Impact of Mobile Technologies on Cervical Cancer Screening Practices in Lagos, Nigeria (mHealth-Cervix): A Randomized Controlled Trial

Health Behavior Change Interventions Using Mobile Phones: A Meta-Analysis

The technological capabilities of mobile phones have made them a useful tool for delivering interventions, but additional research is needed to determine the mechanisms underlying the comparative effectiveness of mobile health interventions. This meta-analysis analyzes the relative effectiveness of mobile phone-based health interventions relative to comparison/control groups (e.g., eHealth interventions, standard of care, etc.), the utility of the theory of planned behavior in mobile phone-based health interventions, and the roles of various moderators. One hundred eighteen studies met inclusion criteria and contributed to an overall effect size of d = 0.27 (95% CI [.22, .32]). Findings indicate that mobile phone-based health interventions are significantly more effective than comparison/control conditions at improving health behaviors. Additionally, perceived behavioral control was a significant moderator providing some support for the usefulness of theory of planned behavior in mobile phone-based health interventions.

Text messaging intervention for Pap smear uptake: a single-institution study

Cervical cancer continues to be one of the leading causes of death among women in many parts of the world. With the increasing proliferation of mobile technology, text messaging interventions have been effective in improving Pap smear uptake in non-United States populations. This study evaluated whether text message reminders from a health system in Galveston, Texas, USA increased uptake of cervical cancer screening as compared to usual care. A single text message reminder was sent to 16,002 unique patient phone numbers using the Televox Communication Program from February 20, 2019, to April 4, 2019. The institution's population health database was subsequently used to determine if patients received cervical cancer screening (Pap smear) following the text message transmission. Patient demographics within text message and control groups were compared using Chi-square tests. Our text messaging intervention to improve Pap smear rates did not show a statistically significant difference between the intervention group receiving a text message and the control. However, there were significant interactions between text messages and age, financial class, and county (P=0.0023, 0.0299, and <0.0001, respectively). Text messaging did have a positive impact on our most vulnerable patient populations given that the text messaging intervention showed a marginally higher rate of Pap smear among Medicaid and low-income/uninsured (MLIU) patients. Text messaging interventions do have effectiveness in increasing Pap smear uptake in populations which are most impacted by health disparities.

Impact of the COVID-19 Pandemic on Cancer Screening Delays

PURPOSE

To examine delays in cancer screenings during the COVID-19 pandemic.

METHODS

Participants from previous studies (N = 32,989) with permissions to be recontacted were invited to complete a survey between June and November 2020. Participants (n = 7,115) who met the age range for cancer screenings were included. Participants were asked if they planned to have and then if they postponed a scheduled mammogram, Pap test, stool blood test, colonoscopy, or human papillomavirus (HPV) test. Logistic regression was used to determine the factors associated with cancer screening delays for each planned test.

RESULTS

The average age was 57.3 years, 75% were female, 89% were non-Hispanic White, 14% had public insurance, and 34% lived in rural counties. Those who planned cancer screenings (n = 4,266, 60%) were younger, more likely to be female, with higher education, had private insurance, and lived in rural counties. Specifically, 24% delayed a mammogram (n = 732/2,986), 27% delayed a Pap test (n = 448/1,651), 27% delayed an HPV test (n = 59/220), 11% delayed a stool blood test (n = 44/388), and 36% delayed a colonoscopy (n = 304/840). Age, race/ethnicity, education, and health insurance were associated with delays in cancer screenings (all P < .05). Compared with non-Hispanic White women, non-Hispanic Black women had lower odds of delaying a mammogram (odds ratio [OR], 0.60; 95% CI, 0.39 to 0.94), Hispanic women had higher odds of delaying Pap test (OR, 2.46; 95% CI, 1.34 to 4.55), and women with other race/ethnicity had higher odds of delaying both Pap test (OR, 2.38; 95% CI, 1.41 to 4.02) and HPV test (OR, 5.37; 95% CI, 1.44 to 19.97).

CONCLUSION

Our findings highlighted the urgency for health care providers to address the significant delays in cancer screenings in those most likely to delay. Strategies and resources are needed to help those with barriers to receiving guideline-appropriate cancer screening.

Barriers and facilitators to cervical cancer screening among under-screened women in Cuenca, Ecuador: the perspectives of women and health professionals

Background

Cervical cancer screening is a cost-effective method responsible for reducing cervical cancer-related mortality by 70% in countries that have achieved high coverage through nationwide screening strategies. However, there are disparities in access to screening. In Ecuador, although cervical cancer is the second most common cancer in women, only 58.4% of women of reproductive age have ever been screened for cervical cancer.

Methodology

A qualitative study was performed to understand the current barriers to screening and to identify strategies that could increase uptake in Azuay province, Ecuador. Seven focus group discussions (FGDs) were conducted with under-screened women and health professionals (HPs). The FGDs were recorded and transcribed. Content analysis was done using the socio-ecological framework to categorize and analyse the data.

Results

Overall, 28 women and 27 HPs participated in the study. The two groups perceived different barriers to cervical cancer screening. The HPs considered barriers to be mainly at the policy level (lack of a structured screening plan; lack of health promotion) and the individual level (lack of risk perception; personal beliefs). The women identified barriers mainly at organizational level, such as long waiting times, lack of access to health centres, and inadequate patient–physician communication. Both groups mentioned facilitators at policy level, such as national campaigns promoting cervical cancer screening, and at community and individual level, including health literacy and women’s empowerment.

Conclusions

The women considered access to health services the main barrier to screening, while the HPs identified a lack of investment in screening programmes and cultural patterns at the community level as major obstacles. To take an integrated approach to cervical cancer prevention, the perspectives of both groups should be taken into account. Additionally, new strategies and technologies, such as self-administered human papillomavirus (HPV) testing and community participation, should be implemented to increase access to cervical cancer screening.

The effectiveness of health education interventions on cervical cancer prevention in Africa: A systematic review

Low levels of knowledge and awareness on cervical cancer play a role in limiting cervical cancer prevention uptake. This systematic review aimed to identify effective educational interventions to increase cervical cancer awareness, knowledge, and subsequently screening or vaccination uptake in African women. A literature search was conducted in Medline and EMBASE databases. We examined original, peer-reviewed English literature published between 2005 and 2020. Nineteen studies examining health education interventions' impact on awareness, knowledge, and screening or vaccination uptake in African women were included. Ten studies were controlled trials, nine performed pre- and post-measurements in one group. Most studies were published between 2015 and 2020 (86%), many were from Nigeria (47%). Studies were mostly set up in communities and schools. The most frequently used intervention was lectures, alone or combined with videos and practical demonstrations. Sixteen studies evaluated knowledge or awareness, and all showed a statistically significant improvement following the intervention. Of the ten studies that evaluated screening uptake, either as the single outcome or combined with knowledge or awareness, six found a significant rise in screening uptake after intervention. Educational interventions increased knowledge and awareness in African women, some boosted uptake of cervical cancer screening, especially when using peer health educators and culturally tailored methods. Innovative approaches such as self-collected HPV testing and mHealth also demonstrated a potential to increase uptake of screening. More research is needed to identify and analyse barriers to screening uptake, which can still be present even after a successful educational intervention.