Impact of Mobile Technologies on Cervical Cancer Screening Practices in Lagos, Nigeria (mHealth-Cervix): A Randomized Controlled Trial

Abstract

PURPOSE We assessed the impact of mHealth on Pap test screening uptake and also determined the factors that affect screening uptake among women in Lagos, Nigeria. MATERIALS AND METHODS A randomized controlled trial was carried out among women in two tertiary health institutions in Lagos, Nigeria, between July 2020 and March 2021. Participants were randomly assigned to either a text message (mHealth) intervention or usual care arm. The main study outcome was the uptake of Pap smear testing within 6 months of enrollment in the study. We tested the associations between two groups of continuous variables using the unpooled independent-sample t-test (normal distribution) and that of two groups of categorical variables with the chi-square (χ2) test. Using a multinomial logistic regression model, we adjusted for relevant sociodemographic and clinical predictors of uptake of Pap smear screening. Statistical significance was defined as P < .05. RESULTS There was a significantly higher rate of uptake of Pap smear screening among women in the mHealth arm compared with those in the usual care arm (51.0% v 35.7%, P = .031). Following adjustment in the final multivariate model, level of income (odds ratio [OR] = 5.13, 95% CI, 1.55 to 16.95), awareness of Pap smear (OR = 16.26; 95% CI, 2.49 to 76.64), General Outpatient clinic attendance, and introduction of mHealth intervention during follow-up (OR = 4.36; 95% CI, 1.44 to 13.22) were the independent predictors of Pap smear uptake. CONCLUSION The use of mHealth technologies intervention via short-text message services is a feasible solution for cervical cancer prevention in low- and middle-income countries, and thus, the widespread use of mHealth services by health care providers and policymakers could contribute to the implementation of cervical cancer prevention services in Nigeria and in the settings of other low- and middle-income countries.

Predictors of Pap smear testing uptake among women in Lagos, Nigeria

“…This was a prospective follow-up study conducted as part of the ‘mHealth-Cervix trial’ [ 16 ]. The study involved women who attended the general outpatient (GOP) clinics of Lagos University Teaching Hospital and Lagos State University Teaching Hospital, Nigeria, between August 2020 and April 2021.…”

“…The study participants were women in the control arm of the ‘mHealth-Cervix trial’ [ 16 ]. They were women aged 25–65 years without prior history of cervical premalignant or malignant lesions; those who have not had a Pap smear in the past 3 years; and those with sufficient physical and mental capacities to understand the purpose of the study.…”

“…Initial health education on cervical cancer and its prevention was given to all women attending the GOP clinics as part of the usual health promotion programme. Eligible women from the clinics were subsequently identified and invited to enrol in the ‘mHealth-Cervix trial’ [ 16 ]. After obtaining their baseline socio-demographic and clinical information, the women were then followed up for 6 months as indicated in the control arm of the trial [ 16 ].…”

“…Eligible women from the clinics were subsequently identified and invited to enrol in the ‘mHealth-Cervix trial’ [ 16 ]. After obtaining their baseline socio-demographic and clinical information, the women were then followed up for 6 months as indicated in the control arm of the trial [ 16 ]. The women’s monthly income and educational status were used as independent determinants of their socio-economic status according to the classification by Yoon et al [ 19 ].…”

“…Several factors are reported to influence the uptake of Pap smear testing and these include a high level of education, reduced perception of risk of developing cervical cancer, lack of knowledge about the benefits of Pap smear and lack of familiarity with screening locations [ 7 , 14 – 16 ]. The healthcare providers also play a significant role in improving the knowledge of cervical cancer prevention and uptake of any of its screening methods [ 17 ].…”