Developing SMS Content to Promote Papanicolaou Triage Among Women Who Performed HPV Self-collection Test: Qualitative Study

Abstract

Background SMS interventions are effective in promoting a variety of health behaviors; however, there is limited information regarding the use of SMS for cervical cancer screening and follow-up care. The Application of Communication and Information Technologies to Self-Collection study aims to evaluate a multicomponent mobile health intervention to increase triage adherence among women with human papillomavirus (HPV)–positive self-collected tests in Jujuy, Argentina. Here, we describe the formative results used to design the content of the SMS to be tested in the trial. Objective This study aimed to understand the cultural and contextual elements, women’s beliefs, and perceptions regarding the use of SMS by the health care system and women’s preferences about the message content. Methods We conducted five focus groups (FGs), stratified by rural or urban residence and age. All participants were aged 30 years or older and had performed HPV self-collection. Participatory techniques, including brainstorming, card-based classification, and discussions were used to debate the advantages and disadvantages of messages. We openly coded the discussions for agreements and preferences regarding the SMS content. Messages for both HPV-negative and HPV-positive women were validated through interviews with health authorities and 14 HPV-tested women. The final versions of the messages were pilot-tested. Results A total of 48 women participated in the FGs. Participants rejected receiving both negative and positive HPV results by SMS because, for them, the delivery of results should be done in a face-to-face interaction with health professionals. They stressed the importance of the SMS content informing them that results were available for pick up and reflecting the kind of relationship that they have with the community health workers and the nearest health center. Women considered that a personalized SMS was important, as was the use of a formal yet warm tone. Owing to confidentiality issues, not using the word “HPV” was also a key component of the desired SMS content; therefore, the final message included the term “self-collection” without the mention of HPV infection. Results from the validation stage and pilot test showed high acceptability of the final version of the message. Conclusions The results suggest that SMS is accepted when notifying women about the availability of the HPV test result, but it should not replace the delivery of results in face-to-face, doctor-patient encounters. In addition, messages must be tailored and must have a persuasive tone to motivate women to adhere to the triage.

A Counseling Mobile App to Reduce the Psychosocial Impact of Human Papillomavirus Testing: Formative Research Using a User-Centered Design Approach in a Low-Middle-Income Setting in Argentina

“…Regarding the app style and tone, women asked for an empathic communication style even when clearly acknowledging that they were interacting with a device (mobile phone). Similar findings were found in a previous study that analyzed women’s preferences regarding SMS content design [ 86 ] to receive information about triage after an HPV-positive result. In that study, also carried out in Argentina, women requested the SMS content to emulate the overall friendly style of community health workers.…”

Self-collection for HPV-based cervical screening: a qualitative evidence meta-synthesis

“…For women who lack self-efficacy, the presence of a CHW provides comfort and support to perform the initial test on their own. Another opportunity is CHWs communicating with women via platforms such as mHealth [ 80 , 81 ] (a digital health service in settings where sending letters might not be an option) that are easily and readily used in resource-limited settings to prevent loss to follow-up and increase testing uptake. Further research is needed to develop effective strategies to communicate information regarding self-collection for HPV testing in resource-limited settings.…”

Effectiveness of an mHealth intervention to increase adherence to triage of HPV DNA positive women who have performed self-collection (the ATICA study): A hybrid type I cluster randomised effectiveness-implementation trial

“…We expected both components of the intervention to increase adherence to triage in the intervention group. 19 , 23 , 24 In addition, the HBM guided formative research carried out to inform the design of the multicomponent intervention 23 , 24 : Firstly, focus group (FGs) included discussions with women to incorporate in the SMS messages a persuasive element that would reinforce the SMS message as a cue to action from women point of view. 23 Secondly, formative research provided information on women’s individual beliefs regarding CC, HPV testing and triage 24 that was used to train CHWs about messages and support to be provided during their visit of positive women who had not been to triage at 60 days.…”