Iterative Development and Pilot of mSaada: A Mobile Phone Application to Support Community Health Volunteers during Cervical Cancer Screening in Western Kenya
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Background: Cervical cancer is the fourth most common cancer worldwide, despite its highly preventable nature. Cervical cancer disproportionately affects individuals in low- and middle-income countries (LMICs), especially those in sub-Saharan Africa. Kenya experiences the highest cervical cancer incidence rate within the East African region (33.8 per 100,000 women) and is among the highest in the world. Huchko et al. demonstrated that cervical cancer screening via Human Papillomavirus (HPV)-based self-collection, led by community health volunteers (CHVs), is acceptable and well attended. While well received by communities in Western Kenya, researchers highlighted key barriers to the scale and potential effectiveness of this approach, including a need for electronic data collection and a lack of protocol and decision support tools for healthcare providers, who are often lay providers. Based on high reported mobile phone ownership within Kenya generally and past research documenting success with text message-based delivery of screening results within Western Kenya, the introduction of a mobile application-based intervention to address the identified challenges to cervical cancer screening and prevention appears feasible. This study sought to iteratively develop an mhealth intervention with key stakeholders, evaluate the usability of the intervention, and describe factors that limit and build cervical cancer screening self-efficacy among lay providers.
Methods: Between June 2019 and January 2020, we conducted a two-part study in Kisumu, Kenya to develop and pilot a mobile phone application, “mSaada.” In the first part of the study, between June and August 2019, a purposive sample of 18 participants completed in-depth interviews (IDIs) in two waves to provide a detailed review of the mSaada app and its features. Iterative revisions of the app were informed by participant feedback. During the second part, between October 2019 and January 2020, we conducted a small-scale pilot usability study within three healthcare facilities in Kisumu, Kenya. A convenience sample of 10 community health volunteers incorporated the mSaada mobile application into their daily interactions with clients during cervical cancer screening and education sessions. Participants completed usability and self-efficacy surveys throughout the study period as well as an in-depth interview to provide insight into their experience using mSaada.
Results: Iterative development of the mSaada mobile application resulted in major changes to the app’s user interface, aesthetics and organization, as well as the addition and clarification of educational content included within the platform. Overall, mSaada usability ratings increased significantly during the study period (4.54 to 4.84, p<0.001). During qualitative interviews, participants highlighted the app’s ease of use, impact on their workflow, and the comprehensiveness of the included information as strengths of mSaada. Participants did, however, cite concerns about the feasibility of broader implementation of the platform within Kenya. Overall, CHV self-efficacy increased significantly from the beginning to the end of the study period (4.53 to 4.74, p=0.008). When asked about factors limiting self-efficacy, participants discussed language barriers, time constraints, supply shortage, and privacy issues. Reference materials, personal knowledge, and experience and repetition were seen as factors that build self-efficacy.
Conclusions: While mSaada’s usability increased and the platform was observed to improve lay provider self-efficacy, much research is still needed in this area. Specifically, there is a need to engage women eligible for screening in future studies to help tailor mSaada such that it can best benefit the client population. Also, further development of the technological infrastructure within this setting is needed to promote long-term feasibility and sustainability of an mhealth solution like mSaada.
Stocks, Jacob Benjamin (2020). Iterative Development and Pilot of mSaada: A Mobile Phone Application to Support Community Health Volunteers during Cervical Cancer Screening in Western Kenya. Master's thesis, Duke University. Retrieved from https://hdl.handle.net/10161/20781.
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