple logistic regression analysis. Age (β value =
0.07, p < 0.01), sex (β value = 0.08, p < 0.01), anxiety about radiotherapy (β value = -0.09, p <
0.01), and pre-video correct-answer rates (β value = 0.46, p < 0.01) were the significant factors
for predicting post-video correct-answer rates (Adjusted R = 0.23, p < 0.01), while teachers’
specialisation was not significant (science; β value = 0.022, p = 0.36, HPE; β value = -0.002, p
= 0.93).
Table 4 about here
Discussion
Schools are key to helping young people develop knowledge, socioemotional skills like selfregulation and resilience, and critical thinking that provide a base for a healthy future (World
Health Organization, 2021). In 1995, the World Health Organization launched a global school
health initiative to promote health in schools and issued guidelines for school health services
in 2021 (Ross et al., 2021; World Health Organization, 2021). In line with such global trends,
cancer education in Japan began as a school health education programme following the 2016
revision of the Cancer Control Act (Ministry of Health, Labour and Welfare, 2018a).
A survey by MEXT in 2021 clarified that the popular settings for cancer education
were physical and health education (57.0%), special activities (26.9%), and integrated learning
(15.6%) (Ministry of Education, Culture, Sports, Science and Technology, 2022). The school
utilisation rate of visiting lecturers was low at 8.1%. The most common teachers were cancer
survivors (22.9%), while only 19.3% were oncologists (Ministry of Education, Culture, Sports,
Science and Technology, 2022). This means that only 1.5% of schools were able to use
oncology experts as visiting lecturers. The 2018 report revealed that palliative care (6.8%),
quality of life among cancer patients (11.0%), and cancer treatments (15.9%) were minimally
covered in the teaching (Ministry of Education, Culture, Sports, Science and Technology, 2022),

and it should be assumed that it is difficult for school teachers to teach children about actual
clinical practice. Importantly, a previous study has reported that adolescents prefer learning
through online videos and in school (Abraham et al., 2021).
The usefulness of visual materials in higher education and medical education has
been reported (Dong and Goh, 2015; Kay, 2012). Although there are existing learning videos
on radiotherapy, most of them aim to ease the anxiety of patients undergoing the treatment.
The video used in this study is widely available in Japan, where fewer than 0.5% of the total
330,000 physicians being radiological oncologists (Japanese Society for Radiation Oncology,
2018; Ministry of Health, Labour and Welfare, 2018b), and involves situations of clinical
relevance to cancer patients and radiotherapy. It seeks to support cancer education in
Japanese schools mainly by providing an accurate and straightforward explanation of
radiotherapy. With online information about radiotherapy being a complex for the public to
understand (Rosenberg et al., 2017), the video could be beneficial in enhancing school
students’ understanding of basic information on radiotherapy.
This study found that watching the video increased knowledge about cancer and
radiotherapy (Table 3). It helped improve comprehension, at least in the short-term. However,
knowledge about medical physicists, who play an essential role in radiotherapy, showed no
improvement despite exposure to the video. The International Labor Organization states that
medical physicists are multidisciplinary team members engaged in diagnosing and treating
patients with ionising and non-ionising radiation (International Atomic Energy Agency, 2013).
In Japan, the Japanese Board of Medical Physicist Qualification (JBMP) started certifying
medical physicists in 1987, but the certification remains poorly recognised and is not
considered a national qualification (Iramina et al., 2022; Khaledi et al., 2020). As such,
including information on medical physicists in the video may be beyond the scope of what
cancer education should cover. Furthermore, concerning Question 5, “Radiation therapy
damages not only cancer cells but also normal cells,” the correct-answer rate declined postvideo. The video emphasised decreasing damage to normal organs through high-precision
radiotherapy, which may have confused some respondents. While high-precision radiotherapy
reduces adverse events, it does not prevent damage to normal cells.
Compared to HPE and other-specialty teachers, science teachers proved to be
significantly more knowledgeable about cancer and radiation therapy pre- and post-video.
The number of teachers in Japan anxious about teaching radiation is significantly higher
among general teachers than among science teachers (Hori et al., 2019). This difference is
consistent with the significantly lower level of anxiety science teachers have about radiation
therapy (Table 2). A previous study found that the level of health literacy among health and
science teachers was similar; however, the study was relatively small scale (Denuwara and
Gunawardena, 2017). Even though health knowledge and health literacy are separate issues,
it is undeniable that, to some extent, science teachers are well qualified to contribute to

