CancerNCT05881902
THE EFFECT OF CANCER EDUCATION ON WOMEN'S AWARENESS LEVELS AND THEIR BEHAVIORS ON SCREENINGS
A study testing HEALTH FAITH MODEL GUIDED IN CANCER FREQUENTLY SEEN IN WOMEN EARLY DIAGNOSIS AND SCREENING METHODS EDUCATION and STANDART CANCER EDUCATİON in people with Cancer, run by Yeşim KAYAPA at 1 site in Turkey (Türkiye).
Trial summary
Disability is part of being human. He estimates that the prevalence of disability among women is 60% higher than that of men. Disabled women coexist in a dual state of vulnerability where "being a woman" and "being a disabled person" have two social disadvantages. Read more about this study
- Who is it for?
- Ages 18 to 65 years, women onlyHealthy volunteers can take part
- Conditions the study is for
- Cancer
- What is being tested?
- HEALTH FAITH MODEL GUIDED IN CANCER FREQUENTLY SEEN IN WOMEN EARLY DIAGNOSIS AND SCREENING METHODS EDUCATION and STANDART CANCER EDUCATİON
- Type of treatment
- Lifestyle or therapy programme
- Could I receive a placebo?
- No, everyone receives an active treatment
- How many people
- 60 participants
- Where
- 1 siteTurkey (Türkiye)
- Study dates
- 1 Jan 2023to 1 Jul 2023
- Phase
- Interventional
- Are there results?
- None posted in the registry
Key requirements
Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.
- Ages 18 to 65 years
- Women only
- Healthy volunteers accepted
- Adult, Older adult
Who may be able to join
- Being physically disabled
- Having a disability to perform KKMM and KKVM
- Being between the ages of 18-65 (since these are the age ranges at which screening is started),
- Being married or living with a spouse (for participation in cervical cancer screening),
- Not to do KKMM and KKVM regularly every month,
- Never or in the last three years have not had a pap smear test, CMM or mammography,
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- Not being pregnant, breastfeeding or postpartum,
- Not having a history of common cancers in women,
- Accepting to participate in the research,
- Being literate, accessible and communicative,
- Absence of severe psychiatric problems
Who cannot join
- Hearing impairment
- Being visually impaired
- Being mentally handicapped
- A physically disabled woman who gives up working at any stage of the study will be excluded from the study.
Trial locations and contacts
1 site in 1 country.
Turkey (Türkiye)1 site, 1 recruiting
- Recruiting
Ankara Yildirim Beyazit University
Ankara, 06760
YEŞİM KAYAPA, +905426726220, ysmkyp@hotmail.com
About this study
Official title: THE EFFECT OF CANCER EDUCATION BASED ON THE HEALTH BELIEF MODEL ON AWARENESS OF WOMEN WITH DISABILITIES AND THEIR PARTICIPATION IN SCREENING
Disability is part of being human. He estimates that the prevalence of disability among women is 60% higher than that of men.
Disabled women coexist in a dual state of vulnerability where "being a woman" and "being a disabled person" have two social disadvantages. Among people with disabilities, women with disabilities (WWD) have higher unmet healthcare needs than women without disabilities.
Read more
Cancer is an important public health problem and cause of death all over the world. Among the most common cancers in women; breast, uterine corpus, ovarian and cervix cancers are seen to be prominent, respectively. It is known that with regular examinations and screenings, early diagnosis of breast and cervical cancer increases the chance of treatment.
International studies show that women face barriers and difficulties in accessing reproductive health and cancer screening services. In studies, it was stated that especially women with disabilities living in rural areas had lower mammography and Pap-smear tests compared to women without disabilities. In recent years, the Health Belief Model has been used frequently to examine the effect of health beliefs on cancer screening behaviors in women and to increase screening rates. The model explains the beliefs and attitudes that affect individuals' behaviors. According to the model; If a person has a desire to prevent illness or a belief in recovery, he recommends taking a specific health action to prevent illness as a positive behavior. It was emphasized that nurses have important roles and responsibilities in the protection and development of health, and that they can identify individuals with disabilities who are considered "fragile", and provide health education and counseling to these groups. It is thought that the "disabled-friendly accessible health care" practices under the guidance of the Health Belief Model will bring the preventive health care behavior of women with disabilities to the desired level.
