Evaluation of a Culturally Tailored Mobile Text Messaging Intervention to Promote the Receipt of Pap-Test and HPV Vaccine

Background: Cervical cancer is one of the most preventable cancers, however, it presents a major health disparity among Asian immigrant women. Korean immigrant women, in particular, have a higher cervical cancer burden than other racial/ethnic groups (Gor, Chilton, Gamingue, & Hajek, 2011; Kagawa-Singer & Pourat, 2000) and it may be attributed to their low rates of cervical cancer screening (Juon, Choi, Klassen, & Roter, 2006; Kagawa-Singer et al., 2007; Lee, Roh, Vang, & Jin, 2011). However, little research has been conducted to promote Pap test uptake and HPV vaccination among Korean immigrant women. Mobile text messaging interventions have been marked as an efficacious educational tool to improve sensitive health-related topics such as cervical cancer prevention and sexually transmitted infections management (Lee et al., 2014; Lunny et al., 2014; Velthoven, Brusamento, Majeed, & Car, 2013). Based on existing literature, we developed a text message-based intervention with aims to improve cervical cancer screening and HPV vaccination, a mScreening project. The current study aims to evaluate its  (1) acceptability and feasibility of a culturally tailored mobile text messaging intervention (mScreening) and (2) to explore how the mScreening motivates participants to get a Pap test and/or HPV vaccine.  

Method: Data were collected through qualitative research methods including semi-structured interviews, three focus groups, and follow-up interviews with 30 young Korean immigrant women who attended and completed the mScreening intervention. All interviews were conducted in Korean. The semi-structured interviews were conducted one week after the completion of the mScreening intervention. Each semi-structured interview lasted less than 30mins and notes were taken. All focus groups were conducted within a month after the mScreeening completion. Each focus group lasted approximately between 1 hour and 1.5 hours and was digitally recorded. Lastly, follow-up interviews were conducted three months later after the mScreening was completed. Almost all follow-up interviews were conducted via phone calls and lasted less than 15mins. A thematic analysis of Braun and Clarke’s (2006) was used to analyze the data and develop the essential themes discussed.

Findings: Two themes were identified in evaluating the acceptability of the intervention. First, concise text messaging with images or emoticons was regarded as a convenient mode of communication, leading to high levels of attention to messages and resulting in increased knowledge. Second, technical issues were reported, including network connection difficulties and limitations of using regular phones with limited characters. With regard to motivating participants’ health behavior change,  participants reported that awareness on cervical cancer screening and prevention guidelines and information on health care accessibility (e.g., cost and clinic) motivated them to get a Pap test and HPV vaccine. However, participants’ social and cultural beliefs/attitudes on Pap testing and visiting women’s clinic as non-married woman still played as barriers to Pap test uptake and HPV vaccine initiation even after the completion of the mScreening intervention

Implications: The findings indicate that mobile technology could be a useful medium to deliver sensitive health information among underserved immigrant population. Further effort should more focus on cultural beliefs/attitudes to reduce cervical cancer screening disparities.