Mobile Phone Ownership and Use Among Women Screening for Cervical Cancer in a Community-Based Setting in Western Kenya: Observational Study

Abstract

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.

Integrating human papillomavirus testing as a point-of care service using GeneXpert platforms: Findings and lessons from a Kenyan pilot study (2019–2020)

“…Although the community strategy was involved in creating awareness and supporting self-sample collection, other approaches such as use of mobile platforms to reach the targeted population and create awareness were not deployed and/or sustained during the pilot. A study in Kenya found that >70% of women reported ownership and daily use of a mobile phone, and 60% indicated that they would be comfortable receiving results via text messaging [ 27 ]. Another explanation could be logistical challenges, that caused periodic stock-outs of HPV testing commodities in some centers during the pilot.…”

The impact of text message reminders on uptake of cryotherapy among women testing positive for HPV in western Kenya

“…(22,23) As part of a trial of implementation strategies for cervical cancer screening, our team introduced text messaging to deliver HPV test results and follow-up plans to women screened in western Kenya. (24,25) We found that while this was a popular and e cient method of results delivery, it did not result in higher rates of treatment uptake when compared with noti cation through phone calls or home visits. From individual interviews at the time of treatment, we found that women wanted more clear and personalized information when receiving their results.…”

The impact of text message reminders on cryotherapy uptake among women testing positive for HPV in western Kenya: a prospective cohort study

“…As part of a two-phase trial of implementation strategies for cervical cancer screening in western Kenya, our team introduced text messaging to deliver HPV test results and follow-up plans to women [ 24 , 25 ]. In the first phase, while text messaging was a popular and efficient method of results delivery, it did not result in higher rates of treatment uptake when compared with notification through phone calls or home visits.…”