cancer education programmes, especially those focusing on radiotherapy.
The multiple regression analysis showed that age, sex, radiotherapy anxiety, and prevideo correct-answer rates significantly affect post-video correct-answer rates. A past study
found that women and older adults have a better understanding of cancer (Minamitani et al.,
2022), which aligns with the results of this investigation. Although a video-based class requires
teachers to understand the content of the material, it is practically unfeasible to administer
pre-tests or measure anxiety levels pre-video to identify the types of teachers most
appropriate for cancer education programmes. In this study, a multiple regression analysis
without a pre-test and anxiety score was performed. The results suggest that science teachers
better understood the video content (p = 0.01), although the adjusted R2 value dropped
substantially (adjusted R2 = 0.014, p < 0.01) (Supplemental table) from before subtracting pretest and anxiety level (Table 4). This suggests that science teachers may be better suited to
teach cancer and radiation therapy to children to a small extent. Our results implied that for
radiotherapy education, cross-disciplinary instruction involving both HPE and science teachers
might be more effective strategy.
Limitations
This study has some limitations. First, the survey questions created in relation to the video
content were not validated. Watching the video did not necessarily lead to an overall
improvement in understanding of cancer and radiotherapy. Second, the video was developed
for cancer education classes. Since the present study targeted teachers, we cannot conclude
whether the video would likely lead to improved understanding among students. A future
study targeting students is worth considering. Third, we mentioned the possibility that science
teachers may be better suited to teach about radiotherapy. However, we recognise that good
comprehension does not necessarily guarantee the ability to teach effectively. Fourth, cancer
education programmes cover a broad range of cancers and cancer-related topics. This study
discussed only a small subset of cancer education programmes. Despite these limitations, the
JASTRO video has the potential to improve teachers’ understanding of cancer and radiation
therapy and may be used as a valuable teaching tool as part of cancer education programmes.
Implications
There are at least three stages to the delivery of health education in school: the transmission
of basic information, the opportunity to develop skills, and the chance to engage with
classroom and community learning opportunities that address health-related problems. Each
of these stages leads in turn to the development of functional, interactive and critical health
literacy (St Leger, 2001). By nature of its medium, the video only conveys information, thus we

believe it should be made available as part of classwork whenever possible to reach its fulleducational potential (Dong and Goh, 2015; St Leger, 2001). Providing opportunities for a
more interactive experience could promote cognitive engagement and improve the learning
process (Dong and Goh, 2015).
Conclusion
This study evaluated responses to a cancer and radiotherapy educational video developed by
JASTRO through a web survey targeting junior and senior high school teachers. The findings
revealed that viewing the videos improved teachers’ understanding of cancer and
radiotherapy. Although HPE teachers are assigned to conduct cancer education in schools,
science teachers showed the highest level of post-video understanding. Thus, the video could
beneficially be used in a cross-disciplinary fashion in conjunction with science teachers to
further enhance its effectiveness.

Competing Interests
The authors declare that there are no conflicts of interest. The Department of
Comprehensive Radiation Oncology, to which Masanari Minamitani and Keiichi Nakagawa
belong, is an endowed department, supported with an unrestricted grant from Elekta K. K.
However, the sponsor had no role to play in this study, and no funding was received for
conducting this study.
Acknowledgements
We thank the Japanese Society for Radiation Oncology for developing the great educational
video. We would also like to thank the participants for their engagement in the survey.

Data availability
The datasets analysed during the current study are available from the corresponding author
up on reasonable request.

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Figure 1 Examples of video content

Table 1. Demographic characteristics of study respondents
Science teacher

HPE teacher

Other-specialised teacher

(N=173)

(N=90)

(N=1141)

N

%

N

%

N

%

Age

P
value
0.049

Mean (SD)

49.4

(11.3)

45.7

(13.2)

48.0

(11.6)

Sex

0.046
Male

133

77%

64

71%

772

68%

Female

40

23%

26

29%

369

32%

School location

0.46
Predominantly urban
Intermediate/ predominantly
rural

83

48%

50

56%

594

52%

90

52%

40

44%

547

48%

School grade

0.49
Junior high

79

46%

45

50%

500

44%

Seninor high

94

54%

45

50%

641

56%

School type

0.045
Public

138

80%

77

86%

858

75%

Private

35

20%

13

14%

283

25%

Rank in school

0.69
leading teacher

137

79%

68

76%

871

76%

Chief teacher/ head teacher/ principal

36

21%

22

24%

270

24%

Smoking

0.075
Recommended

115

66%

51

57%

779

68%

Non-recommended

58

34%

39

43%

362

32%

Alcohol

0.81
Recommended

147

85%

74

82%

950

83%

Non-recommended

26

15%

16

18%

191

17%

Exercise

< 0.01
Recommended

42

24%

44

49%

324

28%

Non-recommended

131

76%

46

51%

817

72%

Salt with a meal

0.068
Recommended

157

91%

77

86%

1054

92%

Non-recommended

16

9%

13

14%

87

8%

Obesity

0.69
Recommended

136

79%

73

81%

883

77%

Non-recommended

37

21%

17

19%

258

23%

Abbreviations: HPE: Health and Physical Education, SD: Standard
deviation
Recommendation cut-off points: never smoked (smoking),

weekly alcohol consumption of < 150g (alcohol), : ≥ 37.5 and ≥ 31.9 metabolic

equivalent hours per day for male and female (exercise), consumption of < 0.67g of fish roe per day (salt meal), body mass index within the
range of 21 – 27 for male and 19 – 25 for female (obesity)

Table 2. Anxiety score toward each cancer treatment
Science teacher

HPE teacher

Other-specialised teacher

All respondents

(N=173)

(N=90)

(N=1141)

(N=1404)

Mean

SD

Mean

SD

Mean

SD

P value

Mean

SD

Radiothearpy

2.73

1.10

2.63

1.14

2.48

1.03

< 0.01

2.52

1.05

Surgery

2.85

1.16

2.73

1.16

2.59

1.08

< 0.01

2.63

1.10

Chemotherapy

2.72

1.03

2.61

1.09

2.64

1.05

0.64

2.65

1.05

Abbreviations: HPE: Health and Physical Education, SD: Standard deviation
Anxiety score was investigated on a five-point Likert scale, where a lower score meant more anxiety.

