Centre for the Study of State and Society, National Council for Scientific and Technical Research AR, Buenos Aires, Argentina.
Cancer Health Equity, Cancer Institute of New Jersey, Rutgers - the State University of New Jersey, New Jersey, USA.
BMC Womens Health. 2023 Jun 23;23(1):332. doi: 10.1186/s12905-023-02475-0.
Low adherence to triage after positive screening is a widespread problem for cervical cancer screening programs in Low- and Middle-income Countries. Adherence to cytology-based triage can be challenging, especially among women with self-collected tests. SMS-based interventions are accepted by women and can increase screening uptake. The ATICA study was an effectiveness-implementation hybrid type I trial, combining a cluster randomized controlled trial (RCT) with a mixed-methods implementation evaluation involving quantitative and qualitative methods. Although the RCT provided evidence regarding the effectiveness of the SMS-based intervention, less is known about its acceptability, relevance, and usefulness from the women´s perspective.
We carried out a cross-sectional study based on a structured questionnaire among HPV-positive women who were enrolled in ATICA's intervention group. We measured acceptability, appropriateness, and message content comprehension. Also, we evaluated if the SMS message was considered a cue to encourage women to pick up their HPV test results and promote the triage.
We interviewed 370 HPV-positive women. Acceptability of SMS messages among women who had received at least one message was high (97%). We found high levels of agreement in all appropriateness dimensions. More than 77% of women showed high comprehension of the content. Among women who received at least one SMS message, 76% went to the health center to pick up their results. Among those who got their results, 90% reported that the SMS message had influenced them to go. We found no significant differences in acceptability, appropriateness or message comprehension between women who adhered to triage and those who did not adhere after receiving the SMS messages.
The intervention was highly acceptable, and women reported SMS was an appropriate channel to be informed about HPV test results availability. SMS was also a useful cue to go to the health center to pick up results. The implementation did not encounter barriers associated with the SMS message itself, suggesting the existence of other obstacles to triage adherence. Our results support the RCT findings that scaling up SMS is a highly acceptable intervention to promote cervical screening triage adherence.
在中低收入国家，宫颈癌筛查项目中阳性筛查后的低依从性是一个普遍存在的问题。基于细胞学的分流的依从性可能具有挑战性，尤其是在自我采集检测的女性中。基于短信的干预措施被女性接受，并可以提高筛查率。ATICA 研究是一项有效性-实施混合 I 型试验，将基于集群的随机对照试验 (RCT) 与涉及定量和定性方法的混合方法实施评估相结合。虽然 RCT 提供了基于短信的干预措施有效性的证据，但从女性的角度来看，对其可接受性、相关性和有用性知之甚少。
我们基于 ATICA 干预组中 HPV 阳性女性的结构化问卷进行了一项横断面研究。我们测量了可接受性、适宜性和信息内容理解。此外，我们还评估了短信信息是否被认为是鼓励女性取 HPV 检测结果并促进分流的线索。
我们采访了 370 名 HPV 阳性女性。接受至少一条短信的女性对短信消息的接受度很高（97%）。我们在所有适宜性维度都发现了高度的一致性。超过 77%的女性对内容的理解程度很高。在接受至少一条短信的女性中，76%的人去了卫生中心取结果。在那些拿到结果的人中，90%的人报告说短信消息影响了他们去取结果。我们没有发现接受短信消息后依从性分流和不依从性分流的女性在可接受性、适宜性或信息理解方面存在显著差异。
该干预措施具有高度可接受性，女性报告称短信是一种合适的渠道，可以通知她们 HPV 检测结果的可用性。短信也是去卫生中心取结果的有用线索。实施过程中没有遇到与短信本身相关的障碍，这表明存在其他阻碍依从性分流的障碍。我们的结果支持 RCT 的发现，即扩大短信的使用是一种高度可接受的干预措施，可以促进宫颈癌筛查的依从性。
