Mobile technology and cancer screening: Lessons from rural India
Mobile technology and cancer screening: Lessons from rural India
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DOI：
10.7189/jogh.08.020421
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发表时间：
2018-12-01
影响因子：
7.2
通讯作者：
Weller, David
中科院分区：
文献类型：
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作者：
Bhatt, Shreya;Isaac, Rita;Weller, David
背景 印度宫颈癌和口腔癌的发病率高得令人无法接受。这些癌症的生存率很差，主要原因是发病较晚以及缺乏早期诊断和筛查计划。移动医疗（“mHealth”）显示出作为支持筛查活动的一种手段的前景，特别是在缺乏所需信息基础设施的农村和偏远社区。方法我们开发了一个 mHealth 原型并对其使用进行了培训课程。然后，我们在 3 个为贫困、健康素养较低的社区提供服务的地点实施了移动医疗支持的筛查干预措施：RUHSA（已建立子宫颈筛查项目）、Mungeli（恰蒂斯加尔邦）和 Padhar（中央邦）。筛查由社区卫生工作者（CHW - 10 名来自 RUHSA、8 名来自 Mungeli、7 名来自 Padhar）在护士（Mungeli 和 Padhar 2 名、RUHSA 5 名）的支持下进行：宫颈筛查由 VIA 进行；口腔癌筛查是通过照明口腔检查进行的。我们的评估包括对筛查和后续邀请的吸收情况进行分析，并辅以来自 8 次关键知情者访谈和 2 个焦点小组的定性数据。结果 8686 人通过移动医疗干预进行了筛查，其中大多数 (98%) 患有口腔癌。宫颈癌筛查的阳性率为 28%（其中 37% 参加了随访），口腔癌筛查的阳性率为 5%（其中 31% 参加了随访）。移动医疗原型非常受社区卫生工作者的欢迎，他们认为这使得筛查任务更加可靠。发现了对检测呈阳性的个体进行筛查和随访的许多障碍。移动医疗原型的使用对提供干预措施的社区卫生工作者的社会地位产生了积极影响。 结论 移动医疗方法可以支持健康素养水平较低的贫困农村社区的癌症筛查。然而，它们不足以克服筛查和随访方面的一系列社会、文化和财务障碍。将移动医疗与广泛的社区教育相结合、根据目标人群的健康素养水平以及明确的诊断和治疗途径量身定制的方法最有可能在这些社区取得良好的反应。
Background Rates of cervical and oral cancer in India are unacceptably high. Survival from these cancers is poor, largely due to late presentation and a lack of early diagnosis and screening programmes. Mobile Health ('mHealth') shows promise as a means of supporting screening activity, particularly in rural and remote communities where the required information infrastructure is lacking.Methods We developed a mHealth prototype and ran training sessions in its use. We then implemented our mHealth-supported screening intervention in 3 sites serving poor, low-health-literacy communities: RUHSA (where cervical screening programmes were already established), Mungeli (Chhattisgarh) and Padhar (Madhya Pradesh). Screening was delivered by community health workers (CHWs - 10 from RUHSA, 8 from Mungeli and 7 from Padhar), supported by nurses (2 in Mungeli and Padhar, 5 in RUHSA): cervical screening was by VIA; oral cancer screening was by mouth inspection with illumination. Our evaluation comprised an analysis of uptake in response to screening and follow-up invitations, complemented by qualitative data from 8 key informant interviews and 2 focus groups.Results 8686 people were screened through the mHealth intervention - the majority (98%) for oral cancer. Positivity rates were 28% for cervical screening (of whom 37% attended for follow-up) and 5% for oral cancer screening (of whom 31% attended for follow-up). The mHealth prototype was very acceptable to CHWs, who felt it made the task of screening more reliable. A number of barriers to screening and follow-up in test-positive individuals were identified. Use of the mHealth prototype has had a positive effect on the social standing of the CHWs delivering the interventions.Conclusions mHealth approaches can support cancer screening in poor rural communities with low levels of health literacy. However, they are not sufficient to overcome the range of social, cultural and financial barriers to screening and follow-up. Approaches which combine mHealth with extensive community education, tailored to levels of health literacy in the target population, and well-defined diagnostic and treatment pathways are the most likely to achieve a good response in these communities.