mHealth delivered narrative intervention to increase cervical cancer screening among Malawian Women living with HIV

移动医疗提供叙事干预，以增加马拉维艾滋病毒感染者的宫颈癌筛查

• 批准号: 9979152
• 负责人: Haeok Lee
• 金额: $ 21.53万
• 依托单位: UNIVERSITY OF MASSACHUSETTS BOSTON
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-04-23 至 2022-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9979152
• 关键词: AIDS/HIV problem; Acetic Acids; Active Learning; Acute; Address; Adherence; African; Area; Awareness; Behavior; Car Phone; Caring; Cellular Phone; Cervical Cancer Screening; Charge; Communities; Computer Assisted; Country; Data; Data Collection; Development; Diagnosis; Diffusion; Educational process of instructing; Effectiveness; Effectiveness of Interventions; Electricity; Emotional; Enrollment; Ethnography; Evaluation; Evidence based intervention; Foundations; HIV; HIV Infections; Health; Health Personnel; Health Professional; Health behavior; Health behavior change; Health education; Healthcare; Home environment; Human Papillomavirus; Infection; Intervention; Interview; Knowledge; Learning; Lesion; Low Literacy Population; Malawi; Malignant Neoplasms; Malignant neoplasm of cervix uteri; Manuals; Methods; Morbidity - disease rate; Outcome; Outcomes Research; Penetration; Personal Satisfaction; Phase; Population; Prevention; Procedures; Process; Public Health Informatics; Quality of Care; Randomized; Randomized Clinical Trials; Research; Resources; Rural; Screening for cancer; Self Efficacy; Self Management; Services; Social support; Standardization; Support Groups; System; Tablets; Testing; Translating; Visual; Woman; Work; arm; attentional control; base; behavior change; cervical cancer prevention; clinical practice; cohesion; control trial; cost; cost effective; cost effectiveness; disorder prevention; effective intervention; effectiveness testing; electronic data; evidence base; experimental study; global health; handheld mobile device; health belief; health care settings; health training; implementation strategy; improved; innovation; interactive multimedia; intervention effect; literacy; low income country; mHealth; member; mortality; novel; operation; pedagogy; premalignant; prevent; programs; prospective; recruit; rural area; rural residence; screening; social media; theories; uptake; wireless fidelity

Cervical cancer (CC) is the leading cause of morbidity and mortality among women living with HIV (WLWHIV) in Malawi. Screening and treating women with precancerous lesions has been shown to be highly effective in the prevention of CC but the availability of CC screening does not automatically translate into their utilization among WLWHIV. . Prevention of HPV-related cervical cancers in WLWHIV, particularly in the context of resource-constrained settings where prevention-oriented services are either lacking or the health beliefs of the population are oriented toward the treatment of acute illness is problematic. Culturally tailored and evidence- based interventions to increase screening uptake is needed. Storytelling narrative interventions hold particular promise as a means to engage vulnerable (often low-literacy) populations in positive health behaviors including cancer screening. In addition, narrative interventions such as storytelling made available through social media holds the promise of engaging WLWHIV in more active participation in health prevention/self-management. This study addresses the following specific aims: Phase I: Developmental Phase: Develop intervention Specific Aim 1: We will develop an interactive, multi-media intervention based on authentic stories from Malawian WLWHIV, local community leaders, and Malawian health care providers that encompasses targeted health messages that are consistent with the situation-specific theory and the desired behavior (CC screening). Phase II: Implement Phase: Conduct a pilot randomized clinical trial (RCT) Specific Aim 2: We will conduct a pilot RCT with three groups (Arm 1: Storytelling Narrative+mHealth; Arm 2: mHealth; and Arm 3: Attention control; N=180) to assess the feasibility, acceptability, and preliminary effectiveness of a narrative intervention delivered by mHealth (tablets) among WLWHIV. We will select 15 established HIV support groups within the rural areas of the Lilongwe district of Malawi and randomly assign the group to an intervention strategy (Arms 1, 2, or 3). Within each selected HIV support group, 12 WLWHIV who are willing to participate in the study will be prospectively enrolled. The findings and experiential learning gained from this study will lay the foundation for a larger trial that can test the effectiveness of the intervention. Although the proposed implementation strategy is evidence-informed and promising, its use is novel in HIV support group settings and in mHealth delivery. There needs to be feasibility testing in the mHealth setting prior to a larger-scale evaluation of its effectiveness in a low-income country. This project is innovative in that it attempts to integrate CC screening into the HIV support group system already in place in Malawi and develops a locally tailored novel narrative intervention that is culturally and literacy sensitive. The proposed study is significant because of its potential to improve CC prevention by equipping Malawian WLWHIV with self-confidence with cultural and evidence-based strategies to increase CC screening uptakes.

宫颈癌（CC）是艾滋病毒（WLWHIV）女性发病率和死亡率的主要原因 在马拉维。筛查和治疗癌性病变的妇女已被证明在 预防CC，但CC筛选的可用性不会自动转化为其利用率 在WLWHIV中。 。预防WLWHIV中与HPV相关的宫颈癌，特别是在 资源受限的设置缺乏以预防为导向的服务或缺乏的健康信念 人口针对急性疾病的治疗是有问题的。具有文化量身定制和证据 - 需要采取基于增加筛查吸收的干预措施。讲故事的叙事干预措施特殊 承诺作为一种使弱势群体（通常是低数字）人口参与积极健康行为的手段 癌症筛查。此外，通过社交媒体提供了诸如讲故事之类的叙事干预措施 有望让WLWHIV更积极参与健康预防/自我管理。 这项研究解决了以下具体目的： 第一阶段：发展阶段：开发干预 特定目的1：我们将根据来自真实故事的互动性，多媒体干预 马拉维WLWHIV，当地社区领导者和马拉维医疗保健提供者，包括针对目标的 与特定情况理论和所需行为（CC筛查）一致的健康消息。 第二阶段：实施阶段：进行飞行员随机临床试验（RCT） 具体目的2：我们将与三个小组进行飞行员RCT（ARM 1：讲故事的叙事+MHealth； ARM 2： MHealth;和手臂3：注意控制； n = 180）评估可行性，可接受性和初步 MHealth（平板电脑）在WLWHIV中提供的叙事干预措施的有效性。我们将选择15 马拉维利隆韦区农村地区建立的艾滋病毒支持小组，然后随机分配 小组采取干预策略（武器1、2或3）。在每个选定的HIV支持组中，12个wlwhiv 愿意参加这项研究的人将被前瞻性地入学。发现和体验式学习 从这项研究中获得的将为更大的试验奠定基础，该试验可以测试干预的有效性。 尽管拟议的实施策略是证明和有希望的，但其用途是新颖的艾滋病毒 支持小组设置和MHealth交付。在MHealth环境中需要进行可行性测试 在对其在低收入国家的有效性进行大规模评估之前。这个项目是创新的 它试图将CC筛查集成到马拉维已经建立的HIV支持组系统中，并且 开发了一种本地量身定制的小说叙事干预措施，对文化和扫盲敏感。提议 研究之所以重要，是因为它通过为马拉维wlwhiv提供了改善预防CC预防的潜力 具有文化和基于证据的策略的自信，以增加CC筛选吸收。