SMS behaviour change communication and eVoucher interventions to increase uptake of cervical cancer screening in the Kilimanjaro and Arusha regions of Tanzania: a randomised, double-blind, controlled trial of effectiveness

Erwin, E. S.; Aronson, Kristan J.; Day, Andrew G.; Ginsburg, Ophira; Macheku, Godwin; Feksi, A; Oneko, Olola; Sleeth, Jessica; Magoma, Best; West, Nicola; Marandu, Prisca Dominic; Yeates, Karen

doi:10.1136/bmjinnov-2018-000276

Cited by 46 publications

(60 citation statements)

References 16 publications

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“…The systematic search returned 3704 unique entries, after duplicates were removed. Screening and application of eligibility criteria produced 19 studies for inclusion in the review [15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30][31][32][33]. Figure 2 shows the results of the study selection process.…”

Section: Study Characteristicsmentioning

confidence: 99%

“…Pap smear or cytology-based cervical screening was assessed most often (n = 6, 31.6%) [16,17,21,26,31,33]. A quarter of studies (n = 5, 26.3%) did not specify which screening test was being performed [20,22,24,29,32]. Multiple screening methods were used in some studies, such as those that compared uptake of HPV self-sampling to facility-based visual inspection screening methods [19,25,27,28].…”

Section: Study Characteristicsmentioning

confidence: 99%

“…One was an SMS behavior change communication intervention, offered with and without additional eVouchers to cover transportation costs to the screening clinic. Women who received the 15 SMS messages over 21 days had three times greater odds of screening during the study period than women in the control group (12.9% uptake vs. 4.3%, adjusted odds ratio [AOR] = 3.0, 95% CI: 1.5-6.2) [20]. Women randomized to receive the eVoucher for transportation in addition to the behavior change communication had almost five times the odds of uptake compared to the control group (18% uptake vs. 4.3%, AOR = 4.7, 95% CI: 2.93-7.44) [20].…”

Section: Effectiveness Of Interventions: Screening Uptakementioning

confidence: 99%

“…Women who received the 15 SMS messages over 21 days had three times greater odds of screening during the study period than women in the control group (12.9% uptake vs. 4.3%, adjusted odds ratio [AOR] = 3.0, 95% CI: 1.5-6.2) [20]. Women randomized to receive the eVoucher for transportation in addition to the behavior change communication had almost five times the odds of uptake compared to the control group (18% uptake vs. 4.3%, AOR = 4.7, 95% CI: 2.93-7.44) [20]. Mbachu et al designed a health education intervention that trained clergy wives in Anglican dioceses to deliver peer health education on cervical cancer to women they worship with.…”

Section: Effectiveness Of Interventions: Screening Uptakementioning

confidence: 99%

“…Erwin 2019 [20] Women, aged 25 Follow-up: Unclear Uptake: 6.8% difference in "ever screened" from pre-to post-intervention (10.5 to 17.3%, p = 0.02). Willingness to screen: No significant increase from pre-to post-intervention (79.3 to 80.8%, p = 0.52).…”

Section: [18]mentioning

confidence: 99%

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Interventions to increase uptake of cervical screening in sub-Saharan Africa: a scoping review using the integrated behavioral model

et al. 2020

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Background: Sub-Saharan Africa (SSA) experiences disproportionate burden of cervical cancer incidence and mortality due in part to low uptake of cervical screening, a strategy for prevention and down-staging of cervical cancer. This scoping review identifies studies of interventions to increase uptake of cervical screening among women in the region and uses the Integrated Behavioral Model (IBM) to describe how interventions might work. Methods: A systematic search of literature was conducted in PubMed, Web of Science, Embase, and CINAHL databases through May 2019. Screening and data charting were performed by two independent reviewers. Intervention studies measuring changes to uptake in screening among women in SSA were included, with no restriction to intervention type, study setting or date, or participant characteristics. Intervention type and implementation strategies were described using behavioral constructs from the IBM.Results: Of the 3704 citations the search produced, 19 studies were selected for inclusion. Most studies were published between 2014 and 2019 (78.9%) and were set in Nigeria (47.4%) and South Africa (26.3%). Studies most often assessed screening with Pap smears (31.6%) and measured uptake as ever screened (42.1%) or screened during the study period (36.8%). Education-based interventions were most common (57.9%) and the IBM construct of knowledge/skills to perform screening was targeted most frequently (68.4%). Willingness to screen was high, before and after intervention. Screening coverage ranged from 1.7 to 99.2% post-intervention, with six studies (31.6%) reporting a significant improvement in screening that achieved ≥60% coverage. (Continued on next page)Conclusions: Educational interventions were largely ineffective, except those that utilized peer or community health educators and mHealth implementation strategies. Two economic incentivization interventions were moderately effective, by acting on participants' instrumental attitudes, but resulted in screening coverage less than 20%. Innovative service delivery, including community-based self-sampling, acted on environmental constraints, striving to make services more available, accessible, and appropriate to women, and were the most effective. This review demonstrates that intent to perform screening may not be the major determinant of screening behavior, suggesting other theoretical frameworks may be needed to more fully understand uptake of cervical screening in sub-Saharan Africa, particularly for health systems change interventions.

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