Developing a Tailored mHealth Intervention for Cervical Cancer Screening and Prevention in African American Women

Background: Cervical cancer has been on a downward trajectory since the creation of the pap smear test in the 1940s and the rise of HPV vaccination. Unfortunately, while cervical cancer incidence and mortality have reduced over the years, health disparities still exist. African American women are within the top two for cervical cancer incidence, number one in mortality, and have a 5-year survivorship rate of 62% (Siegel, 2020). The black-white difference in cervical cancer survivorship is a difference of 22%. African American adolescents have a low completion rate of the HPV vaccination cycle (Walker et al., 2017). This is concerning due to the fact that the HPV vaccine prevents six-different types of cancer. The disparities experienced by this group are dangerous towards the health and well-being of African Americans. The purpose of this study was to test the acceptability, appropriateness, and feasibility of a mobile health intervention targeting cervical cancer screening and prevention knowledge and attitudes in African American women.

Methods: A community advisory board was formed for the express purpose of tailoring cervical health and HPV messages for African American women. Using a quasi-experimental design, African American women were recruited and assigned to either the intervention group or control. At baseline, all participants were assessed on their cervical cancer knowledge and perceived discrimination in the medical settings. Over a period of 4 weeks, 3 times a week, cervical cancer and HPV health messages were delivered to the mobile phones of women in the intervention group. Women in the control group did not receive messages. The intervention group was reassessed on cervical cancer knowledge and assessed on their acceptability, appropriateness, and feasibility of the intervention.

Results: Forty-eight women participated in this study. At baseline 56.3% of the women were never married, 37.5% have a bachelor’s degree, 79.2% were employed, 29.2% made between $40,000 and $59,000, 81.3% had private insurance and 18.8% had public insurance. The majority of women reported experiencing some form of discrimination in medical settings. At baseline, both groups had low scores in cervical cancer knowledge, with a mean of 34.69 out of 66. Women in the intervention group rated the mHealth intervention positively as appropriate, acceptable, and feasible.

Discussion/Implications: In this new age of social distancing, mHealth intervention offer opportunities to continue health education uninterrupted. Because the women in the intervention group received health messages to their mobile phones there were little concerns about the dangers of face to face contact. For a population that is at risk from cervical cancer disparities, and HPV infections it is important to reach this group even in the midst of a pandemic. Women in the intervention group viewed the mHealth intervention favorably and there was some improvement in cervical cancer knowledge.