Acceptability and implementation challenges of smartphone-based training of community health nurses for visual inspection with acetic acid in Ghana: mHealth and cervical cancer screening

Abstract

ObjectiveTo explore acceptability and feasibility of smartphone-based training of low-level to mid-level health professionals in cervical cancer screening using visual inspection with acetic acid (VIA)/cervicography.DesignIn 2015, we applied a qualitative descriptive approach and conducted semi-structured interviews and focus groups to assess the perceptions and experiences of community health nurses (CHNs) (n=15) who performed smartphone-based VIA, patients undergoing VIA/cryotherapy (n=21) and nurse supervisor and the expert reviewer (n=2).SettingCommunity health centres (CHCs) in Accra, Ghana.ResultsThe 3-month smartphone-based training and mentorship was perceived as an important and essential complementary process to further develop diagnostic and management competencies. Cervical imaging provided peer-to-peer learning opportunities, and helped better communicate the procedure to and gain trust of patients, provide targeted education, improve adherence and implement quality control. None of the patients had prior screening; they overwhelmingly accepted smartphone-based VIA, expressing no significant privacy issues. Neither group cited significant barriers to performing or receiving VIA at CHCs, the incorporation of smartphone imaging and mentorship via text messaging. CHNs were able to leverage their existing community relationships to address a lack of knowledge and misperceptions. Patients largely expressed decision-making autonomy regarding screening. Negative views and stigma were present but not significantly limiting, and the majority felt that screening strategies were acceptable and effective.ConclusionsOur findings suggest the overall acceptability of this approach from the perspectives of all stakeholders with important promises for smartphone-based VIA implementation. Larger-scale health services research could further provide important lessons for addressing this burden in low-income and middle-income countries.

Evaluating smartphone strategies for reliability, reproducibility, and quality of VIA for cervical cancer screening in the Shiselweni region of Eswatini: A cohort study

“…Many sub-Saharan countries have already implemented a healthcare system in which community health workers and nurses deliver primary care. With inexpensive smartphones equipped with quality digital cameras, cervicography no longer requires complex and expensive equipment [15][16][17]22]. To improve the sustainability, transportability, and scalability of the intervention effect, the program nurses served as trainers and provided mentorship to MoH nurses in a total of 30 facilities.…”

“…Barriers to cervical cancer screening include lack of a nonphysician health workforce and infrastructure for follow-up [9,12]. Task shifting by training nurses in VIA has been effective in low-resource settings [13][14][15][16][17][18], but there are major barriers including lack of comprehensive training of nonphysician health workers and opportunities for repeated training [18][19][20][21]. This contributes to a decline in diagnostic and management accuracy over time [19,20].…”

Digital Health Strategies for Cervical Cancer Control in Low- and Middle-Income Countries: Systematic Review of Current Implementations and Gaps in Research

“…The review focused on LMICs: 19 studies were conducted in sub-Saharan Africa [ 30 , 31 , 34 - 39 , 42 - 46 , 50 , 52 , 54 - 56 , 59 ], 7 in Asia [ 32 , 33 , 40 , 47 - 49 , 51 , 53 , 58 ], and 1 in South America [ 41 ].…”

“… a Scores of 1, 2, and 3 indicate low, moderate, and high risks of bias, respectively. The risk of bias was assessed cumulatively for studies with multiple sources, for example, Asgary et al [ 30 , 31 ]. b N/A: not applicable.…”

“…For example, we found 3 studies that aimed to increase the demand for screening by increasing women’s knowledge of human papillomavirus or cervical cancer. c Some studies were associated with multiple records, for example, Asgary et al [ 30 , 31 ]. …”