Disabled women experience inequalities in benefiting from routine health services and health screening services in special areas such as reproductive health and protection from women's cancers. Being diagnosed with cancer is undoubtedly devastating for anyone. For this reason, it becomes more important to raise awareness about the prevention, prevention, early diagnosis and development of a healthy lifestyle in women with physical disabilities, and to encourage health-seeking behaviors.
Read the detailed description
Disability is part of being human. Everyone may be temporarily or permanently disabled at some point in their life, and it has been stated that they will experience increasing difficulties in functioning in old age. He estimates that the prevalence of disability among women is 60% higher than that of men.
Disabled women coexist in a dual state of vulnerability where "being a woman" and "being a disabled person" have two social disadvantages. Among people with disabilities, women with physical disabilities have higher unmet healthcare needs than women without disabilities.
Cancer is an important public health problem and cause of death all over the world. According to the Turkish Cancer Statistics, it is estimated that approximately 69,633 women are diagnosed with cancer in our country. Among the most common cancers in women; breast, uterine corpus, ovarian and cervix cancers are seen to be prominent, respectively. It is known that with regular examinations and screenings, early diagnosis of breast and cervical cancer increases the chance of treatment.
International studies show that women face barriers and difficulties in accessing reproductive health and cancer screening services. In the study of Horner-Johson et al., it was stated that especially rural women with disabilities had lower mammography and Pap-smear tests compared to non-disabled women. It is emphasized that as a result of lower screening participation of persons with disabilities, there is a higher risk of cancer mortality with delayed diagnosis.
In another study investigating the reasons why women with physical disabilities do not engage in preventive health services; time constraints and priorities, interactions between health professionals and women with disabilities, lack of knowledge, belief, sensitivity, belief that people with disabilities have more information than service providers, economic problems, transportation problems, appointment problems, availability of accessible facilities, physical pain, mammography, pap smear It has been stated that factors such as both psychological and physical discomfort during the test and pelvic examination are effective.
In recent years, the Health Belief Model (SIM) has been frequently used to examine the effect of health beliefs on cancer screening behaviors in women and to increase screening rates. The model explains the beliefs and attitudes that affect the behavior of individuals. The most basic components of the model are the perception of susceptibility, the perception of seriousness, the perception of benefit, the perception of obstacles, the health motivation and the perception of trust. The SIM recommends that if a person has a desire to prevent illness or a belief in recovery, he or she should take a specific health action to prevent illness as a positive behavior. In an interventional study conducted with Korean-American women to improve breast cancer screening, using SIM for early diagnosis and behavioral change, it was determined that the rate of mammography and Breast Self-Examination (BSE) application rates increased significantly. It has been emphasized that nurses have important roles and responsibilities in the protection and development of health, and that they can identify disabled individuals who are considered "fragile" and provide health education and counseling to these groups. It is thought that awareness training on cancers that are common in women, given under the guidance of the Health Belief Model, will bring the preventive health behavior of women with disabilities to the desired level. When the literature is examined, the limited number of randomized controlled studies that will increase the participation of disabled women in cancer screening services increases the importance of the subject.
Disabled women experience inequalities in benefiting from routine health services and health screening services in special areas such as reproductive health and protection from cancers that are common in women. Being diagnosed with cancer is undoubtedly devastating for anyone. For this reason, it becomes more important to raise awareness about the prevention, prevention and early diagnosis of cancers that are common in women with physical disabilities, to raise awareness on this issue and to encourage health-seeking behaviors.
This study was conducted to determine the barriers for women with physical disabilities between the ages of 18-65 to adopt behaviors to diagnose common cancers in women at an early stage, and to increase participation in early diagnosis behaviors in cancers that are common in women (Breast Self Examination (BSE), Clinical Breast Examination (CBE), Self-Examination). Vulva Self Examination (KKVM), Mammography and PapSmear Test) was planned to determine the effectiveness of awareness training based on SIM.
