Developing a culturally tailored short message service (SMS) intervention for improving the uptake of cervical cancer screening among Ghanaian women in urban communities

Abstract

Background There has been extensive research across the globe to understand the barriers and facilitators of cervical cancer (CC) screening. However, few studies have focused on how such information has been used to develop text messages for mHealth screening programs, especially in resource-poor countries. This study elicited information on barriers and facilitators, the preferences of women regarding the modalities for delivery of health SMS messages on screening for cervical cancer, and demonstrates how this information was used to create a health screening program among women in the Greater Accra Region of Ghana. Methods Four main activities were carried out, including (1) a total of five focus group discussions, (2) a baseline survey involving 62 female bankers and 68 women from the communities, (3) a stakeholder meeting involving experts in cervical cancer research and clinical care, and (4) pilot testing of the text messages. Focus group discussions and the baseline survey data were collected concurrently between February and May 2017 and the results were used to develop 5 specific communication objectives during the stakeholder engagements held in June 2017. Results In all, 32 text messages were developed and pretested in July 2017(13 addressed knowledge on CC; 6 highlighted the importance of early detection; 5 allayed fear as a barrier to CC screening; 5 encouraged women to have time for their health, and 3 messages contained information on where to go for screening and the cost involved). Although awareness about the disease was high, knowledge of CC screening was low. For two-thirds of respondents (22/33), perceived lack of time, high cost, and fear (of cc, screening procedure, and potential for negative outcome) accounted for the reasons why respondents will not go for screening, while education on CC, especially from health workers and the mass media enabled uptake of CC screening. Conclusion Several factors prevent women from accessing screening services for CC, however, barriers such as low levels of education on CC, lack of time, and fear can be targeted in SMS messaging programs.

Effectiveness of a culturally tailored text messaging program for promoting cervical cancer screening in accra, Ghana: a quasi-experimental trial

“…A qualitative study of cervical cancer screening attendance among 15 HPV-positive Tanzanian women who had previously participated in a study evaluating the effectiveness of one-way text messaging on attendance to follow-up cervical cancer screening found that fear of gynecologic examination, as well as long waiting times at the clinic and transportation to screening sites, were factors that hindered their women’s cervical cancer screening attendance [ 31 ]. As indicated by our research and other observational studies undertaken in Ghana [ 11 , 13 , 28 , 36 ] such impediments to cervical cancer screening are not uncommon.…”

“…This also implies that direct interaction with women and healthcare professional recommendations could impact cervical screening uptake. Indeed, multiple cross-sectional studies in Ghana [ 11 , 28 , 34 , 35 ] have shown professional guidance as a major facilitator of cervical cancer screening. A qualitative study of cervical cancer screening attendance among 15 HPV-positive Tanzanian women who had previously participated in a study evaluating the effectiveness of one-way text messaging on attendance to follow-up cervical cancer screening found that fear of gynecologic examination, as well as long waiting times at the clinic and transportation to screening sites, were factors that hindered their women’s cervical cancer screening attendance [ 31 ].…”

“…Women between the ages of 18 and 39, with at least one personal phone and the ability to read text messages, were eligible to participate. Bonful et al [ 28 ] explain in greater detail the baseline survey, the inclusion and exclusion criteria, and other aspects of the intervention design.…”

“…Given that the intervention was meant to be culturally tailored for our study population, data from the baseline survey were combined with qualitative formative data from focus group discussions on issues that should be taken into account by researchers and other relevant stakeholders in the design of SMS messages for promoting the uptake of screening services [ 28 ]. The content, preferred delivery time, frequency, and duration of texts were the primary elements explored when developing mobile text messaging.…”

Mobile Health Interventions for Cancer Care and Support: The Next Level of Digitalization in Healthcare?

“…Consequently, academic research on the efficacy and efficiency of mHealth interventions for cancer management has gained momentum. Such applications have focused on providing information and support to patients, survivors, and their caregivers through various methods, such as mobile apps [7,14,15] and SMS-based interventions [16][17][18]. For example, a recent study developed and tested the TouchStream app's feasibility for delivering geriatric assessment (GA)-driven interventions to older individuals with cancer [19].…”