Background Mobile phone ownership among women of reproductive age in western Kenya is not well described, and our understanding of its link with care-seeking behaviors is nascent. Understanding access to and use of mobile phones among this population as well as willingness to participate in mobile health interventions are important in improving and more effectively implementing mobile health strategies. Objective This study aims to describe patterns of mobile phone ownership and use among women attending cervical cancer screening and to identify key considerations for the use of SMS text message–guided linkage to treatment strategies and other programmatic implications for cervical cancer screening in Kenya. Methods This analysis was nested within a cluster randomized trial evaluating various strategies for human papillomavirus (HPV)–based cervical cancer screening and prevention in a rural area in western Kenya between February and November 2018. A total of 3299 women were surveyed at the time of screening and treatment. Questionnaires included items detailing demographics, health history, prior care-seeking behaviors, and patterns of mobile phone ownership and use. We used bivariate and multivariable log-binomial regression to analyze associations between independent variables and treatment uptake among women testing positive for high-risk HPV. Results Rates of mobile phone ownership (2351/3299, 71.26%) and reported daily use (2441/3299, 73.99%) were high among women. Most women (1953/3277, 59.59%) were comfortable receiving their screening results via SMS text messages, although the most commonly preferred method of notification was via phone calls. Higher levels of education (risk ratio 1.23, 95% CI 1.02-1.50), missing work to attend screening (risk ratio 1.29, 95% CI 1.10-1.52), and previous cervical cancer screening (risk ratio 1.27, 95% CI 1.05-1.55) were significantly associated with a higher risk of attending treatment after testing high-risk HPV–positive, although the rates of overall treatment uptake remained low (278/551, 50.5%) among this population. Those who shared a mobile phone with their partner or spouse were less likely to attend treatment than those who owned a phone (adjusted risk ratio 0.69, 95% CI 0.46-1.05). Treatment uptake did not vary significantly according to the type of notification method, which were SMS text message, phone call, or home visit. Conclusions Although the rates of mobile phone ownership and use among women in western Kenya are high, we found that individual preferences for communication of messages about HPV results and treatment varied and that treatment rates were low across the entire cohort, with no difference by modality (SMS text message, phone call, or home visit). Therefore, although text-based results performed as well as phone calls and home visits, our findings highlight the need for more work to tailor communication about HPV results and support women as they navigate the follow-up process.

Background To achieve the World Health Organization targets for cervical cancer elimination, low- and middle-income countries will need to develop innovative strategies to provide human papillomavirus (HPV)–based screening at a population level. Although mobile health (mHealth) interventions may help realize these goals by filling gaps in electronic specimen tracking and patient education, effective implementation of mHealth interventions is dependent upon context-specific development that is acceptable and usable by the target population. Detailed feedback should be gathered at the design and development stages to yield final products that reflect the needs, desires, and capabilities of target users. Objective The aim of this study is to develop an mHealth app (mSaada) to support HPV-based screening in partnership with community health volunteers (CHVs) and program planners in western Kenya. Methods A team of student programmers developed a prototype to meet previously identified gaps in screening: patient education, protocol support, data capture, and specimen tracking. The prototype was iteratively developed through 2 waves of in-person working sessions with quantitative (survey) and qualitative (in-depth interview) feedback. Research staff engaged key stakeholders from both urban and rural locations and with varying levels of experience in delivering screening services. During the sessions, participants completed simulation exercises and role-play activities to become familiar with the platform. Once feedback was gathered and synthesized after each wave of in-person data collection, developers implemented changes to improve mSaada functionality. Results A total of 18 CHVs and clinicians participated in the in-person sessions. Participants found mSaada useful, easy to use, and would meet the needs of CHVs to provide HPV-based cervical cancer screening (electronic data capture, client education resources, and specimen tracking). They provided key feedback to enhance user experience, workflow, and sustainability. Key changes included altering the appearance of the wireframes, adding translation in additional local languages, changing potentially insensitive figures, alphabetizing lengthy dropdown menus, adding clinically relevant logic checks when entering data, and incorporating the ability to make real time edits to client records. They also made recommendations for additional features that might enhance mSaada’s impact at the facility and health system levels, specifically the inclusion of a report-generating tool consistent with the Ministry of Health standards. Conclusions Using a process of iterative feedback with key stakeholders and rapid response from developers, we have developed a mobile app ready for pilot testing in HPV-based screening programs led by CHVs.