- Conditions
- Cancer
- Being tested
- HEALTH FAITH MODEL GUIDED IN CANCER FREQUENTLY SEEN IN WOMEN EARLY DIAGNOSIS AND SCREENING METHODS EDUCATION, STANDART CANCER EDUCATİON
- Keywords
- cancer screening, cancer early detection, physically disabled, early screening, health blief model, breast cancer, cervix cancer, awareness
- Medical subject headings
- Neoplasms, Breast Neoplasms, Uterine Cervical Neoplasms
What participants receive
What participants receive. In a randomised study each person is assigned to one group by chance.
HEALTH FAITH MODEL GUIDED IN CANCER FREQUENTLY SEEN IN WOMEN EARLY DIAGNOSIS AND SCREENING METHODS EDUCATIONBehavioural
A total of 4 home visits and 2 phone calls will be made by giving awareness training based on the Health Belief Model to the participants in the Intervention 1 group in order to eliminate the lack of information about the common female cancers in women and to increase their awareness. For 3 months, intervention 1 group will be given applications to reinforce their awareness in the education based on the Health Belief Model (for BSE and KKVM, erasable calendar magnets, booklets, phone cases and accessories themed as "common cancers awareness in women" as a reminder, phone call) will be made
STANDART CANCER EDUCATİONBehavioural
The participants in the intervention 2 group will be given the standard training applied by the Ministry of Health in KETEM for women's cancers during home visits, and a total of 4 home visits and 2 SMS reminders will be made.
| Study group | Role | What they receive |
|---|---|---|
| İntervention 1: Cancer awareness training based on the Health Belief Model | Experimental | Awareness training based on the Health Belief Model will be given to the participants in the Intervention 1 group during home visits in order to eliminate the lack of information about the common female cancers in women and to increase their awareness. For 3 months, intervention 1 group will be given applications to reinforce their awareness in the education based on the Health Belief Model (for BSE and KKVM, erasable calendar magnets, booklets, phone cases and accessories themed as "common cancers awareness in women" as a reminder, phone call) will be made. Receives: Behavioral: HEALTH FAITH MODEL GUIDED IN CANCER FREQUENTLY SEEN IN WOMEN EARLY DIAGNOSIS AND SCREENING METHODS EDUCATION |
| İntervention 2: Standart cancer education | Experimental | Participants in the Intervention 2 group will be provided with the standard training applied at KETEM by the Ministry of Health on female cancers, which are frequently seen in physical women, during home visits. The training will be held in the form of power-point presentation, question and answer. For 3 months, intervention 2 groups will be applied to reinforce their awareness in standard education (sms reminder). Receives: Behavioral: STANDART CANCER EDUCATİON |
What is being measured
The primary outcome is the main question the study is designed to answer.
The Gynecological Cancers Awareness Scale
The Gynecological Cancers Awareness Scale consists of 41 questions in total, with a minimum of 41 and a maximum of 205 points that can be obtained from the scale. The increase in the scores obtained from the scale indicates that the awareness of gynecological cancer increases.
Measured: 12 weeks
Secondary outcomes (1)
Champion's Health Belief Model Scale for Breast Cancer and Screening
In the scale, 2 sub-dimensions will be used that question the "barriers" of performing breast self-examination and the "barriers" of mammography. Higher scores indicate that obstacles are perceived as high for the perception of obstacles.
Measured: 12 weeks
Timeline
From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.
- First posted31 May 2023
- Study start1 Jan 2023
- Primary completion1 Jul 2023 (estimated)
- Study completion1 Jul 2023 (estimated)
Resources
- Official record on ClinicalTrials.govThe registry entry this page is built from, with its full change history.
- Other trials for CancerStudies of the same condition, open and under way.
- What the trial phases meanHow a treatment moves from first tests in people to approval.
More details
For doctors and researchers: how the study is designed, who runs it, and its registry IDs.
Study design
- Study type
- Interventional
- Phase
- Phase N/A
- Primary purpose
- Screening
- Allocation
- Randomised
- Intervention model
- Parallel groups
- Model description
- Randomized controlled experimental design
- Masking
- Double blind
- Who is masked
- Participant, Outcomes assessor
- Enrolment
- 60 participants (estimated)
Sponsor and investigators
- Lead sponsor
- Yeşim KAYAPA
- Sponsor type
- University, hospital or other
- Responsible party
- Sponsor-investigator, Yeşim KAYAPA, Ankara Yildirim Beyazıt University
IDs, dates and publications
- ClinicalTrials.gov ID
- NCT05881902
- Sponsor's protocol ID
- AYBÜ-HMS-YK-01
- Status last verified
- May 2023
- First submitted
- 27 Feb 2023
- Last updated
- 31 May 2023
- Results posted
- No
- Data monitoring committee
- No
- FDA-regulated drug
- No
- FDA-regulated device
- No
- Individual data sharing
- No: It can be used in metaanalysis research, but provided that you receive an information mail.
