European Code Against Cancer receptivity: latent profile analysis across four European countries

Background

Rogers’ Diffusion of Innovations theory explains how people adopt new ideas based on five attributes: perceived usefulness (relative advantage), alignment with existing values (compatibility), ease of use (complexity), opportunity to test (trialability), and visibility of results (observability). This study aimed to identify groups of individuals with similar perceptions of the 4th European Code Against Cancer (ECAC4) and to examine how these group profiles differ by country and Cancer Information-Seeking Behaviour (CISB).

Methods

Data were drawn from a cross-national online survey (2025) in four European countries (Italy, Portugal, Romania, Bulgaria; n = 4,251). ECAC4 perceptions were assessed through 25 items (five per attribute) on a 5-point agreement scale. Latent profile analysis was conducted on five composite attribute scores. Multinomial logistic regression examined associations between profile membership and country of residence and CISB.

Results

A 3-profile solution was retained (entropy=.89; mean probabilities ≥.93): Moderate receptivity (62.6%), with moderate ratings across all attributes (means 3.60–3.90); Low receptivity (23.0%) with consistently lower ratings (means 2.83–3.06); and High receptivity (14.5%), with uniformly positive ratings across all attributes (means 4.39–4.69). Compared to Portuguese respondents, participants from Bulgaria (RRR=2.46, 95%CI [1.98, 3.06]) and Romania (RRR=1.63, 95%CI [1.30, 2.05]) showed greater likelihood of Low (vs Moderate) receptivity. Additionally, the absence of CISB was associated with Low (vs Moderate) receptivity (RRR=2.26, 95%CI [1.90, 2.68]).

Conclusions

Three distinct ECAC4 receptivity profiles were identified, varying by national context, with Bulgarian and Romanian respondents showing lower receptivity than Portuguese. Findings highlight the need for context-tailored communication strategies to improve ECAC4 recommendations’ perceived value and relevance.

Key messages

• Cancer prevention messaging must adapt to national contexts.

• Adults who do not seek cancer information are more likely to perceive ECAC4 recommendations as less useful, compatible, and observable — reinforcing the need to reach disengaged audiences.