The development of a culturally-informed cervical cancer screening and prevention mhealth intervention for African American women.

Background: Significant strides have been made in reducing the burden of cervical cancer and HPV. Between pap smear screenings and HPV vaccinations, there has been a reduction in cervical cancer incidence in the United States. Unfortunately, those reductions have not been experienced by all ethnic groups. Cervical cancer disparities are a threat to the health of African American women, and innovation in education and the healthcare experience is needed to eliminate this threat. This study aimed to develop and evaluate a culturally tailored intervention using mHealth services to improve cervical cancer and HPV knowledge. Methods: The development and evaluation of this mHealth intervention involved two phases. The first phase included the culturally tailoring of health messages using a community advisory board of African American women. By meeting in person and virtually, the women were able to tailor twenty-four messages to be disseminated using mHealth. The second phase of this study involved testing of the intervention and evaluation. African American women were recruited and then assessed on their baseline knowledge of cervical cancer and their experiences of discrimination in medical settings. Participants were then assigned to either the control or intervention group. Those in the intervention group received health messages three times a week for four weeks on their mobile phones. After four weeks had passed, both the control and intervention group were reassessed on their cervical cancer knowledge. mHealth was evaluated for its acceptability, appropriateness, and feasibility using three evaluation measures and qualitative interviews. Results: Forty-eight women were recruited for this study, with non-random assignment of twenty-five to the intervention group and twenty-three to the control. The baseline scores on the cervical cancer awareness measure indicated a need for education in both groups. Additionally, all participants expressed having experienced some form of discrimination in medical settings. Using a paired-samples t-test the complete-case analysis shows an improvement in cervical cancer knowledge for women in the intervention group. Conclusions: mHealth intervention shows potential in educating African American women about cervical cancer and HPV. Using mobile phone technology allowed the women to be educated at their convenience and to return to the material later. Future research and practice should consider using the mHealth intervention with hard-to-reach populations or as educational material along with appointment reminders

Utilizing mHealth technology to increase HPV knowledge and HPV vaccine uptake in adolescents: A qualitative study

This study sought to identify communication preferences for tailoring mHealth interventions on HPV and what information in messaging should be included to increase HPV education, vaccination and schedule adherence among youth. A convenient sample of 210 students answered an online survey. Participants were 18 – 25 years old (88%), female (85.6%), Caucasian (60%), never been diagnosed with HPV (92.9%) and completed all 3 doses (61.6%). Our respondents were initially hesitant to use SMS text messages and mobile apps for HPV primarily due to privacy, memory and data cost concerns but thought the personalization options would increase message saliency and information trustworthiness if sent by a healthcare provider. Healthcare providers should use the information to tailor HPV and sexual health interventions

Designing the concept for a mobile health solution to educate female scholars residing in a low-to-middle income socio economic setting in Cape Town about HPV and its vaccine

Introduction Cervical cancer is the second most common cancer in South African women and fourth most common in women worldwide. Human papillomavirus (HPV) infection is the causative agent of 90% of cervical cancers. It can be prevented, especially in younger, non-sexually active individuals through a 2- or 3-dose vaccination. The vaccines are given free of charge to female grade 4 learners (9-15 year-olds) in South African public schools since 2014. The vaccination programme was promoted through educational pamphlets, posters, publications on the government websites, social media, and broadcasts on national radio and television prior to the start of the campaign. However, the available vaccines do not protect against all types of HPVs, and thus consistent education would be useful to advise young girls about safe lifestyle choices. Young people use mobile devices extensively, and therefore these devices may be an effective way to reach them directly, and to engage with them consistently. The project aimed to design the concept for a mobile health (mHealth) solution to aid in educating young female scholars residing in a low-to- middle-income setting in Cape Town about HPV and its vaccine. Methodology A user-centred approach known as the Information systems research (ISR) design framework was used to design the concept for a mHealth solution. It involved three main steps that were applied in a cyclic manner: namely the cycles of relevance, design and rigour. The relevance cycle involved assessment of the needs and knowledge of the target population (grade 4-7 female scholars of the Ikamva Labantwana Bethu tutoring programme in Crossroads) through a quantitative survey with 43 participants, which was followed by two focus group discussion with 8 participants each. The focus group discussion formed part of the design cycle, where a mock mHealth tool (based on the survey results) was presented to the groups to engage them about their attitudes, preferences, and perceptions towards the proposed solution. The rigour cycle involved combining the survey and focus group discussion data with knowledge from literature, for the conceptual design of the mHealth tool. Results A total of 43 learners completed the survey, and all participants indicated that they were vaccinated for HPV at school; however, none of them were able to answer the HPV knowledge questions. There was a high level of access to mobile technologies, as all the participants reported that they had access to cell phones and laptops (own or borrowed). The learners showed a strong preference for learning about sexual health and HPV from schoolteachers and tutors, with 25 out the 41 participants selecting this option, and 52% preferring an interactive learning style. During the focus group discussions, emphasis was placed on the mHealth application having entertainment features, while still being informative. Conclusions There was sufficient access to mobile technologies and WIFI access, which made an mHealth solution feasible. The fact that the participants had all been vaccinated, but they still didn't know what HPV was, showed that an mHealth tool could be useful. The learners prefer to learn interactively, and from their teachers and tutors, which is an element that can be introduced to the mHealth platform through a chatting function and educational video