Study at a glance
From the registry record, last updated by the sponsor on 31 May 2023. Recruitment status is as the sponsor reported it: confirm with the study team.
- Official title
- THE EFFECT OF CANCER EDUCATION BASED ON THE HEALTH BELIEF MODEL ON AWARENESS OF WOMEN WITH DISABILITIES AND THEIR PARTICIPATION IN SCREENING
- ClinicalTrials.gov ID
- NCT05881902
- Acronym / sponsor ID
- AYBÜ-HMS-YK-01
- Conditions
- Cancer
- Keywords
- cancer screening, cancer early detection, physically disabled, early screening, health blief model, breast cancer, cervix cancer, awareness
- Study type
- Interventional
- Recruitment status
- Unknown status
- Enrolment
- 60 participants (estimated)
- Lead sponsor
- Yeşim KAYAPAUniversity, hospital or other
- Study start
- 1 Jan 2023 (actual)
- Primary completion
- 1 Jul 2023 (estimated)
- Study completion
- 1 Jul 2023 (estimated)
- First posted
- 31 May 2023 (actual)
- Results
- Not posted in the source record
Clinical summary
The research question as the sponsor registered it. This describes what the study plans to test, not what it found.
Disability is part of being human. He estimates that the prevalence of disability among women is 60% higher than that of men.
Disabled women coexist in a dual state of vulnerability where "being a woman" and "being a disabled person" have two social disadvantages. Among people with disabilities, women with disabilities (WWD) have higher unmet healthcare needs than women without disabilities.
Cancer is an important public health problem and cause of death all over the world. Among the most common cancers in women; breast, uterine corpus, ovarian and cervix cancers are seen to be prominent, respectively. It is known that with regular examinations and screenings, early diagnosis of breast and cervical cancer increases the chance of treatment.
International studies show that women face barriers and difficulties in accessing reproductive health and cancer screening services. In studies, it was stated that especially women with disabilities living in rural areas had lower mammography and Pap-smear tests compared to women without disabilities. In recent years, the Health Belief Model has been used frequently to examine the effect of health beliefs on cancer screening behaviors in women and to increase screening rates. The model explains the beliefs and attitudes that affect individuals' behaviors. According to the model; If a person has a desire to prevent illness or a belief in recovery, he recommends taking a specific health action to prevent illness as a positive behavior. It was emphasized that nurses have important roles and responsibilities in the protection and development of health, and that they can identify individuals with disabilities who are considered "fragile", and provide health education and counseling to these groups. It is thought that the "disabled-friendly accessible health care" practices under the guidance of the Health Belief Model will bring the preventive health care behavior of women with disabilities to the desired level.
Disabled women experience inequalities in benefiting from routine health services and health screening services in special areas such as reproductive health and protection from women's cancers. Being diagnosed with cancer is undoubtedly devastating for anyone. For this reason, it becomes more important to raise awareness about the prevention, prevention, early diagnosis and development of a healthy lifestyle in women with physical disabilities, and to encourage health-seeking behaviors.
Detailed description
Disability is part of being human. Everyone may be temporarily or permanently disabled at some point in their life, and it has been stated that they will experience increasing difficulties in functioning in old age. He estimates that the prevalence of disability among women is 60% higher than that of men.
Disabled women coexist in a dual state of vulnerability where "being a woman" and "being a disabled person" have two social disadvantages. Among people with disabilities, women with physical disabilities have higher unmet healthcare needs than women without disabilities.
Cancer is an important public health problem and cause of death all over the world. According to the Turkish Cancer Statistics, it is estimated that approximately 69,633 women are diagnosed with cancer in our country. Among the most common cancers in women; breast, uterine corpus, ovarian and cervix cancers are seen to be prominent, respectively. It is known that with regular examinations and screenings, early diagnosis of breast and cervical cancer increases the chance of treatment.
