BackgroundIn Chile, more than 500 women die every year from cervical cancer, and a majority of Chilean women are not up-to-date with their Papanicolau (Pap) test. Mobile health has great potential in many health areas, particularly in health promotion and prevention. There are no randomized controlled trials in Latin America assessing its use in cervical cancer screening. The ‘Development of Mobile Technologies for the Prevention of Cervical Cancer in Santiago, Chile’ study aims to determine the efficacy of a text-message intervention on Pap test adherence among Chilean women in the metropolitan region of Santiago.Methods/designThis study is a parallel randomized-controlled trial of 400 Chilean women aged 25–64 who are non-adherent with current recommendations for Pap test screening. Participants will be randomly assigned to (1) a control arm (usual care) or (2) an intervention arm, where text and voice messages containing information and encouragement to undergo screening will be sent to the women. The primary endpoint is completion of a Pap test within 6 months of baseline assessment, as determined by medical record review at community-based clinics. Medical record reviewers will be blinded to randomization arms. The secondary endpoint is an evaluation of the implementation and usability of the text message intervention as a strategy to improve screening adherence.DiscussionThis intervention using mobile technology intends to raise cervical cancer screening adherence and compliance among a Chilean population of low and middle-low socioeconomic status. If successful, this strategy may reduce the incidence of cervical cancer.Trial registrationClinicaltrials.gov NCT02376023 Registered 2/17/2015.First participant enrolled Feb 22nd 2016.Electronic supplementary materialThe online version of this article (10.1186/s12885-017-3870-8) contains supplementary material, which is available to authorized users.

Introduction: Cervical cancer is a serious public health problem. An estimated 270,000 women die every year from cervical cancer and more than 85% of these deaths take place in developing countries. Chile´s national cervical cancer program was created in 1987. Since then, and with the systematic implementation of cervical cancer screening through Papanicolau (Pap) smears, cervical cancer mortality rates have dropped significantly. Cancer screening rates, however, have stabilized in the last 10 years at approximately 59%. Additionally, most late-stage cervical cancers are diagnosed in low-socioeconomic-status (SES) Latinas. Mobile technologies may have use in improving health disparities due to their widespread availability. In Chile, more than 80% of low-SES people own a cell phone. Nevertheless, developing an effective mHealth intervention may require tailoring and adjusting of available technology in developing countries. The aim of this study was to describe key aspects of an mHealth intervention to be used in Latinas from an underserved area of Santiago, Chile. Methods: We held 9 focus groups at three health care centers with Latinas between 25-64 years old and midwives. Focus groups were recorded, and transcribed verbatim. We analyzed and coded the data grouping findings into relevant themes. With these findings, we developed a customized mHealth intervention that is now being tested using a randomized controlled trial (RCT) in a vulnerable area of Santiago, Chile. Results: Development: The results of our study revealed key aspects to consider for the final intervention: We asked about mode of delivery, content, frequency, and duration of the ideal intervention. Mode of delivery: Although younger women preferred texting and other “indirect” modes of communication, older women were not as savvy with reading texts--their preferred method of contact was a phone call. Content: Women agreed that messages needed to be clear and written in simple language. They would like the messages to have information about cervical cancer, as well as Pap smear availability at their health care centers. Frequency and duration of the intervention: Women mentioned the messages should be sent every week and no more than two times a week. They would like the messages to alternate being sent during weekends and weekday evenings to allow for sufficient time to read them. Previous studies had shown that a duration of 6 months would be effective to promote change in screening behavior. The final intervention was designed with the following characteristics: 1. Four months of text messages and two months of automated phone calls; 2. Twice a week on Wednesday and Sunday evenings; 3. Two types of messages: Information about cervical cancer and clinic hours, scheduling procedures, etc. Implementation: We planned to deliver the text and phone messages using a custom web platform connected to a generic SMS gateway provider. Lack of close relations between two such providers and Chilean mobile carriers generated profound disruptions in the reliability with which messages were sent during testing. After an iterative trial-and-error we settled for our current provider, which is delivering messages for our clinical trial without major issues. Conclusions: Developing and implementing an effective mHealth intervention requires tailoring according to cultural, socioeconomic, and educational characteristics of the population as well as knowledge of the technology available in every country. Transferring technologies proven easy to implement in developed countries is not as straightforward as it may seem. Our intervention is currently being tested through a RCT in a vulnerable population of Santiago, Chile. We hope to learn more about the implementation of such technologies in vulnerable populations, thus improving cancer screening rates across the country. Citation Format: Javiera Martinez Gutierrez, Daniel Capurro, Francis Ciampi, Mauricio Soto, Mackenzie C. Momany, Emilia Cea, Tania Mergudich, Klaus Puschel. Developing and implementing an mHealth intervention for cervical cancer prevention in Santiago, Chile [abstract]. In: Proceedings of the Tenth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2017 Sep 25-28; Atlanta, GA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2018;27(7 Suppl):Abstract nr C74.

