Abstract
BackgroundAlthough Hispanic women have the highest cervical cancer incidence rate, African American women account for a disproportionate burden of cervical cancer incidence and mortality when compared with non-Hispanic white women. Given that religion occupies an essential place in African American lives, delivering health messages through a popular communication delivery channel and framing them with important spiritual themes may allow for a more accessible and culturally appropriate approach to promoting cervical cancer educational content to African American women.ObjectiveThe aim of this paper was to describe the design and development of the CervixCheck project, a spiritually based short message service (SMS) text messaging pilot intervention to increase cervical cancer awareness and Papanicolaou test screening intention among church-attending African American women aged 21 to 65 years.MethodsThrough focus group interviews (n=15), formative research was conducted to explore facilitators, motivators, and barriers to cervical cancer screening. The interviews were also used to identify logistical factors that should be considered when developing the CervixCheck intervention. Culturally appropriate and spiritually grounded SMS text messages were developed based on the analysis of focus group data and the review of previous studies that incorporated technology into health behavior change interventions. After the CervixCheck intervention was developed, cognitive response interviews (n=8) were used to review the content of the SMS text messaging library, to ensure that the content was acceptable and understandable, particularly for church-attending African American women aged 21 to 65 years.ResultsDesign and development of the SMS text messages involved consideration of the content of the messages and technological specifications. Focus group participants overwhelmingly reported cell phone use and an interest in receiving spiritually based SMS text messages on cervical cancer prevention and early detection. Findings from the cognitive response interviews revealed that the content of the SMS text messaging library was acceptable and understandable with the target population. The revised SMS text messaging library currently includes 22 messages for delivery over 16 days, averaging 11 texts per week, with no more than two messages delivered per day. Initial usability testing also showed early feasibility.ConclusionsThe design and development of the CervixCheck intervention provides important insight into what may be considered an overlooked minority population and missed opportunity in health information technology research. With increased internet penetration through the use of mobile phones, it is appropriate to investigate the viability of technology as a means to reach minority communities and to reduce health disparities.
Highlights
Cervical cancer incidence and mortality rates have drastically decreased in the United States over the last few decades [1,2], because of Papanicolaou (Pap) testing, some populations still continue to bear a larger burden of the disease [1,3,4]
This paper reports on the design and development of the CervixCheck project, a spiritually based short message service (SMS) educational pilot intervention aimed at increasing cervical cancer awareness and Pap test screening intention among church-attending African American women aged 21 to 65 years
This paper reports on formative research conducted to inform the development of an automated one-way SMS text messaging intervention to disseminate cervical cancer prevention and early detection education
Summary
Background Information cervical cancer incidence and mortality rates have drastically decreased in the United States over the last few decades [1,2], because of Papanicolaou (Pap) testing, some populations still continue to bear a larger burden of the disease [1,3,4]. When compared with white women in the general population, African American women have a 34% higher incidence of cervical cancer and are twice as likely to die of the disease in the United States [1,3,4]. Despite the similarities in cancer screening habits between African American and white women, the former is still more likely to be diagnosed with advanced stage of cervical cancer [4,5,6] These racial differences are evident, several studies have indicated that race is not a predictor of cervical cancer; the effect of race diminishes as other factors such as education and socioeconomic status are taken into account [5,7]. Given that religion occupies an essential place in African American lives, delivering health messages through a popular communication delivery channel and framing them with important spiritual themes may allow for a more accessible and culturally appropriate approach to promoting cervical cancer educational content to African American women
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