Implementation of an mHealth intervention to increase adherence to triage among HPV-positive women with HPV - self-collection (ATICA study): post-implementation evaluation - women's perspective

Abstract

Abstract BACKGROUND Low adherence to triage after positive screening is a widespread problem for cervical cancer screening programs in Low- and Middle-income Countries. Adhering 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. ATICA study was an effectiveness-implementation hybrid type I trial, combining a cluster randomized controlled trial (RCT) with a mixed-methods approach involving quantitative and qualitative evaluations of the implementation. Although ATICA RCT provided evidence regarding the effectiveness of SMS-based intervention, less is known about its acceptability, relevance, and usefulness from the women´s perspective. METHODS We carried out a cross-sectional based on a structured questionnaire among HPV-positive women who had participated in the 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. RESULTS 370 HPV-positive women were interviewed. 97.2% of women showed high acceptability of SMS messages. We found higher levels of agreement in all appropriateness dimensions. More than 77% of women showed high comprehension of the content. 76.1% of women who received at least one SMS message went to the health center to pick up their results. Among them, 90.5% mentioned that the SMS message had influenced them to go. We found high acceptability, appropriateness, and comprehension of the SMS message among HPV-positive women with no significant differences between women with vs. without triage Pap at day 60 after receiving the SMS messages. CONCLUSION The intervention was an appropriate channel to be informed about HPV test results availability and as a useful cue to go to the health center to pick up results. These results indicate that the implementation of the intervention did not encounter barriers associated with the characteristics of the SMS message itself, suggesting the existence of other obstacles to triage adherence. Our results contributed to a better understanding of the effectiveness achieved in ATICA RCT and provided evidence that could be useful to the scaling up of the intervention in similar settings.