Community‐based health literacy focused intervention for cervical cancer control among Black women living with human immunodeficiency virus: A randomized pilot trial

Abstract

Background Health literacy plays an essential role in how individuals process health information to make decisions about health behaviours including cancer screening. Research is scarce to address health literacy as a strategy to improve cancer screening participation among women living with human immunodeficiency virus (HIV), particularly Black women who, despite the heavy burden of cervical cancer, report consistently low screening rates. Aim To assess the feasibility, acceptability and preliminary efficacy of a health literacy‐focused intervention called CHECC‐uP—Community‐based, HEalth literacy focused intervention for Cervical Cancer control—among women living with HIV. Methods We conducted a community‐based, single‐blinded randomized pilot trial. A total of 123 eligible women were enrolled and randomized to one of two conditions, control (i.e., cervical cancer brochure) or intervention (cervical cancer brochure plus 30–60 min health literacy‐focused education followed by monthly phone counselling and navigation assistance for 6 months). Study assessments were done at baseline, 3 and 6 months. The final analysis sample included 58 women who completed all data points and whose Papanicolaou (Pap) test status was confirmed by medical records. Results All intervention participants who completed the programme would recommend the CHECC‐uP to other women living with HIV. However, adherence in the experimental conditions was low (49.6% attrition rate including 20 women who dropped out before the intervention began) due, in large part, to phone disconnection. Those who had received the intervention had a significantly higher Pap test rate compared to women in the control group at 6 months (50% vs. 21.9%, p = .025). Participation in the intervention programme was associated with improved health literacy and other psychosocial outcomes at 3 months but the trend was attenuated at 6 months. Conclusions The CHECC‐uP was highly acceptable and led to improved Pap testing rates among Black women living with HIV. Future research should consider addressing social determinants of health such as phone connectivity as part of designing a retention plan targeting low‐income Black women living with HIV. Implications The findings should be incorporated into a future intervention framework to fulfil the unmet needs of Black women living with HIV to facilitate their decision‐making about Pap test screening. Patient or Public Contribution Nineteen community members including women living with HIV along with HIV advocates and care providers participated in four focus groups to develop cervical cancer screening decision‐relevant information and the health literacy intervention. Additionally, a community advisory board was involved to provide guidance in the general design and conduct of the study.

Analysis of WSI Images by Hybrid Systems with Fusion Features for Early Diagnosis of Cervical Cancer

“…CNN offers different layers, such as convolutional layers, which are the most important and relevant. Convolutional layers are a set of filters that wrap around an input, resulting in feature maps being produced as output as in Equation (7). CNN uses the image and applies filters to it while extracting deep features that represent the image [43].…”

“…The classification layers were removed from the models, and the convolutional, pooling, and auxiliary layers were preserved. ResNet50, VGG19, and GoogLeNet models generated high-level feature maps as follows: (3, 3, 512), (7,7,512), and (7, 7, 512), respectively. The high-level feature maps were converted into single-feature vectors for each image by the global average pooling (GAP) layer and saved in feature vectors of size 2048, 4096, and 4096 for ResNet50, VGG19, and GoogLeNet, respectively.…”

“…According to World Health Organization reports [5], 342,000 women died in 2020 due to cervical cancer [6]. Human papillomavirus (HPV) is a virus of the genital tract and is the main cause of cervical cancer [7]. HIV-positive women are more likely to develop cervical cancer at a younger age and with more advanced disease.…”

Research Gap in Health Literacy: Are We Overlooking a Possible Solution to Inadequate Cancer Screening in India?

“…women in the control group. (50% vs. 21.9%, p =0.025) (Han et al, 2023) Another health literacy-focused intervention cluster randomized trial among Korean American women reported higher odds of undergoing a mammogram (18.5 times; 95% confidence interval [CI] = 9.2, 37.4) and Papanicolaou test (13.3 times; 95% CI = 7.9, 22.3) in the intervention group compared to the control group, thus successfully promoting cancer-screening behavior. (Han et al, 2017) There is a dearth of HL research on cancer screening in India, which often uses proxy variables like disease knowledge and attitude, as well as socio-demographic correlates like education, socioeconomic status, and rurality (Changkun et al, 2022).…”