Centre for Public Health and UKCRC Centre of Excellence for Public Health, Queen's University Belfast, Belfast, United Kingdom.
South East Asia Community Observatory (SEACO), Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Subang Jaya, Malaysia.
PLoS One. 2023 Oct 5;18(10):e0288437. doi: 10.1371/journal.pone.0288437. eCollection 2023.
Breast cancer (BC) screening uptake in Malaysia is low and a high number of cases present at a late stage. Community navigation and mobile health (mHealth) may increase screening attendance, particularly by women from rural communities. This randomized controlled study evaluated an intervention that used mHealth and community health workers to educate women about BC screening and navigate them to clinical breast examination (CBE) services in the context of the COVID-19 pandemic.
Women aged 40-74 years, from Segamat, Malaysia, with a mobile phone number, who participated in the South East Asian Community Observatory health survey, (2018) were randomized to an intervention (IG) or comparison group (CG). The IG received a multi-component mHealth intervention, i.e. information about BC was provided through a website, and telephone calls and text messages from community health workers (CHWs) were used to raise BC awareness and navigate women to CBE services. The CG received no intervention other than the usual option to access opportunistic screening. Regression analyses were conducted to investigate between-group differences over time in uptake of screening and variable influences on CBE screening participation.
We recruited 483 women in total; 122/225 from the IG and 144/258 from the CG completed the baseline and follow-up survey. Uptake of CBE by the IG was 45.8% (103/225) whilst 3.5% (5/144) of women from the CG who completed the follow-up survey reported that they attended a CBE during the study period (adjusted OR 37.21, 95% CI 14.13; 98.00, p<0.001). All IG women with a positive CBE attended a follow-up mammogram (11/11). Attendance by IG women was lower among women with a household income ≥RM 4,850 (adjusted OR 0.48, 95% CI 0.20; 0.95, p = 0.038) compared to participants with a household income <RM 4,850.
The results suggested that the bespoke multicomponent mHealth intervention may be used to address the significant public health problem of low uptake of BC screening in rural Malaysia.
马来西亚的乳腺癌（BC）筛查参与率较低，且大量病例就诊时已处于晚期。社区导航和移动医疗（mHealth）可以提高筛查参与率，尤其是对农村社区的女性。本随机对照研究评估了一项干预措施，该措施使用 mHealth 和社区卫生工作者向女性宣传 BC 筛查，并在 COVID-19 大流行期间引导她们进行临床乳房检查（CBE）服务。
来自马来西亚士古来的年龄在 40-74 岁之间、拥有手机号码且参加过东南亚社区观察健康调查（2018 年）的女性被随机分配到干预组（IG）或对照组（CG）。IG 组接受了多组分 mHealth 干预，即通过网站提供有关 BC 的信息，并通过社区卫生工作者（CHWs）的电话和短信来提高 BC 意识，并引导女性进行 CBE 服务。CG 组除了可以选择接受机会性筛查外，没有接受任何干预。回归分析用于调查组间在筛查参与率上的随时间变化的差异以及对 CBE 筛查参与的变量影响。
我们总共招募了 483 名女性；IG 组有 122/225 名女性和 CG 组有 144/258 名女性完成了基线和随访调查。IG 组接受 CBE 的比例为 45.8%（103/225），而 CG 组中完成随访调查的 144 名女性中，有 3.5%（5 名）报告在研究期间接受了 CBE（调整后的 OR 37.21，95%CI 14.13；98.00，p<0.001）。IG 组中所有 CBE 阳性的女性都接受了后续乳房 X 光检查（11/11）。与家庭收入<RM 4,850 的参与者相比，家庭收入≥RM 4,850 的 IG 组女性的 CBE 参与率较低（调整后的 OR 0.48，95%CI 0.20；0.95，p=0.038）。
结果表明，定制的多组分 mHealth 干预措施可用于解决马来西亚农村地区 BC 筛查参与率低这一重大公共卫生问题。
