Global Health, George Washington University Milken Institute of Public Health, Washington, District of Columbia, USA.
Medicine, Weill Cornell Medical College, New York, NY, USA.
BMJ Open. 2019 Jul 16;9(7):e030528. doi: 10.1136/bmjopen-2019-030528.
To explore acceptability and feasibility of smartphone-based training of low-level to mid-level health professionals in cervical cancer screening using visual inspection with acetic acid (VIA)/cervicography.
In 2015, we applied a qualitative descriptive approach and conducted semi-structured interviews and focus groups to assess the perceptions and experiences of community health nurses (CHNs) (n=15) who performed smartphone-based VIA, patients undergoing VIA/cryotherapy (n=21) and nurse supervisor and the expert reviewer (n=2).
Community health centres (CHCs) in Accra, Ghana.
The 3-month smartphone-based training and mentorship was perceived as an important and essential complementary process to further develop diagnostic and management competencies. Cervical imaging provided peer-to-peer learning opportunities, and helped better communicate the procedure to and gain trust of patients, provide targeted education, improve adherence and implement quality control. None of the patients had prior screening; they overwhelmingly accepted smartphone-based VIA, expressing no significant privacy issues. Neither group cited significant barriers to performing or receiving VIA at CHCs, the incorporation of smartphone imaging and mentorship via text messaging. CHNs were able to leverage their existing community relationships to address a lack of knowledge and misperceptions. Patients largely expressed decision-making autonomy regarding screening. Negative views and stigma were present but not significantly limiting, and the majority felt that screening strategies were acceptable and effective.
Our findings suggest the overall acceptability of this approach from the perspectives of all stakeholders with important promises for smartphone-based VIA implementation. Larger-scale health services research could further provide important lessons for addressing this burden in low-income and middle-income countries.
探索使用醋酸视觉检查（VIA）/子宫颈摄影术对中低级卫生专业人员进行基于智能手机的宫颈癌筛查培训的可接受性和可行性。
2015 年，我们采用定性描述方法，进行了半结构化访谈和焦点小组讨论，以评估执行基于智能手机的 VIA 的社区卫生护士（CHN）（n=15）、接受 VIA/冷冻疗法的患者（n=21）以及护士主管和专家审查员（n=2）的看法和经验。
加纳阿克拉的社区卫生中心。
为期 3 个月的基于智能手机的培训和指导被认为是进一步发展诊断和管理能力的重要和必要的补充过程。子宫颈成像提供了同行学习的机会，有助于更好地向患者传达程序并获得他们的信任，提供有针对性的教育，提高依从性并实施质量控制。没有患者之前接受过筛查；他们非常接受基于智能手机的 VIA，没有表示出明显的隐私问题。两个组都没有提到在 CHC 进行 VIA 时遇到的重大障碍，也没有提到通过短信进行智能手机成像和指导的障碍。CHN 能够利用他们现有的社区关系来解决知识和误解的缺乏。患者在很大程度上表示对筛查有自主权。存在负面观点和耻辱感，但并不具有明显的限制，大多数人认为筛查策略是可接受和有效的。
从所有利益相关者的角度来看，我们的研究结果表明了这种方法的总体可接受性，这对基于智能手机的 VIA 的实施具有重要的意义。更大规模的卫生服务研究可以为解决低收入和中等收入国家的这一负担提供重要经验。