Table 3. Change in the correct-answer rates to 10 questions before and after watching the video
Science teacher (N=173)
Answer

Pre

Post

P

test

test

value

HPE teacher (N=90)
Pre test

Other-specialised teacher

All respondents

(N=1141)

(N=1404)

Post

P

Pre

Post

P

Pre

Post

P

test

value

test

test

value

test

test

value

Question 1) Cancer cells appear
every day, even in healthy

Correct

85%

96%

< 0.01

80%

87%

0.57

76%

91%

Correct

75%

95%

< 0.01

59%

82%

< 0.01

60%

88%

Incorrect 18%

13%

0.083

14%

17%

0.62

18%

19%

Incorrect 41%

69%

< 0.01

20%

53%

< 0.01

31%

60%

Correct

75%

54%

< 0.01

61%

53%

0.21

64%

54%

Correct

64%

93%

< 0.01

39%

84%

< 0.01

42%

85%

Incorrect 25%

63%

< 0.01

18%

63%

< 0.01

22%

56%

people.
Question 2) Cancer cells evade
immune cell attacks and grow.

<
0.01
<
0.01

78%

91%

< 0.01

62%

89%

< 0.01

18%

18%

0.72

31%

61%

< 0.01

65%

54%

< 0.01

45%

86%

< 0.01

22%

58%

< 0.01

Question 3) A medical physicist is
a technician who irradiates

0.40

patients under the doctor's order.
Question 4) Patients feel the
irradiated lesion hot during
radiotherapy.
Question 5) Radiation therapy
damages not only cancer cells but
also normal cells.

<
0.01
<
0.01

Question 6) Radiotherapy
delivery systems can change the
beam shape correctly to fit the

<
0.01

shape of cancer.
Question 7) Radiotherapy cannot
completely cure cancer patients.

<
0.01

Question 8) Most patients can
undergo radiation therapy on an

Correct

58%

94%

< 0.01

36%

83%

< 0.01

45%

87%

Incorrect 34%

82%

< 0.01

26%

69%

< 0.01

33%

77%

Incorrect 76%

87%

< 0.01

68%

80%

< 0.01

73%

83%

outpatient schedule.
Question 9) Most radiotherapy
are expensive and not covered by
health insurance.

<
0.01
<
0.01

46%

87%

< 0.01

33%

77%

< 0.01

73%

84%

< 0.01

Question 10) Patients don't have
the right to decide their
treatments, but their doctors
have it.
Abbreviations: HPE: Health and Physical Education

<
0.01

Table 4. Multiple logistic regression analysis: association between post-watch correct-answer rates and other characteristics
B value

SE

(constant)

0.44

0.06

Age

0.001

0.00

β value

0.07

95%

95%

Lower

Upper

< 0.01

0.31

0.56

< 0.01

0.00

0.002

< 0.01

0.01

0.06

0.09

-0.04

0.003

0.35

-0.01

0.03

0.64

-0.02

0.03

0.37

-0.04

0.01

0.58

-0.02

0.03

t

P value

7.0
2.7

Sex
Male
Female

(reference)
0.04

0.01

0.08

2.8

School location
Predominantly urban
Intermediate/ predominantly rural

(reference)
-0.02

0.01

-0.04

-1.7

School grade
Junior high
Senior high

(reference)
0.01

0.01

0.02

0.94

School type
Public
Private

(reference)
0.01

0.01

0.01

0.47

Rank in school
Leading teacher
Chief teacher/ head teacher/ principal

(reference)
-0.01

0.01

-0.02

-0.89

Healthy behaviour score
0-3
4-5

(reference)
0.01

0.01

0.01

0.55

Anxiety score of radiotherapy
Anxious

(reference)

Neutral/ not anxious

-0.04

0.01

-0.09

-3.6

< 0.01

-0.06

-0.02

Science

0.01

0.02

0.02

0.92

0.36

-0.02

0.05

-0.002

0.02

-0.002

-0.09

0.93

-0.04

0.04

< 0.01

0.39

0.48

Teacher specialisation
HPE
Other-specialised
Pre-watch correct-answer rates

(reference)
0.44

0.02

0.46

19.5

Abbreviations: HPE: Health and Physical Education, SE: Standard Error
B: regression coefficient, β: standardised regression coefficient

Adjusted R2 = 0.23 (N = 1404, P value < 0.01 )

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