Exploring the feasibility of using mobile phones to improve the management of clients with cervical cancer precursor lesions

Jennifer Moodley,Deborah Constant,Mariette Momberg,Matthys H Botha,Amanda Edwards,Frederick H Van Der Merwe

doi:10.1186/s12905-018-0702-1

Jennifer Moodley, Deborah Constant + Show 4 more

Open Access

https://doi.org/10.1186/s12905-018-0702-1

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Abstract

BackgroundCancer screening programs hold much potential for reducing the cervical cancer disease burden in developing countries. The aim of this study was to determine the feasibility of mobile health (mHealth) phone technology to improve management and follow-up of clients with cervical cancer precursor lesions.MethodsA sequential mixed methods design was employed for this study. Quantitative data was collected using a cross-sectional survey of 364 women eligible for a Pap smear at public sector health services in Cape Town, South Africa. Information was collected on socio-demographic status; cell phone ownership and patterns of use; knowledge of cervical cancer prevention; and interest in Pap smear results and appointment reminders via SMS-text messages. Descriptive statistics, crude bivariate comparisons and logistic regression models were employed to analyze survey results. Qualitative data was collected through 10 in-depth interviews with primary health care providers and managers involved in cervical cancer screening. Four focus group discussions with 27 women attending a tertiary level colposcopy clinic were also conducted. Themes related to loss of mobile phones, privacy and confidentiality, interest in receiving SMS-text messages, text language and clinic-based management of a SMS system are discussed. Thematic analyses of qualitative data complemented quantitative findings.ResultsPhone ownership amongst surveyed women was 98% with phones mostly used for calls and short message service (SMS) functions. Over half (58%) of women reported loss/theft of mobile phones. Overall, there was interest in SMS interventions for receiving Pap smear results and appointment reminders. Reasons for interest, articulated by both providers and clients, included convenience, cost and time-saving benefits and benefits of not taking time off work. However, concerns were expressed around confidentiality of SMS messages, loss/theft of mobile phones, receiving negative results via SMS and accessibility/clarity of language used to convey messages. Responsibility for the management of a clinic-based SMS system was also raised.ConclusionsResults indicated interest and potential for mHealth interventions in improving follow-up and management of clients with abnormal Pap smears. Health system and privacy issues will need to be addressed for mHealth to achieve this potential. Next steps include piloting of specific SMS messages to test feasibility and acceptability in this setting.

Highlights

Cancer screening programs hold much potential for reducing the cervical cancer disease burden in developing countries
Against a backdrop of growing access to, and increasing enthusiasm for, the use of mobile health (mHealth), this study explored the feasibility of using mobile phones to improve the management and follow-up of clients with cervical cancer precursor lesions in Cape Town, South Africa (SA)
Qualitative data complemented the interpretation of quantitative data and was collected through in-depth interviews (IDIs) with primary health care providers and managers and focus group discussions (FGDs) with first time colposcopy clinic attendees

Summary

Introduction

Cancer screening programs hold much potential for reducing the cervical cancer disease burden in developing countries. South Africans continue to face one of the worst human immunodeficiency virus (HIV) epidemics in the world with approximately one fifth of South African woman between 15 and 49 years currently living with the disease [4] These women are at increased risk for human papillomavirus (HPV) infection, the underlying cause of cervical cancer; cervical precancerous lesions and; cervical cancer [5, 6]. A Papanicolaou (Pap) smear has long been regarded as an effective cytology-based screening tool to detect precancerous cervical abnormalities [7]. Further investigation of these abnormalities typically includes assessment with a magnifying instrument (a colposcope) that enables good visualization of the cervix. In developing countries, cervical cancer remains a persistent concern due to ineffective or absent screening programs, lack of awareness, health system challenges and resource constraints [7, 9,10,11]

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