Background: To achieve the World Health Organization targets for cervical cancer elimination, low- and middle income countries must develop innovative strategies to provide human papillomavirus (HPV) -based screening at a population level. Mobile health may help fill gaps in electronic specimen tracking and patient education. We sought to develop a mobile health application (mSaada) to support HPV-based screening in partnership with community health volunteers and program planners in western Kenya. Methods: A team of student programmers developed a prototype to meet previously identified gaps in screening: patient education, protocol support, data capture and specimen tracking. The protoype was iteratively developed through three waves of in-person working sessions with quantitative and qualitative feedback, with planned improvements in mSaada functionality after each wave of in-person data collection. Results: Twelve Community Health Volunteers (CHVs) and clinicians took part in the in-person sessions. Participants found mSaada useful and easy to use. Key feedback was used to alter the appearance of the mainframes, add translation in additional local languages and change potentially embarrassing figures. Participants also suggested workflow design and technology needs necessary for sustainability. Conclusion: Using a process of iterative feedback with key stakeholders and rapid response from developers, we have developed a mobile application ready for pilot testing in HPV-based screening programs led by CHVs.

Purpose: Due to the rapid expansion of mobile phone usage throughout the world, mobile health (mHealth) technologies offer an innovative strategy to overcome challenges of care coordination and limited communication between pediatric cancer providers in LMICs. Our objective was to evaluate the use of the social media application WhatsApp to improve provider communication and outcomes for children diagnosed with Wilms tumor at a regional cancer treatment facility in Tanzania. Methods: A WhatsApp provider group was established in 2016 to facilitate communication between surgical, medical and psychosocial support providers at the regional cancer referral hospital in northern Tanzania. All messages exchanged from 2016-2019 were extracted and coded for thematic content. Treatment compliance and process outcomes were compared for patients discussed versus those that were not over the 4-year period. Results: A total of 669 messages for 55 patients were reviewed. Most messages were sent by the pediatric oncologist (44.8%, n=273) and urology resident (43.2%, n=263). Using the application to coordinate patient care reduced time to surgery from 90 days [IQR 65-109] to 60 days [IQR 47-80], and time to post-operative chemotherapy initiation from 46 days [IQR 39-55] to 19 days [IQR 16-30]. Rate of treatment abandonment was decreased for patients discussed in the chat group (26.7%) compared to those not discussed (38.2%). Conclusion: To our knowledge this is the first study to assess the use of WhatsApp to improve provider communication for children with cancer in LMICs. As access to smartphone technology and internet access improves, applications like WhatsApp can be used as a low-cost strategy to target health system inefficiencies and improve outcomes for children with cancer globally. Citation Format: John Igenge, Jacob Stocks, Gloria Zhang, Mocha George, Frank Kiwara, Judy Mafwimbo, Mastidia Maxmilian, Austin Wesevich, Kristin Schroeder. Use of WhatsApp to Improve Medical Provider Communication for Children with Wilms Tumor in Tanzania [abstract]. In: Proceedings of the 9th Annual Symposium on Global Cancer Research; Global Cancer Research and Control: Looking Back and Charting a Path Forward; 2021 Mar 10-11. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2021;30(7 Suppl):Abstract nr 112.

BACKGROUND Mobile phone ownership among women of reproductive age in western Kenya is not well-described and our understanding of its link with care-seeking behaviors is nascent. Understanding access to and use of mobile phones among this population, as well as willingness to take part in mhealth interventions, is important in improving and more effectively implementing mhealth strategies. OBJECTIVE We sought to describe patterns of mobile phone ownership and use among women attending cervical cancer screening, as well as to identify key considerations for the use of SMS-guided linkage to treatment strategies. METHODS This analysis was nested within a two-phase cluster-randomized trial evaluating varying strategies for HPV-based cervical cancer screening and prevention in a rural area of western Kenya. 3,299 women were surveyed at the time of screening and treatment. Questionnaires included items detailing demographics, health history, prior care-seeking behaviors, and patterns of mobile phone ownership and use. RESULTS Rates of mobile phone ownership and reported daily usage were high among women. The majority of women were comfortable receiving their screening results via SMS text message, although the most commonly preferred method of notification was via phone call. Higher levels of education, missing work to attend screening, and previous cervical cancer screening were significantly associated with a higher odds of attending treatment if hrHPV+. Those who shared a mobile phone were significantly less likely to attend treatment compared to those who owned a phone. CONCLUSIONS While rates of mobile phone ownership and daily use among women of reproductive age in western Kenya are high, there is a need for multi-pronged approaches to augment mhealth interventions to ensure equity for women without mobile connectivity or mobile phone access. Further research is needed in order to understand the usefulness of text-based interventions among this population as well as strategies to increase reach and appeal of text approaches.