Abstract
BackgroundIn Chile and Latin America, cervical cancer disproportionately affects women of low socioeconomic status. Mobile technology (mobile health, mHealth) may be able to address this disparity by targeting women in underserved populations. However, there is a lack of information regarding barriers to the implementation of mHealth interventions in underserved populations.ObjectiveThe objective of this study was to investigate the use of cell phones and text messaging (short message service, SMS) in Latina women from disadvantaged communities to design an mHealth intervention for improving cervical cancer screening rates.MethodsWe conducted 9 focus groups among women aged 25-64 years to better understand the implementation barriers and perceptions of a text message (SMS)–based intervention designed to improve cervical cancer screening rates. We used the PRECEDE-PROCEED model to categorize identified themes using template analysis.ResultsFocus group results indicated that older women use mobile phones to receive calls from family and friends but seldom send text messages. Furthermore, they prefer personal contact with their health care providers regarding Papanicolaou (Pap) testing. Younger women, on the other hand, find text messaging easy to use and frequently send texts to family and friends. Importantly, women of all ages mentioned they would like to receive text messages about Pap tests. Factors that facilitate the uptake of the intervention include ease of access to Pap testing, inclusion of family members, and reminder messaging. Potential barriers include cost and the impersonal nature of messaging. Health team members support an mHealth intervention even though they acknowledge the potential barriers to this strategy. Overall, these results support the implementation of an mHealth intervention to increase cervical cancer screening rates.ConclusionsThis study describes the opinions of women nonadherent to Pap testing on the potential use of mobile technologies for cervical cancer screening. Although the overall acceptance was positive, older women prefer personal contact and phone calls over text messaging. Information surrounding these preferences will aid in the implementation of effective strategies to improve cancer screening in underserved populations.
Highlights
Cervical-uterine cancer is the fourth oncological cause of death in Chile with a mortality rate of 6/100,000 women in 2012
Health team members support an mobile health (mHealth) intervention even though they acknowledge the potential barriers to this strategy
These results support the implementation of an mHealth intervention to increase cervical cancer screening rates
Summary
Cervical-uterine cancer is the fourth oncological cause of death in Chile with a mortality rate of 6/100,000 women in 2012. This rate is well above that in developed countries (Canada: 1.71/100,000 women; United States: 2.7/100,000 women) [1]. Studies in Chile have shown marked inequalities in cancer mortality rates between women with low and high educational levels [2]. Since 1965, the peak cervical cancer screening adherence rate in Chile has been 67%, far from the international recommendation of 80%. In Latin America, factors associated with screening adherence include access to health insurance and high socioeconomic status, while factors associated with nonadherence (in women with preinvasive cervical lesions) include concern about the procedure, time constraints, and lack of knowledge. There is a lack of information regarding barriers to the implementation of mHealth interventions in underserved populations
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