Clinic and Patient Perspectives on a Proposed mHealth Intervention to Improve Colposcopy Attendance (Preprint)

Abstract

Cervical cancer disparities persist among urban, minoritized women due to infrequent screening and poor follow-up.

To solicit feedback from clinic staff and patients referred for colposcopy regarding an adapted mHealth intervention to address barriers and improve colposcopy attendance among those referred after abnormal screening results.

In-depth qualitative interviews were conducted over Zoom or telephone with a purposive sample of 22 clinic staff (including clinicians) and 34 patients referred for colposcopy from three urban, academic OB-GYN clinics in New Jersey and Pennsylvania. Participants were asked about colposcopy attendance barriers and perspectives on a proposed text message intervention to provide tailored education and support in the time between abnormal cervical screening and colposcopy. The analytic team discussed interviews, wrote summaries, and consensus-coded transcripts, analyzing output for emergent findings and crystallizing themes.

Clinic staff and patients had mixed feelings about a text-only intervention. They overwhelmingly perceived a need to provide patients with appointment reminders and information about abnormal cervical screening results and colposcopy purpose and procedure. Both groups also thought messaging emphasizing that HPV is common and cervical cancer can be prevented with follow-up could enhance attendance. However, some had concerns about the privacy of text messages and text fatigue. Both groups thought that talking to clinic staff was needed in certain instances; they proposed connecting patients with complex psychosocial or structural barriers to staff for additional information, psychological support, and help with scheduling around work and finding childcare and transportation solutions. They also identified inadequate scheduling and reminder systems as barriers. From this feedback, we revised our text message content and intervention design, adding a health coaching component to support patients with complex barriers and concerns.

Clinic staff and patient perspectives are critical for designing appropriate and relevant interventions. These groups conveyed that text message-only interventions may be useful for patients with lesser barriers who may benefit from reminders, basic educational information, and scheduling support. However, multi-modal interventions may be necessary for patients with complex barriers to colposcopy attendance.