Electronic swallowing intervention package to support swallowing function in patients with head and neck cancer: development and feasibility study

Background: Many patients undergoing treatment for head and neck cancer (HNC) experience significant swallowing difficulties, and there is some evidence that swallowing exercises may improve outcomes, including quality of life. This feasibility study developed an evidence-based, practical Swallowing Intervention Package (SiP) for patients undergoing chemo-radiotherapy (CRT) for HNC. As part of the study, an electronic version of SiP (e-SiP) was concurrently developed to support patients to self-manage during treatment. This paper reports on the e-SiP component of this work. Objective: To develop and conduct preliminary evaluation of an electronic support system (e-SiP) for patients undergoing CRT for head and neck cancer. Methods: The study involved health professionals and patients who were undergoing CRT for head and neck cancer. The scoping stage of e-SiP development involved investigated the potential usefulness of e-SiP, exploring how e-SiP would look and feel and what content would be appropriate to provide. Patient and carer focus groups and a health professionals’ consensus day were used as a means of data gathering around potential e-SiP content. A repeat focus group looked at an outline version of e-SIP and informed the next stage of its development around requirements for tool. This was followed by further development and a testing stage of e-SiP involved the coding of a prototype which was then evaluated using a series of steering group meetings, semi-structured interviews with both patients and health care professionals, and analysis of e-SiP log data. Results: Feedback from focus groups and health professional interviews was very positive and it was felt e-SiP use would support and encourage patients in conducting their swallowing exercises. However, of the ten patients offered e-SIP, only two opted to use it. For these patients, aspects of the e-SIP application were considered useful, in particular the ease of keeping a diary of exercises performed. Interviews with users and non-users suggested significant barriers to its use. Most significantly the lack of flexibility of platform on which e-SiP could be accessed appeared a dominant factor in deterring e-SiP use. Conclusions: Results suggest a need for further research to be conducted around the implementation of e-SiP. This involves evaluating how e-SiP can be better integrated into usual care, and through patient training and staff engagement, can be seen as a beneficial tool to help support patients in conducting swallowing exercises

The American Academy of Health Behavior 2021 Annual Scientific Meeting: Transforming the Narrative to Meet Emerging Health Behavior Challenges

The American Academy of Health Behavior (AAHB) hosted it\u27s 21th Annual Scientific Meeting online in March 2021. The meeting\u27s theme was Transforming the Narrative to Meet Emerging Health Behavior Challenges . This publication describes the meeting theme and includes the refereed abstracts presented at the 2021 Annual Scientific Meeting

Applying technology to promote sexual and reproductive health and prevent gender based violence for adolescents in low and middle-income countries: digital health strategies synthesis from an umbrella review