Background: Mobile technology uptake has increased exponentially in the past years; in 2009, mobile telephones could be found in more than 90% of Chilean homes and are widely distributed across all socioeconomic levels. Because of this technological explosion, mobile health (mHealth), or medical and public health practice supported by mobile devices, has gained potential in many health areas such as cancer prevention. Chile has a very well organized Cervical Cancer Prevention Program, with universal coverage, and a centralized registry. Despite all efforts, more than 500 Chilean women die of cervical cancer each year and Papanicolau (Pap) adherence is lower than 60%. Like many other cancers sites, cervical cancer affects the most vulnerable and under-served women. An intervention based on mobile health might be able to narrow this gap by increasing cervical cancer screening in vulnerable Latinas. The aim of this study is to assess mobile use and barriers, facilitators and acceptability to an intervention based on text messaging to increase cervical cancer-screening rates in three health care centers of Santiago Chile. Methods: We held 9 focus groups at 3 under-served health care centers in Santiago Chile; 6 focus groups among 27 women between 25-64 years old and 3 among 11 midwifes working at the health care centers. Focus groups were conducted in Spanish, recorded, and transcribed verbatim. Our research team analyzed and coded the data grouping findings into relevant themes. Results: Regarding mobile use, older women (44 to 65 years) in our study used their phones mainly to keep in touch and receive news from family and friends. Most women did not call or send messages for two main reasons: a. Most women owned prepaid phones and did not have the money to be able perform such tasks. b. Some women did not know how to check or answer a text message. Younger women (25 to 44 years) were more prone to use cell phones for different tasks such as navigating the Internet, using chat apps and making calls through Wi-Fi if they did not have the money to pay for their calls. Acceptability: Most women mentioned liking the idea of receiving messages regarding their health. They mentioned they would have to be written in simple language and the content be general enough to respect confidentiality. They would like the messages to have information regarding cervical cancer and days and hours for them to be able to get the Pap at their health care centers. They would also like to receive reminders of their scheduled Pap appointments. Older women mentioned they preferred to get phone calls from their provider or even automated calls rather than text messages. Providers were also very prone to the idea of a text message intervention since it would increase cervical cancer screening rates and would make their jobs easier. Facilitators to the implementation of a strategy based on text messages were easy access to the technology and better communication with the health care team. Potentials barriers were: Switching cell phone number rather frequently. They find it easier to buy prepaid cell phones each time rather than keep their number and get a cell phone plan. Also, male providers and the need to schedule an appointment for their Pap rather than getting it instantly whenever they arrive at the health care center were mentioned as organizational barriers. Conclusions: Cell phone use is widely spread in the Chilean population. An intervention based on text messaging might help increase cervical cancer-screening rates in Santiago, Chile. Women and providers were prone to accept an intervention using mHealth. Facilitators and barriers described such as availability of cell phones, difficulty to operate messages and use of prepaid phones need to be considered when planning an mHealth intervention for cancer prevention. Citation Format: Javiera Martinez-Gutierrez, Mauricio Soto, McKenzie Momany, Francis Ciampi, Daniel Capurro, Emilia Cea, Klaus Puschel. “Messages for your health”: Mobile use and cancer prevention for underserved Latinas in Santiago, Chile. [abstract]. In: Proceedings of the Eighth AACR Conference on The Science of Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; Nov 13-16, 2015; Atlanta, GA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2016;25(3 Suppl):Abstract nr B77.

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