mHealth to Train Community Health Nurses in Visual Inspection With Acetic Acid for Cervical Cancer Screening in Ghana

Abstract

Objectives There is a shortage of trained healthcare personnel for cervical cancer screening in low/middle income countries. We evaluated the feasibility and limited efficacy of a smartphone-based training of community health nurses in Visual Inspection of the cervix under Acetic Acid (VIA). Methods During April-July of 2015 in urban Ghana, we designed and developed a study to determine the feasibility and efficacy of an mHealth supported training of community health nurses (CHNs) (n=15) to perform VIA and to use smartphone images to obtain expert feedback on their diagnoses within 24 hours and improve VIA skills retention. CHNs completed a 2-week on-site introductory training in VIA performance and interpretation followed by an ongoing 3-month text messaging supported VIA training by an expert VIA reviewer. Results CHNs screened 169 women at their respective community health centers while receiving real-time feedback from the reviewer. The total agreement rate between all VIA diagnoses made by all CHNs and the expert reviewer was 95%. The average rate of agreement between each CHN and the expert reviewer was 89.6% (Standard Deviation (SD)=12.8). The agreement rates for positive and negative cases were 61.5% and 98.0%, respectively. Cohen's kappa statistic was 0.67 (95% CI; 0.45-0.88). Around 7.7% of women tested VIA positive and received Cryotherapy or further services. Conclusions Our findings demonstrate the feasibility and efficacy of mHealth-supported VIA training of CHNs and has the potential to improve cervical cancer screening coverage in Ghana.

Feasibility of implementing cervical cancer screening program using smartphone imaging as a training aid for nurses in rural India

“…Our study though conducted with fidelity had some limitations. First of all, we believe that real‐time feedback from expert would have improved skill retention for the nurse (Asgary et al., ). Moreover, a setup for telemedicine for such distant centers can help overcome the issue of image sharing and early feedback (within 24 hr).…”

“…Furthermore, there were images which the expert could not assess for screening decision. Technical training in photography skills or better imaging devices could fill this gap (Asgary et al., ).…”

“…On the other hand, the use of mobile smartphone camera as an imaging device for screening cervical cancer has been proved feasible and reliable (Bagga et al., ). Therefore, to overcome the gradual decrease in skills, mHealth‐supported (mobile Health) continuous VIA training has been found to improve cervical cancer screening (Asgary et al., ). In the study, 15 community health nurses performed VIA and obtained expert feedback on their diagnoses within 24 hr.…”

“…In the study, 15 community health nurses performed VIA and obtained expert feedback on their diagnoses within 24 hr. Widely used messaging application—Whatsapp, was used as the mHealth tool for obtaining feedback (Asgary et al., ). To this end, we propose a potential role of medical institutes in not only training but also in constant mentoring of nurses using smartphone imaging.…”

mHealth, Health, and Mobility: A Culture-Centered Interrogation

“…These include inconsistencies in the kinds of smartphones used by community healthcare workers that lead to poor imaging of the condition, which in turn, causes difficulties in assessing and diagnosing patients (Asgary et al, 2016;Free et al, 2013). Additionally, a systematic review of mHealth interventions on community healthcare workers found that most interventions were overwhelmingly focused on the context of the global North, with many of them having limited success outside of that space (Free et al, 2013).…”