Evaluation of a Culturally Tailored Mobile Phone Multimedia Messaging Intervention to Promote Breast Cancer Screening

Background and Purpose: Korean American immigrant women have among the highest breast cancer mortality rates (CDC, 2010) and lowest breast cancer screening rates of U.S women across racial/ethnic groups (McCracken, et al., 2007; Lee et al., 2010). While a significant breast cancer burden exists for Korean American immigrant women, cancer screening behavior is strikingly low and extremely little intervention development has focused on this population. We developed a mobile phone multimedia messaging intervention, a mMammogram project, with aims to improve breast cancer screening. The current study aims to (1) explore how the mMammogram motivates the women to get a mammogram and (2) evaluate the acceptability and feasibility of the mMammogram.

Methods: Data were collected through qualitative research methods. Three focus groups and semi-structured individual interviews were conducted with 14 Korean immigrant women who attended and completed the mMammogram. All interviews were conducted in Korean. Each focus group lasted approximately between 1 hour and 1.5 hours and was digitally recorded. The semi-structured interviews were conducted one week after the completion of the mMammogram. Each semi-structured interview lasted no more than 15 minutes and notes were taken. A thematic analysis of Braun and Clarke’s (2006) was used to analyze the data and develop the essential themes discussed.

Findings: Findings revealed three themes related to the intervention’s impact on participants’ health behavior change. First, mMammogram motivated study participants to get a mammogram by increasing their awareness and knowledge on breast cancer and mammography, as well as reducing their anxiety on breast cancer screening. Second, participants were highly satisfied with visual messages including video clips (e.g., a video demonstrated the detailed procedure of a mammogram at a hospital) that particularly brought about positive motivation for screening. Lastly, convenient services such as bilingual health navigator (e.g., helping to schedule for mammogram appointment and providing transportation) or free mammogram events through a local hospital triggered women to get a mammogram. Further, two themes were identified in evaluating the acceptability and feasibility of the intervention: one of the biggest benefits of the mMammogram is its easy accessibility, dissemination, and portability by having important health information at their fingertips. Participants stated that they used the app to educate their daughters and friends and talked about the importance of regular breast cancer screening in their churches after the intervention ended. Lastly, participants provided very constructive feedback on App contents and the App program (e.g., text size on videos) that should be considered when we design an app in the future.

Conclusion and Implications: Mobile app intervention that is culturally tailored and language-appropriate with health navigation services can be a feasible, effective, and acceptable tool to promote breast cancer screening behaviors in underserved immigrant women. A mobile app can cover a broad range of breast cancer health topics and the health navigator can further help women overcome barriers to screening. Especially for newly arrived immigrant population, a health navigation service is critical in overcoming language, transportation, and health accessibility barriers and triggering a positive change in their health screening behavior.