International studies show that women face barriers and difficulties in accessing reproductive health and cancer screening services. In the study of Horner-Johson et al., it was stated that especially rural women with disabilities had lower mammography and Pap-smear tests compared to non-disabled women. It is emphasized that as a result of lower screening participation of persons with disabilities, there is a higher risk of cancer mortality with delayed diagnosis.
In another study investigating the reasons why women with physical disabilities do not engage in preventive health services; time constraints and priorities, interactions between health professionals and women with disabilities, lack of knowledge, belief, sensitivity, belief that people with disabilities have more information than service providers, economic problems, transportation problems, appointment problems, availability of accessible facilities, physical pain, mammography, pap smear It has been stated that factors such as both psychological and physical discomfort during the test and pelvic examination are effective.
In recent years, the Health Belief Model (SIM) has been frequently used to examine the effect of health beliefs on cancer screening behaviors in women and to increase screening rates. The model explains the beliefs and attitudes that affect the behavior of individuals. The most basic components of the model are the perception of susceptibility, the perception of seriousness, the perception of benefit, the perception of obstacles, the health motivation and the perception of trust. The SIM recommends that if a person has a desire to prevent illness or a belief in recovery, he or she should take a specific health action to prevent illness as a positive behavior. In an interventional study conducted with Korean-American women to improve breast cancer screening, using SIM for early diagnosis and behavioral change, it was determined that the rate of mammography and Breast Self-Examination (BSE) application rates increased significantly. It has been emphasized that nurses have important roles and responsibilities in the protection and development of health, and that they can identify disabled individuals who are considered "fragile" and provide health education and counseling to these groups. It is thought that awareness training on cancers that are common in women, given under the guidance of the Health Belief Model, will bring the preventive health behavior of women with disabilities to the desired level. When the literature is examined, the limited number of randomized controlled studies that will increase the participation of disabled women in cancer screening services increases the importance of the subject.
Disabled women experience inequalities in benefiting from routine health services and health screening services in special areas such as reproductive health and protection from cancers that are common in women. Being diagnosed with cancer is undoubtedly devastating for anyone. For this reason, it becomes more important to raise awareness about the prevention, prevention and early diagnosis of cancers that are common in women with physical disabilities, to raise awareness on this issue and to encourage health-seeking behaviors.
This study was conducted to determine the barriers for women with physical disabilities between the ages of 18-65 to adopt behaviors to diagnose common cancers in women at an early stage, and to increase participation in early diagnosis behaviors in cancers that are common in women (Breast Self Examination (BSE), Clinical Breast Examination (CBE), Self-Examination). Vulva Self Examination (KKVM), Mammography and PapSmear Test) was planned to determine the effectiveness of awareness training based on SIM.
Study design
- Primary purpose
- Screening
- Allocation
- Randomised
- Intervention model
- Parallel groups
- Masking
- Double blind (participant, outcomes assessor)
- Number of arms
- 2
- Model description
- Randomized controlled experimental design
| Arm | Type | Receives |
|---|---|---|
| İntervention 1: Cancer awareness training based on the Health Belief Model | Experimental | Behavioral: HEALTH FAITH MODEL GUIDED IN CANCER FREQUENTLY SEEN IN WOMEN EARLY DIAGNOSIS AND SCREENING METHODS EDUCATIONAwareness training based on the Health Belief Model will be given to the participants in the Intervention 1 group during home visits in order to eliminate the lack of information about the common female cancers in women and to increase their awareness. For 3 months, intervention 1 group will be given applications to reinforce their awareness in the education based on the Health Belief Model (for BSE and KKVM, erasable calendar magnets, booklets, phone cases and accessories themed as "common cancers awareness in women" as a reminder, phone call) will be made. |
| İntervention 2: Standart cancer education | Experimental | Behavioral: STANDART CANCER EDUCATİONParticipants in the Intervention 2 group will be provided with the standard training applied at KETEM by the Ministry of Health on female cancers, which are frequently seen in physical women, during home visits. The training will be held in the form of power-point presentation, question and answer. For 3 months, intervention 2 groups will be applied to reinforce their awareness in standard education (sms reminder). |
Who may qualify
- Ages
- 18 to 65 years
- Sex
- Female only
- Healthy volunteers
- Accepted
- Age groups
- Adult, Older adult
Key inclusion criteria (11 listed)
- Being physically disabled
- Having a disability to perform KKMM and KKVM
- Being between the ages of 18-65 (since these are the age ranges at which screening is started),
- Being married or living with a spouse (for participation in cervical cancer screening),
- Not to do KKMM and KKVM regularly every month,
Key exclusion criteria (4 listed)
- Hearing impairment
- Being visually impaired
- Being mentally handicapped
- A physically disabled woman who gives up working at any stage of the study will be excluded from the study.
