Mobile health–delivered narrative intervention to increase cervical cancer screening among Malawian women living with HIV: A pilot randomized controlled trial

ObjectivesTo develop and evaluate an mHealth-delivered, theory-guided, culturally tailored storytelling narrative (STN) intervention to increase cervical cancer screening among Malawian women living with HIV.MethodsThis study involved two phases: Phase 1: development of a theory-guided and culturally adapted storytelling narrative intervention and Phase 2: a pilot randomized controlled trial was conducted. Participants were randomly assigned to one of three-arms: Arm1: tablet-based video (mHealth) with STN (n=60); Arm 2: mHealth with a video of non-narrative educational materials (n=59); and Arm 3: control group with only reading non-narrative educational materials in person (n=60). Cervical cancer screening was measured using visual inspection with acetic acid (VIA) uptakes by self-report and health passport record review at 2 and 6 months after intervention.ResultsBoth Arms 1 and 2 had nearly twice the rate of VIA uptakes than those in Arm 3 (51.0% and 50% vs. 35.0%, p= 0.01) at 2 months follow-up but there were no differences among groups from 2 to 6-month follow-ups. All groups demonstrated significant improvement of knowledge about risk factors, intention and VIA uptakes.ConclusionThe findings demonstrate the preliminary effectiveness of the intervention on cervical cancer screening behavior and the feasibility of the study regarding recruitment, retention, treatment fidelity, and acceptability of the single 30-minute session. The feasibility and the preliminary results of the effectiveness of the proposed study indicate scaling up the STN intervention to a larger population of women to increase cervical cancer screening uptake to prevent deaths due to cervical cancer in Malawi. To develop and evaluate an mHealth-delivered, theory-guided, culturally tailored storytelling narrative (STN) intervention to increase cervical cancer screening among Malawian women living with HIV. This study involved two phases: Phase 1: development of a theory-guided and culturally adapted storytelling narrative intervention and Phase 2: a pilot randomized controlled trial was conducted. Participants were randomly assigned to one of three-arms: Arm1: tablet-based video (mHealth) with STN (n=60); Arm 2: mHealth with a video of non-narrative educational materials (n=59); and Arm 3: control group with only reading non-narrative educational materials in person (n=60). Cervical cancer screening was measured using visual inspection with acetic acid (VIA) uptakes by self-report and health passport record review at 2 and 6 months after intervention. Both Arms 1 and 2 had nearly twice the rate of VIA uptakes than those in Arm 3 (51.0% and 50% vs. 35.0%, p= 0.01) at 2 months follow-up but there were no differences among groups from 2 to 6-month follow-ups. All groups demonstrated significant improvement of knowledge about risk factors, intention and VIA uptakes. The findings demonstrate the preliminary effectiveness of the intervention on cervical cancer screening behavior and the feasibility of the study regarding recruitment, retention, treatment fidelity, and acceptability of the single 30-minute session. The feasibility and the preliminary results of the effectiveness of the proposed study indicate scaling up the STN intervention to a larger population of women to increase cervical cancer screening uptake to prevent deaths due to cervical cancer in Malawi.