Aim: Adolescents in low-and-middle-income countries (LMICs) are facing numerous developmental, sexual and reproductive health (SRH) challenges including exposure to multidimensional violence. Gender-based violence (GBV) specifically intimate partner violence (IPV) are both highly prevalent in LMICs and are strongly linked with poor SRH outcomes. However, GBV and IPV interventions have not yet been adequately integrated in SRH due to individual, social, cultural, service, and resource barriers. To promote long-term SRH, a more holistic approach that integrates GBV and IPV, and adolescent development needs is imperative. Digital health has the potential to address multiple service setup, provision, and addressing access barriers through designing and providing integrated SRH care. However, there are no guidelines for an integrated digital SRH and development promotion for adolescents in LMICs. Methods: An umbrella review was conducted to synthesize evidence in three inter-related areas of digital health intervention literature: (i) SRH, (ii) GBV specifically IPV as a subset, and (iii) adolescent development and health promotion. We first synthesize findings for each area of research, then further analyze the implications and opportunities to inform approaches to develop an integrated intervention that can holistically address multiple SRH needs of adolescents in LMICs. Articles published in English, between 2010 and 2020, and from PubMed were included. Results: Seventeen review articles met our review inclusion criterion. Our primary finding is that application of digital health strategies for adolescent SRH promotion is highly feasible and acceptable. Although effectiveness evidence is insufficient to make strong recommendations for interventions and best practices suggestions, some user-centered design guidelines have been proposed for web-based health information and health application design for adolescent use. Additionally, several digital health strategies have also been identified that can be used to further develop integrated GBV-IPV-SRH-informed services to improve adolescent health outcomes. We generated several recommendations and strategies to guide future digital based SRH promotion research from our review. Conclusions: Rigorous research that focuses on intervention effectiveness testing using a combination of digital health strategies and standardized albeit contextualized outcome measures would be important. Methodological improvement such as adoption of longitudinal experimental design will be crucial in generating evidence-based intervention and practice guidelines for adolescents in LMICs. Keywords: Gender-based violence, Intimate partner violence, Sexual and reproductive health, Low-and-middle - income countries, mHealth, Digital health, Adolescents Development, Revie

Designing Technology to Overcome the Lack of Transmission of HPV Facts: Step One-”A Theory of the Problem

The lack of health knowledge among people may cause serious health problems. Cervical cancer, which kills hundreds of thousands of women around the world each year, is almost always caused by Human Papilloma Virus (HPV). Much is known about HPV that women could use to avoid infections, but widespread lack of transmission of HPV facts to women prevents them from taking the steps necessary to avoid infection. This paper theorizes about the problem of lack of transmission of HPV facts. Hence, HPV Facts Transmission Model, Including Barriers and Resources Factors has been identified. A theory of the problem [1] may assist in developing a theory of the solution, in which to-be-developed IT artifacts could play an important role

Use of Short Messaging Service to Improve Follow-Up for Abnormal Pap Test Results in Minority and Medically Underserved Women in North Carolina: Questionnaire on Attitudes and Acceptability

Background: An estimated one in eight cervical cancer cases are due to a lack of follow-up care for abnormal Pap test results. Low rates of completion of follow-up care particularly affect low-income minority women. The burden of cervical cancer could be reduced through interventions that improve timely colposcopy follow-up and treatment of abnormal screening results. Mobile communications via text messaging present a low-cost opportunity to increase rates of clinic return among women referred to follow-up after obtaining abnormal screening results. Objective: Our aims were to determine the acceptability and feasibility of using text messaging to increase completion of follow-up care following abnormal cervical cancer screening (Pap test) results and to examine factors that may affect the acceptability and use of text messaging to increase communications between health care providers (HCP) and low-income minority women. Methods: The study participants were 15 low-income women who had undergone a Pap test within the preceding 12 months. Semistructured interviews, including open- and closed-ended questions from a validated questionnaire, were conducted by phone or in person. Responses to closed-ended survey items were tabulated, and descriptive statistics were generated using Microsoft Excel. Responses to the open-ended questions were coded and analyzed using NVivo 11 qualitative analysis software. Results: Nearly all participants (14/15, 93%) were comfortable receiving a text message from an HCP stating that their Pap test results were available (<40 years: 100%; ≥40 years: 86%). Over half (8/15; 53%) of the participants were comfortable receiving a text message stating that their Pap test results were abnormal, although many preferred to receive such information via a phone call (6/15; 40%). Most participants (9/15; 60%) believed that receiving a text reminder would make them more likely to attend their appointment. The preferred method for receiving a reminder appeared to vary by age, with older women preferring telephone reminders over text messaging reminders. Analysis of open-ended questions suggested that text messaging appeals to some women due to its wide use and convenience for communicating with HCPs. However, women cited concerns about the confidentiality of messages and barriers to understanding the messages, including the physical capacity to read and accurately interpret the content of the messaging. Conclusions: Most participants indicated a willingness to receive text messages from their HCPs about cervical cancer screening results and believed that text messages were the best way to remind them of appointments for follow-up care. Potential concerns could be addressed by excluding explicit references to the nature of the appointment in the text message in order to avoid disclosure of sensitive health information to unauthorized individuals. Although text messaging seems promising to improve adherence to timely follow-up, personal preferences should be considered by allowing patients to opt-out of text communications