Eligibility is decided by the study team after screening; this overview does not establish that a patient qualifies. Full inclusion and exclusion criteria.
Interventions
| Intervention | Type | Arms |
|---|---|---|
| HEALTH FAITH MODEL GUIDED IN CANCER FREQUENTLY SEEN IN WOMEN EARLY DIAGNOSIS AND SCREENING METHODS EDUCATIONA total of 4 home visits and 2 phone calls will be made by giving awareness training based on the Health Belief Model to the participants in the Intervention 1 group in order to eliminate the lack of information about the common female cancers in women and to increase their awareness. For 3 months, intervention 1 group will be given applications to reinforce their awareness in the education based on the Health Belief Model (for BSE and KKVM, erasable calendar magnets, booklets, phone cases and accessories themed as "common cancers awareness in women" as a reminder, phone call) will be made | Behavioural | İntervention 1: Cancer awareness training based on the Health Belief Model |
| STANDART CANCER EDUCATİONThe participants in the intervention 2 group will be given the standard training applied by the Ministry of Health in KETEM for women's cancers during home visits, and a total of 4 home visits and 2 SMS reminders will be made. | Behavioural | İntervention 2: Standart cancer education |
Primary outcome
The Gynecological Cancers Awareness Scale
Time frame: 12 weeks
The Gynecological Cancers Awareness Scale consists of 41 questions in total, with a minimum of 41 and a maximum of 205 points that can be obtained from the scale. The increase in the scores obtained from the scale indicates that the awareness of gynecological cancer increases.
1 secondary outcome
Champion's Health Belief Model Scale for Breast Cancer and Screening
Time frame: 12 weeks
Results and safety
Results are not available in the source record.
Research links
- Official record on ClinicalTrials.govLast updated by the sponsor 31 May 2023.
- Individual participant dataSharing planned: No. It can be used in metaanalysis research, but provided that you receive an information mail.
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Referral and contact
AzTrials does not enrol participants or take referrals. Contact the study team or a site listed below; they decide who can take part. This study is not recruiting at the moment.
1 site in 1 country: see every site and its status.
Questions about this trial
What is this clinical trial studying?
A study testing HEALTH FAITH MODEL GUIDED IN CANCER FREQUENTLY SEEN IN WOMEN EARLY DIAGNOSIS AND SCREENING METHODS EDUCATION and STANDART CANCER EDUCATİON in people with Cancer, run by Yeşim KAYAPA at 1 site in Turkey (Türkiye).
The full registered description is in the About this study section and the official record.
Who may be eligible to take part?
The sponsor lists 11 inclusion and 4 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.
Is this clinical trial currently recruiting?
The record says: status not confirmed, as of the sponsor's last update on 31 May 2023. Status can change between updates, so confirm with the study contact before making plans.
Where is the study taking place?
The record lists 1 site in Turkey (Türkiye). Whether a site is taking part right now should be confirmed with that site. See every site.
What are the possible benefits and risks?
They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.
Are results available for this study?
Results are not available in the source record.
How can a doctor refer a patient or contact the research team?
Contact YEŞİM KAYAPA (+905426726220, ysmkyp@hotmail.com), or a site near the patient. AzTrials does not enrol participants or take referrals.
What does the primary outcome measure?
The Gynecological Cancers Awareness Scale (time frame: 12 weeks). It is what the study was designed to measure, not a finding.
Where can I read the original study information?
Does a listing mean the treatment is approved or proven to work?
No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.
How often is this information updated?
AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 31 May 2023.