Development of a Culturally Tailored Text Messaging Intervention to Promote Cervical Cancer Screening and Prevention in an Underserved Population

Background: Asian American women are found to have the lowest Pap test screening rate compared to women from other racial/ethnic groups (CDC, 2013). Several interventions to promote cervical cancer screening and prevention were implemented targeting Asian American women (Glick, et al., 2012).  However, there has been lack of efforts on Korean American immigrant women. Recent studies reported the effectiveness of text messaging interventions for sensitive health-related issues, such as HIV prevention (Velthoven, Majeed, & Car, 2013) and sexually transmitted infections management (Lunny et al., 2014). Such evidence implies that mobile text messaging can be an effective vehicle to deliver health information and promote preventive behaviors. The purpose of this study is to demonstrate the process of developing a culturally tailored mobile text messaging intervention to promote cervical cancer screening and prevention behaviors among young Korean American immigrant women.

Method: As the first step of developing the intervention, five focus groups were conducted with 21 Korean immigrant women ages 20 to 30 years old residing in the Twin Cities metro area in Minnesota. Participants were recruited from posting on the Minnesota Korean Students Associations’ websites and Korean ethnic churches, and from the research team’s personal network. All focus groups were conducted in Korean and each focus group lasted approximately 1.5 - 2 hours. Braun and Clarke’s (2006) six phases of thematic analysis were used to identify and develop the core themes discussed in the focus groups.

Findings: Four themes were identified to develop effective mobile text message intervention. First, participants made suggestions regarding the content of the research topic which include (1) basic knowledge about cervical cancer to raise awareness, information about cervical cancer screening, and HPV vaccination and (2) practical information related to health care access for Pap-test and HPV vaccine receipt. The next theme is about developing visual images and pictures and interactive messages; the participants recommended using culture-friendly messages designing culture specific-emoticons and quizzes to maximize the engagement level of the target population. Third, the participants suggested a message delivery format that included the length and frequency of messages per day, and the entire length of intervention (e.g., one week). The last theme is about providing incentives (e.g. gift cards) in order to keep a high level of intervention engagement. Based on the suggestions from the participants, the research team developed a week-long text message program that contained a high level of interactive and visual messages (e.g. a cartoon character of cervix).

Implications: The findings showed that culturally competent text message-based intervention should be developed based on the target population’ perspectives and input. The intervention development required collecting data from the participants regarding both the content and delivery formats of culturally relevant health messages. In order to be effective with the target population, the message contents should include culturally-tailored visual and interactive messages. As mobile technology become more popular and advanced, a culturally tailored text message interventions could be an effective medium to deliver sensitive health information and eventually promote positive health behavior in underserved populations.