SPIDER - The Swedish Program for ICT in Developing Regions, Department of Computer and Systems Sciences, Stockholm University, Stockholm, Sweden.
Uganda Cancer Institute, Kampala, Uganda.
J Med Internet Res. 2023 Oct 2;25:e45132. doi: 10.2196/45132.
In Uganda, cervical cancer (CaCx) is the commonest cancer, accounting for 35.7% of all cancer cases in women. The rates of human papillomavirus vaccination and CaCx screening remain low. Digital health tools and interventions have the potential to improve different aspects of CaCx screening and control in Uganda.
This study aimed to describe stakeholders' perceptions of the telemedicine system we developed to improve CaCx screening in Uganda.
We developed and implemented a smartphone-based telemedicine system for capturing and sharing cervical images and other clinical data, as well as an artificial intelligence model for automatic analysis of images. We conducted focus group discussions with health workers at the screening clinics (n=27) and women undergoing screening (n=15) to explore their perceptions of the system. The focus group discussions were supplemented with field observations and an evaluation survey of the health workers on system usability and the overall project.
In general, both patients and health workers had positive opinions about the system. Highlighted benefits included better cervical visualization, the ability to obtain a second opinion, improved communication between nurses and patients (to explain screening findings), improved clinical data management, performance monitoring and feedback, and modernization of screening service. However, there were also some negative perceptions. For example, some health workers felt the system is time-consuming, especially when it had just been introduced, while some patients were apprehensive about cervical image capture and sharing. Finally, commonplace challenges in digital health (eg, lack of interoperability and problems with sustainability) and challenges in cancer screening in general (eg, arduous referrals, inadequate monitoring and quality control) also resurfaced.
This study demonstrates the feasibility and value of digital health tools in CaCx screening in Uganda, particularly with regard to improving patient experience and the quality of screening services. It also provides examples of potential limitations that must be addressed for successful implementation.
在乌干达，宫颈癌（CaCx）是最常见的癌症，占女性所有癌症病例的 35.7%。人乳头瘤病毒疫苗接种和 CaCx 筛查率仍然很低。数字健康工具和干预措施有可能改善乌干达 CaCx 筛查和控制的不同方面。
本研究旨在描述利益相关者对我们为改善乌干达 CaCx 筛查而开发的远程医疗系统的看法。
我们开发并实施了一个基于智能手机的远程医疗系统，用于捕获和共享宫颈图像和其他临床数据，以及一个用于自动分析图像的人工智能模型。我们对筛查诊所的卫生工作者（n=27）和接受筛查的妇女（n=15）进行了焦点小组讨论，以探讨他们对该系统的看法。焦点小组讨论辅以现场观察和对卫生工作者的系统可用性和整个项目的评估调查。
总的来说，患者和卫生工作者对该系统的评价都很积极。突出的好处包括更好的宫颈可视化、获得第二意见的能力、改善护士与患者之间的沟通（解释筛查结果）、改善临床数据管理、绩效监测和反馈，以及筛查服务的现代化。然而，也存在一些负面看法。例如，一些卫生工作者觉得该系统很耗时，尤其是在刚刚推出的时候，而一些患者则对宫颈图像采集和共享感到担忧。最后，数字健康中常见的挑战（例如缺乏互操作性和可持续性问题）以及癌症筛查中普遍存在的挑战（例如转诊困难、监测和质量控制不足）也再次出现。
本研究表明，数字健康工具在乌干达 CaCx 筛查中具有可行性和价值，特别是在改善患者体验和筛查服务质量方面。它还提供了一些必须解决的潜在限制的例子，以便成功实施。
